Female infertility is a major reproductive health concern. Hepatic steatosis index (HSI), a non-invasive marker of liver-related metabolic burden, has not been well studied in relation to infertility across its distribution. We analyzed women aged 20-49 years from three NHANES cycles (2013-2018). HSI was examined as both a continuous variable and in quartiles, and restricted cubic spline models were used to assess potential nonlinearity. Sensitivity analyses using alternative infertility definitions and exploratory interaction analyses were also performed. Among 3,007 women, 416 (13.8%) were classified as having infertility. In the fully adjusted model, women in the highest HSI quartile had higher odds of infertility than those in the lowest quartile (OR 1.66, 95% CI 1.08-2.57; P = 0.031), with a significant trend across quartiles (P for trend = 0.010). Restricted cubic spline analysis showed a nonlinear association between HSI and infertility (P for overall association = 0.005), which was more evident at higher HSI levels. Higher HSI was associated with greater odds of infertility among reproductive-aged women.

Intrauterine pathology can create an unfavourable environment for pregnancy. We therefore sought to determine optimal time interval between operative hysteroscopy and intrauterine insemination (IUI) to optimise pregnancy outcomes. This study was a retrospective cohort study of IUI cycles following an operative hysteroscopy performed at our institution between January 2018 and August 2023. Our primary outcome was clinical pregnancy following IUI. Patients were grouped into one of four cohorts based on the number of days between operative hysteroscopy and subsequent IUI. We compared cohorts by estimating risk ratios using modified Poisson regression models, adjusting for female age, subfertility diagnosis, and number of prior IUI cycles and utilised P values. We identified 896 patients undergoing a total of 917 IUI cycles following an operative hysteroscopy in whom clinical pregnancy occurred in 16.4% of all IUI cycles. After adjustment, a longer interval between operative hysteroscopy and IUI was associated with a lower probability of a clinical pregnancy. In a subgroup analysis of 728 hysteroscopic polypectomies, the clinical pregnancy rate following IUI was similar to that for all operative hysteroscopies (16.3% v 16.4%, respectively). In conclusion, delaying IUI after hysteroscopy is not needed to improve pregnancy outcomes.

The increasing use of direct-to-consumer genetic testing revealed not only more, but also different types of insemination fraud worldwide, making research into the topic urgently needed. This study explores how donor-conceived people and parents experience insemination fraud and their need for and perception of psychosocial support. We conducted a qualitative interview study with 19 participants affected by insemination fraud from the Netherlands and Belgium. Insemination fraud occurs when the doctor uses a different sperm sample for insemination than the (prospective) parents consented to. The study includes eight different cases of insemination fraud. Participants experienced important challenges in fundamental aspects of life, related to reorganizing their identity, changing their family-conception story, navigating dualities regarding the donor, and coping with breaches of trust. Participants described the complex emotional processes they faced and how insemination fraud affected multiple relationships, revealing deeply entangled relational processes. These processes were complicated and/or facilitated by (non-)disclosure of donor conception by parents, type of insemination fraud, presence of heritable disease, the donor/doctor being alive or deceased, the clinic's reaction, and the reaction of the donor's legal family. Participants described short-term and long-term implications and needs for (peer) support. The article concludes with recommendations for clinical practice and policy.

This study investigates the socioeconomic determinants of the total fertility rate (TFR) in Türkiye, with a particular focus on regional disparities. A comprehensive panel data analysis, including the fixed effect regression analyses, was conducted by using a dataset from all 81 provinces over the years 2011 to 2023. TFR exhibits substantial variation across the provinces and regions. To have more homogeneous data, the provinces were classified into two groups based on their 2024 TFR values: high-TFR (>1.5) and low-TFR (≤1.5). This classification also aligns with regional categorisation as higher TFR levels are predominantly concentrated in southeastern Türkiye. The analysis investigates the effects of eight key variables on TFR. The results indicate that female marriage age, marriages between cousins, infant mortality rate, and the number of health care professionals are significant factors across provinces, although the strength of these relationships varies across estimation methods. The findings also reveal important divergence between the province groups. While crude death rate and educational attainment emerge as influencing factors in the low-TFR provinces, no significant evidence is found to support their role in high-TFR provinces. The study provides valuable insights into the fertility behaviour in Türkiye and contributes to a better understanding of the fertility pattern in other countries or regions facing similar demographic transitions. The findings can play an important role in developing relevant policies.

Investigation and management of male infertility is often inconsistent and displaced by female-focused fertility care. This clinical service evaluation aimed to capture the patient journey for male infertility in Ireland. A questionnaire was distributed to men attending two private fertility clinics in the Republic of Ireland to explore referral, investigations, treatment offered, lifestyle advice received and patient perspectives on information provision. A total of 504 men completed the questionnaire. As expected, there was substantial variation in referral pathways. Almost half of respondents were offered no further testing beyond semen analysis, while others underwent repeat analyses or additional investigations. Most men were offered treatment involving their female partner. Lifestyle modification was commonly reported, particularly reduction in alcohol intake and weight loss; however, 27% men reported making no lifestyle changes. Importantly, 79% of respondents felt that more information on male infertility should be provided, with a preference for receiving information via a dedicated website. This study demonstrates marked heterogeneity in the clinical journey for men, alongside a clear unmet need for consistent information and male-focused care. Standardised clinical pathways, improved education and proactive lifestyle counselling represent practical opportunities to enhance patient experience and to optimise care for men affected by infertility.

An increasingly common family type, often referred to as 'solo mothers', 'single mothers by choice' or 'choice mothers', comprises women who intentionally become mothers without the involvement of a partner. Although solo mothers are often described as self-determined, motivated and well prepared for parenting, with both economic and social resources, little is known about their parenting experiences and emotional and practical support needs. This cross-sectional exploratory study used an online survey to examine sources of emotional and practical parenting support, ease of asking for help and parenting confidence. A total of 139 participants responded between July 2021 and February 2022. The most used sources of support were family networks and friendship groups of non-solo mothers. Paid childcare was also frequently used, with many solo mothers accessing it at least a few times per week. While most participants felt confident in their parenting, many occasionally struggled to ask for help and required additional practical, emotional and/or financial support. Positive correlations were found between feeling supported and parenting confidence (r = 0.405, p < 0.001) and between ease of asking for help and feeling supported (r = 0.458, p < 0.001). Greater efforts are needed to ensure solo mothers have equitable access to tailored emotional and practical support resources.

Online sperm donation (OSD) connects prospective parents ('recipients') with donors via digital platforms. While prior research has focused on motivations and experiences, little attention has been given to the norms, identities, and relational dynamics shaping interactions on OSD platforms. Drawing on a year-long digital ethnography of five OSD platforms, this paper reports on a thematic analysis of multi-modal data that show that mistrust was pervasive. Users engaged in ongoing surveillance and scrutiny to 'stay safe' and protect others and future donor-conceived children. Norms about who was 'safe' or a 'good' donor or recipient influenced self-presentation and selection. Experienced donors were often constructed as knowledgeable, legitimising their authority to define what was 'normal'. Platform architectures, including user-driven safety features and gamification, shaped interactions, sometimes paradoxically contributing to harm rather than preventing it. These findings are situated within broader literature on digital sharing economies and connection platforms.

Add-ons are non-essential interventions offered in addition to standard infertility treatments, mainly in vitro fertilisation (IVF) and associated procedures, aimed at improving chances of pregnancy and live birth. While existing guidelines provide recommendations on the use of add-ons, they often overlook the trustworthiness of the underlying randomised controlled trials (RCTs), which may lead to misleading conclusions. Furthermore, some add-ons that may offer genuine benefits have been dismissed due to misinterpretation of trial results, or they are reserved for repeated implantation failure based on strategic rather than evidence-based arguments. Here, we propose a framework for an evidence synthesis process to guide the rational use of add-ons. The evaluation should begin with establishing effectiveness through systematic reviews of trustworthy RCTs, ignoring RCTs that do not meet trustworthiness criteria. When assessing effectiveness, the evaluation should consider evidence relating to the biological mechanisms targeted by the add-on, in addition to clinical outcomes such as live birth. For diagnostic add-ons, evaluations should focus on the group of patients whose test result leads to a change in clinical management, rather than analysing all test-exposed patients. Once effectiveness is confirmed, evaluating cost-effectiveness becomes crucial. Its cost per additional live birth should be compared to a benchmark (e.g., $27,000 or £20,000 for a live birth via standard IVF). Finally, once proven cost-effective, add-ons should be offered early, rather than delayed until after repeated treatment failures. It might be that effectiveness and cost-effectiveness increase with progression along the continuum of diagnosis or IVF failure such as recurrent implantation failure. In that case, add-ons may be offered as soon as they are considered cost-effective.

Subclinical hypothyroidism (SCH) is a biochemical diagnosis with ongoing uncertainty regarding management in reproductive medicine. We performed a retrospective cohort study evaluating fertility and pregnancy outcomes in women undergoing assisted reproductive technology (ART), focusing on untreated preconception SCH with TSH up to 6.0mIU/L. Secondary analysis used data from women screened for thyroid function and thyroid peroxidase antibodies (TPOAb) during the TABLET trial at Birmingham Women's Hospital, UK (June 2012-December 2013). Women with TSH ≥6.0mIU/L received levothyroxine. The primary outcome was live birth. The main comparison was 'total SCH' (TSH >3.63mIU/L) versus 'euthyroid-1' (TSH 0.44-3.63mIU/L), with subgroup analyses comparing 'untreated SCH' (TSH 3.64-5.99mIU/L) to 'euthyroid-1' women, and a stricter euthyroid threshold ('euthyroid-2'; TSH 0.44-2.5mIU/L) versus 'untreated high-normal-mild SCH' (TSH 2.5-5.99mIU/L). Multivariable logistic regression adjusted for key confounders. Of 944 women screened, 560 had outcome data; 60 had SCH. SCH was associated with fewer oocytes retrieved (9.0 vs 10.4, p = 0.02) and mature oocytes (7.4 vs 8.4, p = 0.05), but no difference in live birth was seen across comparisons: 'untreated SCH' vs euthyroid-1 (aOR 1.01, 95% CI 0.54-1.87, p = 1.0) and 'untreated high-normal-mild-SCH' vs euthyroid-2 (aOR 0.96, 95% CI 0.65-1.42, p = 0.8). In women with untreated SCH achieving live birth, TSH normalised spontaneously in 8/15 cases, with no adverse outcomes observed. Untreated TSH <6.0 mIU/L does not appear to adversely affect ART or live birth outcomes, although larger prospective studies are needed.

The objective was to investigate whether there are differences in cumulative live birth rate, cumulative clinical pregnancy rate, or perinatal outcomes after delaying ICSI timing. The design was a retrospective cohort study at Fertility North in Australia using 1,969 ICSI cycles with different ICSI timings among 1,078 patients from 2017 to 2022. Cumulative outcomes included cumulative live birth and cumulative clinical pregnancy rates per oocyte retrieval cycle. Perinatal outcomes included preterm birth, low/high birthweight, and small/large for gestational age. Binomial logistic regression and multinomial logistic regression were used. Generalised estimating equation (GEE) was incorporated into the logistic regression analyses to account for the cluster effect from patients undergoing multiple retrieval cycles. ICSI timing was grouped into quartiles: Q1(37.1-41.1h, n = 498), Q2(41.2-42.4h, n = 510), Q3(42.5-43.3h, n = 483), and Q4(43.4-46.8h, n = 478). No significant difference was found in cumulative live birth in Q2 (aOR: 0.79, 95%CI: 0.55-1.14), Q3 (0.87, 0.61-1.25), and Q4 (0.86, 0.58-1.27), compared with Q1, respectively. Similarly, there was no significant difference in cumulative clinical pregnancy rate between the four groups. Furthermore, no significant differences were found in preterm birth, low birth weight, high birth weight, small for gestational age, and large for gestational age in Q4, compared to Q1. Delaying ICSI until 46.8 hours post-trigger does not compromise cumulative clinical pregnancy or live birth rates, or increase adverse perinatal risks.

This study investigated the association between dietary quality indices and female infertility using data from the National Health and Nutrition Examination Survey (NHANES) 2013-2020. A total of 5,477 women aged 18-59 years were included. Dietary quality was assessed using 24-hour dietary recall data and summarised by four predefined indices: the alternate Mediterranean diet score (MED), the Healthy Eating Index-2020 (HEI-2020), the Alternate Healthy Eating Index (AHEI), and the Dietary Approaches to Stop Hypertension (DASH) score. Weighted logistic regression models were used to estimate the associations between dietary quality and infertility, and restricted cubic spline (RCS) analyses were used to examine potential dose-response patterns. After adjustment for age, race/ethnicity, education level, body mass index (BMI), smoking status, alcohol consumption, marital status, menstrual regularity, age at menarche, history of pelvic inflammatory disease, and total energy intake, higher MED, HEI-2020, AHEI, and DASH scores were inversely associated with infertility. RCS analyses suggested approximately linear inverse associations for these indices (all P for nonlinearity >0.05). Higher overall diet quality was associated with lower odds of infertility among adult women in the United States (US). Because this was a cross-sectional study using self-reported infertility, the findings should be interpreted as associative rather than causal.

As more jurisdictions allow donor-conceived persons (DCPs) access to their genetic information and direct-to-consumer DNA testing becomes increasingly popular, contact between those involved in donor conception, including DCPs, donors, parents and same-donor families, has grown. This mixed methods systematic review (MSSR) collates and examines research on how contact is experienced by these groups in the context of donation from donors previously unknown to recipients prior to donation. A bibliographic search of English-language, peer-reviewed studies was conducted following PRISMA 2020 guidelines across several databases, including CINAHL, JSTOR, MEDLINE, PsycINFO, PubMed, Scopus, Ovid Emcare and Google Scholar. Studies were included if they used empirical methods (quantitative, qualitative, or mixed) and involved participants with post-birth contact experiences following donation to recipients from donors not known to recipients prior to donation. These could include clinic-recruited donors (both anonymous/non-identified and identity-release) and donors recruited by recipients, such as through online platforms. From 1,397 initial records, 231 were full text screened. 57 studies meeting inclusion criteria and varying in methodology and sample size were assessed using the Joanna Briggs Institute (JBI) Checklist for Systematic Reviews and Research Synthesis. Findings were synthesised by stakeholder groups (DCPs, donors, parents), examining the form, frequency and experience of contact, as well as influencing factors. Contact ranged from occasional online interactions to regular in-person meetings, with experiences generally positive across all groups. Variations in experience were associated with attitudes towards and expectations of contact, and the size of donor networks. Further research is needed on how contact evolves over time, particularly regarding early linking (before the legislated age of access in identity-release jurisdictions) and connections made via DNA testing.

This article examines the reproductive decisions and concept of kinship of single mothers by choice (SMBC) in Hungary who pursued motherhood through assisted reproductive technologies (ART). Twenty-one women in Hungary participated in interviews examining their decisions to become SMBCs, to select ART, and whether to seek information or contact with their child's genetic relatives. The findings show that genetic ties were central to reproductive decisions. All reported a strong desire to have a child; most had hoped to conceive within a relationship but, approaching the end of their reproductive years, had opted for ART. The use of donor eggs was considered as a last resort; maintaining genetic links to the child was important for their sense of motherhood. Many described their child's interest in knowing about genetic relatives. Most participants attempted to identify donor-conceived half-siblings, and several were successful. In the Hungarian context, this study highlights the increasing importance of digital technologies in challenging the legal framework of anonymity, enabling women to locate donors or their children's half-siblings. The study contributes to debates on family, kinship, and reproductive autonomy, and provides insights into how SMBCs navigate donor conception under conditions of strict donor anonymity and constrained access to ART.

The aim of this article is to analyse the motivations, expectations, and experiences of information exchange and contact among parties linked through donor conception of solo mothers who had their children with the help of assisted reproduction technology (ART) across donor types (e.g. sperm, egg, embryo) and settings in Spain, where donation is anonymous, and the United Kingdom, where donor anonymity was lifted in 2005. This study draws on ethnographic research that took place in Madrid (Spain) and in London (the United Kingdom), where I conducted 60 in-depth interviews with solo mothers.