Assisted reproductive techniques (ART) are increasingly used worldwide. Concerns persist regarding the long-term cardiovascular health of ART-conceived offspring. To systematically review and meta-analyze cardiovascular, vascular, and echocardiographic outcomes in ART-conceived offspring compared with naturally conceived children. PubMed and Scopus were searched from database inception to January 2025. Reference lists of eligible articles were manually screened. Searches included terms related to assisted reproductive technologies, offspring, and cardiovascular outcomes. Only human studies published in English were included. Observational cohort, cross-sectional, and case-control studies evaluating cardiovascular outcomes in ART-conceived offspring with a naturally conceived comparison group were eligible. Studies without relevant outcomes, lacking a control group, or including populations with genetic conditions affecting cardiovascular health were excluded. Two reviewers independently screened studies, with disagreements resolved by a third investigator. Eighty-one studies met inclusion criteria. Data extraction was independently performed by two reviewers following PRISMA and MOOSE guidelines. Risk of bias and study quality were assessed using the Cambridge Quality Checklist. Meta-analyses were conducted using fixed- or random-effects models according to heterogeneity (I[2] statistic). Meta-regression analyses explored the influence of parental and perinatal factors. Primary outcomes included vascular indices (carotid intima-media thickness [CIMT], flow-mediated dilation [FMD]), risk of congenital heart disease (CHD), echocardiographic measures of cardiac structure and function, and blood pressure. ART conception was associated with increased CIMT in singleton offspring (mean difference, 0.03 mm; 95% CI, 0.01-0.06) and reduced FMD (mean difference, - 2.32%; 95% CI, - 3.05 to - 1.59). ART-conceived children showed a higher risk of CHD, including severe forms, particularly in singleton pregnancies. Echocardiographic analyses revealed subtle alterations in left ventricular function, including reduced shortening fraction and prolonged isovolumetric relaxation time. Systolic blood pressure was slightly higher in ART offspring. Meta-regression indicated that vascular and echocardiographic alterations were largely independent of parental age, body mass index, gestational age, and birth weight. ART conception is associated with early vascular dysfunction, increased CHD risk, and subtle cardiac functional alterations that may precede future cardiovascular disease, supporting the need for long-term cardiovascular follow-up.

Ovarian ageing is a central determinant of female reproductive potential, defined by a progressive and largely irreversible decline in both the quantity and the quality of oocytes. Although the process is universal, its onset and pace vary widely, and early ovarian ageing (EOA) affects a substantial minority of women, contributing to subfertility, miscarriage and earlier menopause. This narrative review synthesises current understanding of the biology, diagnosis and management of ovarian ageing. Two interrelated but partly independent processes drive the decline: exhaustion of the primordial follicle pool and deterioration of oocyte developmental competence. Beneath them lies an interconnected molecular network encompassing mitochondrial and metabolic dysfunction, genomic and meiotic instability, cellular senescence and inflammation and progressive ageing of the ovarian microenvironment. In clinical practice, assessment still depends on surrogate markers-anti-Müllerian hormone (AMH), antral follicle count (AFC) and follicle-stimulating hormone (FSH)-that quantify reserve but cannot measure oocyte quality; importantly, these markers predict ovarian response rather than natural fertility, and improvements in AMH, AFC, oocyte yield or menstrual function do not necessarily translate into better oocyte competence, euploid embryo formation or live birth. Management remains centred on fertility preservation and optimisation of assisted reproductive technology, with pharmacological adjuvants offering, at best, modest and inconsistent benefit and none currently endorsed by guidelines for improving live birth. A new generation of experimental strategies-in vitro activation, platelet-rich plasma, stem-cell and exosome therapies, mitochondrial replacement and in vitro gametogenesis-signals a conceptual shift from managing decline towards restoring ovarian function, but the supporting evidence remains preliminary. Despite remarkable progress, no intervention currently reverses ovarian ageing or reliably improves age-related oocyte competence, and bridging this gap will require rigorous translational research and careful, evidence-based clinical integration.

To our knowledge, this is the first documented case of presumed recurrent monozygotic (MZT) dichorionic diamniotic (DCDA) twin gestations following programmed single thawed euploid embryo transfer (STEET) cycles in an individual who is herself a MZT twin. This report presents a 34-year-old nulligravid female patient and her 33-year-old male partner with unexplained infertility who underwent in vitro fertilization with preimplantation genetic testing for aneuploidy followed by subsequent embryo transfers, resulting in a presumed MZT DCDA twin gestation (STEET #1), a singleton gestation (STEET #2) and a confirmed MZT DCDA twin gestation (STEET#3). Monozygosity was confirmed for the second twin gestation (STEET #3) via single nucleotide polymorphism (SNP)-based cell-free DNA screening; the first twin gestation (STEET#1) is presumed to be MZT with high likelihood given that it resulted from a STEET performed in the setting of confirmed ovulation suppression. Chorionicity was confirmed via first-trimester ultrasound in both twin gestations (STEET #1 and #3). Nevertheless, this case shows that recurrent MZT DCDA twinning may be possible even after single blastocyst transfer and that observed chorionicity may not always conform to traditional twinning. Further research is needed to better understand the mechanisms and predisposing factors underlying MZT twinning as well as the development of DCDA twin gestations after single blastocyst transfers in assisted reproduction. Specific factors contributing to early embryo splitting may relate to the individual person, the embryo cohort or laboratory techniques. Informed consent counseling should include a discussion that MZT DCDA twinning remains a rare but real possibility despite single embryo transfer.