Male infertility can be primary or secondary, depending on whether pregnancy has been achieved before or not, but thyroid gland involvement is rarely investigated in the laboratory work-up. This study aimed to assess thyroid hormone abnormalities among primary and secondary infertile men.

This is a cross-sectional study involving male partners of infertile couples presenting at the fertility clinic with an established diagnosis of infertility after review by the clinician. Males with proven fertility served as controls.

The study was conducted at the Human Reproduction and Research Programme unit and the Chemical Pathology Laboratory of the University of Benin Teaching Hospital, Benin City, Edo State, Nigeria.

This study involved 200 participants who consisted of 50 controls (fertile men) and 150 infertile men (80 primary infertile men and 70 secondary infertile men). The participants were reviewed by a clinician, and a semen analysis was done to ascertain their fertility status.

The results show that sperm indices, such as sperm count, total motility, progressive motility, viable sperm cells, normal forms and volume were significantly lower (p

Thyroid abnormalities were more predominant among secondary infertile men than primary infertile men in this study.

Infertility is a significant reproductive health issue that affects couples physically, emotionally and socially. This qualitative study aims to explore the psycho-social experiences and coping strategies of infertile couples attending infertility clinics at Saint Paul’s Hospital, Addis Ababa, Ethiopia.

This study employed a descriptive phenomenological research design. In-depth interviews were conducted with 12 purposively selected couples experiencing infertility. The study used thematic analysis to capture the emotional, social and psychological impacts of infertility on individuals and their relationships.

Key themes identified include emotional distress, social stigma, marital strain and a sense of isolation. Participants reported experiencing feelings of shame, depression and anxiety, often exacerbated by societal expectations and pressure to conceive. Coping strategies varied across individuals and included seeking medical intervention, social support, religious faith and, in some cases, withdrawal from social interactions.

The study highlights the need for comprehensive psychological support and counselling services in infertility care to address the mental health and social challenges faced by infertile couples. Promoting awareness to reduce stigma and enhancing social support systems may improve the overall well-being of affected individuals.

The Cardiometabolic function in Offspring, Mother and Placenta after Assisted Reproductive Technology (COMPART) study is a prospective cohort study aiming to explore health outcomes in mothers and children following assisted reproductive technology (ART), with a particular focus on frozen embryo transfer (FET) versus fresh embryo transfer (fresh-ET). The increasing prevalence of ART and FET emphasises the need to assess potential health risks associated with the procedures, both in pregnancy, such as pre-eclampsia and large for gestational age offspring, and in the children, such as obesity and cardiometabolic dysfunction.

The cohort will include 600 pregnant women, their potential partner and their offspring in a 1:1:1 ratio of pregnancies achieved after ART with FET, ART with fresh-ET and women who conceived naturally. The study will involve extensive data collection from electronic medical records; parental questionnaires; biochemical, genetic and epigenetic analyses in blood, urine and placental tissue; and medical imaging (fetal ultrasound and PEA POD scan) and clinical examinations. Outcomes are grouped into six work packages (WPs) related to fetal growth (WP1), pregnancy (WP2), placenta (WP3), offspring (WP4), genetics (WP5) and epigenetics (WP6).

The COMPART study aims to provide valuable insights into the impact of ART and FET on maternal and offspring health and the underlying mechanisms responsible. The study seeks to advance reproductive medicine, shape clinical practice and guidelines and ultimately ensure maternal-fetal health following ART. The study has been approved by the Danish Ethics Committee (H-23071266; February 2024).

NCT06334003

The COVID-19 pandemic disrupted maternal healthcare access globally, leading many women to give birth outside of healthcare facilities, often assisted by traditional birth attendants (TBAs). This study explored the experiences of Kenyan women who gave birth outside of healthcare facilities during the COVID-19 pandemic based on the Person-Centered Maternity Care (PCMC) framework.

This study used data from descriptive qualitative indepth interviews with Kenyan women who gave birth outside of healthcare facilities between March and November 2020. Participants lived within the catchment areas of six health facilities in Kiambu and Nairobi counties and were recruited by community leaders and community health workers. Interviews were conducted in 2020 via phone and inductively coded and analysed by a team of researchers.

A total of 28 Kenyan women who gave birth outside of healthcare facilities between March and November 2020 completed indepth interviews.

In this sample, approximately one-third of women were assisted by TBAs, while the majority were supported by friends and family members. Women generally described salient aspects of their care pertaining to the PCMC domain of supportive care. During labour, birth and the immediate postpartum, women received emotional support, basic medical assistance and instrumental support such as preparing food and baths. However, women also described concerns about giving birth outside of healthcare facilities, including poor hygiene and lack of privacy in birthing spaces as well as instances of verbal and physical harassment by TBAs. Overall, women worried about potential complications during birth, and many women delayed seeking postpartum and postnatal care.

Women who were unable to access healthcare facilities during the COVID-19 pandemic relied on TBAs and/or friends and family for support during labour and birth. These women faced gaps in PCMC, specifically related to supportive care. Given that birthing outside of healthcare facilities remains common globally, particularly during emergencies such as pandemics, TBAs should be supported to provide more person-centred care to women giving birth outside of healthcare facilities.

Many cancer treatments can result in reduced fertility, impacting survivors’ opportunities for biological parenthood. Fertility preservation (FP) methods for boys and young men, such as cryopreservation of testicular tissue or sperm, offer hope but are currently underused among young male patients with cancer. Despite guidelines recommending early discussion of fertility implications, many newly diagnosed males do not receive FP counselling or referral to fertility services. Male cancer survivors face a higher likelihood of infertility than their peers, yet focused FP decision-making support is lacking. This study aims to address this gap by developing and evaluating the first dedicated patient decision aid (PtDA) for boys and young male patients with cancer aged 11–25 years old, to help them make informed FP decisions before receiving cancer treatment.

The current study follows a multistage process: developing the PtDA, alpha testing for acceptability with former patients, parents and healthcare professionals, and beta testing in clinical settings to ensure effective integration into routine care. Using a combination of interviews and questionnaire data, this research will assess the PtDA’s acceptability and impact on decision-making.

This study has been prospectively registered on the Research Registry (10273). Ethics approval has been obtained from Leeds Beckett University and the National Health Service/Health Research Authority before undertaking data collection. The final resource will be disseminated widely and made freely available online via our dedicated Cancer, Fertility and Me website, for use in clinical and research practice.

Dysmenorrhoea (period pain) is a global public health issue affecting up to 91% of the 1.8 billion individuals who menstruate. While research has emphasised the improvement of menstrual health in low-middle-income countries, undertreated dysmenorrhoea remains an issue in high-income countries (HICs), where individuals often assume their pain experiences are normal. Studies report that individuals with dysmenorrhoea delay seeking medical care, avoid it entirely or are subjected to diagnostic and treatment delays. Difficulties accessing care are troubling, as individuals may suffer without access to evidence-based techniques, as well as the potential for underlying pathologies (eg, endometriosis, pelvic inflammatory disease) to go undiagnosed.

Many HICs have launched strategies for women’s health to address gaps in care access and knowledge around menstruation. Guided by Levesque and colleagues' (2013) Conceptual Framework of Access to Healthcare, this review will contribute to these strategies by providing an overview of factors affecting healthcare access for dysmenorrhoea in HICs from the point of perceiving a healthcare need to engaging with care, as well as factors affecting perceived quality of care.

This scoping review will follow the Joanna Briggs Institute’s (JBI) guidance for scoping reviews and will be conducted with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist extension for Scoping Reviews. Guided by Levesque and colleagues’ (2013) Conceptual Framework of Access to Healthcare, searching will seek to locate both peer-reviewed studies across PubMed, CINAHL, PsycINFO and Web of Science databases, as well as using web scraping to locate relevant grey literature. Results will be synthesised and mapped to construct a pathway to care, highlighting factors affecting the healthcare access for dysmenorrhoea, as well as factors related to the quality of healthcare interactions.

This review does not require ethical approval, as only existing data will be analysed. Results will be shared using peer-reviewed publications and conference presentations. Datasets emerging from the study will be made available on Open Science Framework.

This review was initially registered on Open Science Framework (https://osf.io/2dsrc/) in February 2024, with an updated protocol registered in February 2025.

Time-lapse imaging (TLI) systems for embryo incubation and assessment are hypothesised to improve the success rates of in vitro fertilisation (IVF) treatment by providing undisturbed culture conditions for embryos and/or providing more information on embryo development (morphokinetic parameters) to improve predictive accuracy for embryo selection. Despite numerous aggregate meta-analyses showing uncertainty of benefit, IVF clinics globally continue to invest significant resources into this technology with little translation of evidence into guidelines or policy frameworks. This may be attributed to heterogeneity in participant populations and/or variations in the use of TLI, as highlighted in the aggregate meta-analyses.

Our research proposal for evidence synthesis using individual participant data meta-analysis will provide greater power than aggregate meta-analysis to detect differential treatment effects for effectiveness (live birth, clinical pregnancy) and safety (pregnancy loss, multiple births, congenital malformations) outcomes across three comparisons (overall effect, undisturbed culture and morphokinetic parameters). We will also analyse if there are specific subgroups of women who may benefit from the intervention and if variations in use of the intervention show any benefits. We have incorporated the results of the literature search used for the latest Cochrane review (7 January 2019) into this review and will include all the trials included therein. We will further update the literature search to include new evidence by searching the electronic databases MEDLINE, EMBASE, CINAHL and CENTRAL from 07/01/2019 to date, outcomes for all ongoing trials reported in the 2019 Cochrane review, trial registers for newer ongoing/completed trials and the citation lists of all the newly identified trials for any relevant references. The search strategy will include a combination of subject headings and text words relating to or describing the participants and the intervention, with no language restrictions. Two authors will independently screen the titles and abstracts, and full text of articles retrieved from the search, to finalise a list of trials suitable for inclusion in the review. We will include randomised controlled trials that assess TLI systems for either undisturbed culture and/or use of morphokinetic parameters for embryo selection in women having IVF/ICSI treatment using their own oocytes.

Ethical approval is not required for this study. We plan to disseminate the findings of the research to all stakeholders, including the National Institute for Health and Care Excellence and other international guideline development groups, through publication in peer-reviewed journals, presentation at conferences, newsletters, meetings and websites of the funders, fertility charities and patient support groups.

CRD42024564332.

Childhood cancer treatment can cause subfertility in adulthood. Ovarian or testicular tissue preservation is a rapidly evolving field with significant potential benefits. However, the establishment of patient-centred reproductive survivorship pathways remains a challenge in clinical settings due to a lack of robust evidence to inform its development. Patient and public involvement and engagement (PPIE) consultation may help ensure that future studies align with patient needs and that tailored survivorship care pathways are developed for young people with preserved fertility tissue.

This PPIE consultation aimed to identify priority areas for future research that would support the development of a tailored survivorship care pathway for childhood cancer survivors who have preserved tissue for future fertility.

Recruitment occurred through national networks, including collaborations with advocacy groups such as Candlelighters and clinical networks. Data were collected via telephone or online unstructured interviews, with some supplementary email exchanges. Thematic analysis was used to identify emergent themes. The Guidance for Reporting Involvement of Patients and the Public (GRIPP)-2 guidelines were used to help guide PPIE.

An online focus group and/or a one-to-one interview with e-mail interactions.

In total, 12 unique participants took part in a focus group and/or interview. Participants included parents of children who had stored tissue, young adult cancer survivors with stored tissue and five clinicians from the leading National Health Service (NHS) centres in the UK.

Six key themes emerged that highlighted unmet needs and priority areas for research: (1) Lack of communication and information; (2) unmet needs in follow-up care; (3) emotional impact and psychological support; (4) importance of patient and parental involvement; (5) desire for information and education; and (6) long-term concerns and support. Parents, young adults and healthcare clinicians found talking about fertility issues difficult. They noted that consistency of care, education resources and access to emotional support were important areas where improvements could be made. We used thematic analysis to help identify patterns in the data, and we used the Guidance for Reporting Involvement of Patients and the Public (GRIPP)-2 reporting guidelines for PPIE work.

PPIE provided valuable insights into the experiences of childhood cancer survivors with preserved fertility tissue, their parents and clinicians, highlighting priority areas to guide future research and ensure it addresses the concerns of care recipients. Our findings suggest that childhood cancer survivors who preserve tissue for future fertility need personalised follow-up care with information and psychological support. A larger sample of participants, studied using a qualitative research design, is needed to capture the full range of experiences, needs and preferences and to ensure that care is inclusive and relevant to the wider population.

Tuberculosis (TB) is a significant factor contributing to infertility. For some infertile patients, chest radiography (CXR) screenings prior to assisted reproductive treatment (ART) reveal old/inactive TB lesions. However, the pregnancy outcomes after ART for such patients who had a history of prior anti-TB treatment remain unclear.

Retrospective cohort study.

Peking University Third Hospital, a tertiary care centre.

This study analysed and focused on infertile patients aged 20–50 years with prior TB lesions on CXR (treated/untreated) and normal CXR. Active TB cases were excluded from this study. Patients were categorised into three groups based on CXR findings and prior anti-TB treatment: treated prior-pulmonary TB (PTB) group, untreated prior-PTB group and a non-PTB control group with normal CXR.

ART outcomes, including clinical pregnancy rate, miscarriage rate and live birth rate, were compared among the groups.

Among 8769 patients analysed, including treated prior-PTB group (n=171), untreated prior-PTB group (n=791) and non-PTB group (n=7807). The treated prior-PTB group showed a similar clinical pregnancy rate (41.5% vs 38.1%, p=0.360) and live birth rate (35.3% vs 30.6%, p=0.187) compared with the non-PTB group. The miscarriage rate was slightly lower in the treated prior-PTB group than in the non-PTB group (11.3% vs 15.5%, p=0.325), although the discrepancy was not statistically significant. Compared with the untreated prior-PTB group, the treated prior-PTB group exhibited significantly higher live birth rate (35.3% vs 23.8%, p

Anti-TB treatment in infertile women with prior PTB lesions was associated with improved ART outcomes, comparable to those in patients without TB lesions. This suggests a potential clinical benefit of anti-TB treatment in improving reproductive outcomes in this population. Further research is warranted to explore ART outcomes in patients with untreated prior TB lesions.

The quality of the blastocyst (day 5/6 embryo) selected for transfer is critical for the success of in vitro fertilisation (IVF) treatment. Embryologists perform blastocyst evaluation by observing the morphology of each blastocyst. Human assessment is subjective and inconsistent in predicting which blastocyst can result in a successful pregnancy or birth. Several artificial intelligence (AI) methods have been proposed to predict IVF outcomes from blastocyst images. However, the reasoning processes of these AI methods are uninterpretable, causing epistemic and ethical concerns that prevent their implementation in clinical practice. To address this issue, the authors developed a novel interpretable AI method for blastocyst selection. The method is clinically applicable because it is transparent to embryologists and allows them to understand its reasoning processes. This randomised controlled trial (RCT) aims to test the effectiveness of this blastocyst selection method with the aim of improving IVF outcomes.

In this single-centre, single-blind RCT, we will enrol 1100 women aged 20–35 years undergoing their first cycle of IVF, with or without intracytoplasmic sperm injection. The study will be conducted at Nanjing Drum Tower Hospital, a public class A tertiary hospital in China. On the fifth day of embryo culture, participants with two or more usable blastocysts will be randomised in a 1:1 ratio to either the conventional morphology group or the AI group. The primary outcome is ongoing pregnancy, defined as a viable intrauterine pregnancy of 12 weeks gestation or more.

The research ethics committee of the Nanjing Drum Tower Hospital approved this study (approval number: 2023-259-02). All participants will provide written informed consent prior to enrolment. The findings will be presented at international conferences and published in peer-reviewed journals.

ChiCTR2300076851.

Polycystic ovarian syndrome (PCOS) is a common endocrine disorder that affects reproductive-age women, impairing their ability to conceive and sustain fertility. The efficacy of conventional therapies varies among individuals and is often accompanied by multiple side effects. Acupuncture has shown potential in fertility management for PCOS patients. However, the current evidence on its impact on pregnancy outcomes remains inconclusive. This study aims to synthesise the latest evidence regarding the efficacy and safety of acupuncture in infertile women with PCOS.

A comprehensive literature review will be conducted by searching for randomised controlled trials of acupuncture for infertile women with PCOS in English and Chinese language databases, including the Cochrane Database of Clinical Trials, PubMed, EMBASE, CNKI, Wanfang, VIP and SinoMed. The primary outcome will be live birth rat (LBR) and clinical pregnancy rate (CRP). The secondary outcomes will include multiple pregnancy rate (MPR), ongoing pregnancy rate (OPR), miscarriage rate (MR), ovulation rate (OR), hyperstimulation ovarian syndrome (OHSS) and adverse events. The risk of bias will be assessed using the Cochrane Risk of Bias 2.0 tool. Meta-analysis will be conducted to synthesise the evidence for each outcome, if possible. The heterogeneity will be statistically assessed using a ² test and I² statistic. Subgroup analyses, sensitivity analyses and publication bias will be performed if the available data are sufficient. Evidence strength will be graded using the Grading of Recommendations Assessment, Development and Evaluation system. This protocol is developed following the guidelines of PRISMA-P 2015.

Ethics approval is not required for this review. Our findings will be published in a peer-reviewed journal.

CRD42024601226.

Differences in the profile of the vaginal microbiota (VMB) have been associated with pregnancy rates after medical assisted reproduction (MAR) such as in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI). Monitoring the VMB profile of IVF patients creates an opportunity to identify the best window for IVF treatment and embryo transfer. The ReceptIVFity test is a predictive test that assesses the chances of becoming pregnant in women undergoing IVF treatment based on the VMB composition. A VMB profile dominated by beneficial strains, most notably Lactobacillus species, is associated with increased pregnancy chances. However, to date, limited evidence is available on the effect of active modification strategies to facilitate the modulation of the VMB profile to help restore a VMB dominated by Lactobacillus species.

This is a randomised, placebo-controlled, double-blind intervention study. The study will involve 1:1 randomisation to one of the two arms: oral probiotic or placebo. Vaginal and rectal swabs will be collected at intake and 4, 6 and 8 weeks after the start of the treatment. Our objective is to determine if oral probiotic treatment improves the VMB profile of IVF patients from a low to a medium/high ReceptIVFity score, compared with placebo treatment. Secondary outcomes are: the potential of the bacterial strains in the oral probiotic to be detected in the vaginal tract and/or in the gut, and if the treatment leads to an increased ongoing pregnancy rate after IVF.

Ethical approval was obtained by the local medical ethical review committee at the Maastricht University Medical Centre. Findings from this study will be published in a peer-reviewed scientific journal and presented at one or more scientific conferences.

CCMO NL81210.068.22, registered 25 September 2023.

Thin endometrium poses a major therapeutic challenge in assisted reproductive technologies by compromising pregnancy success and live birth outcomes. A substantial proportion of patients remain refractory to existing therapies. Preliminary evidence suggests acupuncture may improve endometrial thickness (EMT). This study aims to assess the effect of acupuncture against sham acupuncture for women with thin endometrium.

This study is a single-centre, randomised, sham-controlled trial conducted at a specialised acupuncture hospital in Beijing, China. A total of 120 women with thin endometrium will be randomised (1:1) to receive 36 sessions of acupuncture or sham acupuncture over 12 weeks. The primary outcome is the EMT at week 12. Secondary outcomes are endometrial pattern, uterine arterial blood flow parameters (Pulsatility Index, Resistance Index and the ratio of peak systolic to end-diastolic blood flow velocities), endometrium blood flow, serum oestradiol concentration, clinical pregnancy rate and Self-Rating Anxiety Scale Scores.

This study has been approved by the ethics committee of the Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences (approval no.: S2024-04-23-1). Each participant will be required to provide written informed consent before enrolment. Findings will be disseminated through peer-reviewed publications and conference presentations.

ITMCTR2024000053.

This study aimed to examine the impact of the first COVID-19 lockdown period on access to postnatal contraception (PNC) and wider postnatal care and to explore the experiences of PNC care within the North East and North Cumbria (NENC) Integrated Care System (ICS) during the same period.

This study reports a subanalysis of the NENC Postnatal Contraception (PoCo) study, an online survey of a convenience sample of women in the NENC ICS who completed pregnancies between 2019 and 2023.

Women who completed pregnancies between 2019 and 2023 in the NENC ICS.

Out of the total 2509 eligible participants who completed the PoCo survey, women who delivered in April–June 2020, April–June 2021 and April–June 2022 were included within this subanalysis, resulting in 457 eligible survey responses. There were no additional exclusion criteria.

Primary outcome measures were PNC uptake and number of healthcare professional contacts during the postnatal period. Secondary outcome measures were self-reported experiences of PNC care.

Women who delivered in April–June 2020 had fewer postnatal contacts than women who delivered in subsequent non-lockdown cohorts and were less likely to be offered PNC prior to discharge. There were no significant differences in relation to PNC uptake. In qualitative analyses, several women who delivered in 2020 highlighted COVID-19 as a factor perceived to be associated with poor postnatal care. Across all three groups, experiences of PNC care were diverse; feeling pressured to accept PNC was frequently reported.

While the first COVID-19 lockdown appears to have had a significant impact on women’s experiences of postnatal care, this did not result in a substantive decrease in PNC provision, likely reflecting pre-existing shortcomings. These women and families may benefit from additional support postpandemic to mitigate the potential life course implications of restricted support in the postpartum period, and policy-makers and healthcare providers should continue to explore innovative and patient-centred approaches to improving PNC provision. Future research should continue to evaluate the longer-term impacts of these changes in non-pandemic contexts.

Polycystic ovary syndrome (PCOS), recognised as the predominant aetiological factor in ovulatory dysfunction-related infertility, accounts for approximately 70% of anovulatory infertility cases. Patients with PCOS have significantly higher anti-Müllerian hormone (AMH) levels than their counterparts undergoing in vitro fertilisation (IVF) for non-PCOS indications (eg, male/tubal factors). Several studies have suggested that a high AMH level is associated with adverse pregnancy outcomes in IVF, particularly preterm delivery. However, most of these studies are retrospective studies, and their results are inconsistent. The majority of AMH measurements are conducted before pregnancy; however, AMH levels fluctuate dynamically during pregnancy. There is a pressing need for a well-structured prospective study to definitively establish whether high AMH levels during pregnancy are associated with IVF/intracytoplasmic sperm injection (ICSI) pregnancy outcomes in PCOS patients.

This prospective cohort study will be conducted at four reproductive medicine centres. The plan is to enrol 1,320 PCOS patients and 1320 non-PCOS women who undergo IVF/ICSI and achieve singleton clinical pregnancies. Serum samples will be collected at about 6 weeks of gestation to measure the serum AMH level. Follow-up visits will be conducted at 12, 28 and 37 weeks of gestation, delivery and 6 weeks after delivery to obtain information about pregnancy outcomes and complications. The primary outcome is preterm delivery.

The study was approved by the Medical Research Ethics Committee of Peking University Third Hospital (M2022618). Informed consent will be obtained from all patients. The results of this clinical study will be presented at scientific conferences and submitted to a peer-reviewed journal.

ChiCTR2300068554.

The incidence of recurrent implantation failure (RIF) can reach up to 10% among patients undergoing in vitro fertilisation and embryo transfer worldwide. However, the clinical efficacy of low-molecular-weight heparin (LMWH) in RIF remains a subject of controversy. Currently, there is a lack of high-quality clinical research validating the effectiveness of LMWH in treating patients with RIF, particularly during frozen embryo transfer (FET) cycles. Therefore, this randomised controlled trial aimed to investigate the impact of LMWH on pregnancy outcomes in women with RIF undergoing FET.

This prospective, single-centre, double-blind randomised, placebo-controlled clinical trial will be conducted in the Second Hospital of Shandong University, China. A total of 414 women with RIF, aged ≤40 years, who are undergoing FET cycles will be recruited and randomly assigned to the study group (LMWH) or the control group (placebo). Only one blastocyst which is from day 5 or day 6 and has a Gardner morphology score ≥4 BC will be transferred. LMWH 4000–6000 IU per day or placebo will be administered by subcutaneous injection from the day of transplantation. The primary outcome is the live birth rate. The secondary outcomes include the clinical pregnancy rate, biochemical pregnancy rate, embryo implantation rate, early miscarriage rate, ongoing pregnancy rate, ectopic pregnancy rate, pregnancy-related complications, perinatal complications, fetal birth weight, congenital malformations and other adverse reactions.

The protocol received approval from the Ethics Committee of the Second Hospital, Cheeloo College of Medicine, Shandong University (KYLL-2023-442). The findings will be disseminated in peer-reviewed publications.

Chinese Clinical Trial Registry, ChiCTR2400083577.

Unintended pregnancies pose significant public health challenges globally, particularly in the Middle East and North Africa (MENA) region, where cultural, religious and societal factors play the most substantial role. This systematic review and meta-analysis investigated the pooled prevalence and factors associated with unintended pregnancies in the MENA region.

We conducted a systematic review to identify relevant studies in Medical Literature Analysis and Retriaval System (MEDLINE), Embase and Scopus published on unintended pregnancies until July 2024. We included studies that were conducted on unintended pregnancy prevalence within MENA countries and employed suitable measurement tools. We analysed data from 40 studies involving 34 837 participants across the region, including Egypt, Iran, Saudi Arabia and Qatar. We used a random-effects model to estimate the pooled prevalence of unintended pregnancy.

In this meta-analysis, we found that the overall prevalence of unintended pregnancy was 27.0% (95% CI 25.0% to 30.0%) in the MENA region, and the certainty of the evidence was moderate. Saudi Arabia had the highest prevalence of unintended pregnancy at 32.0% (95% CI 27.0% to 38.0%). A lower prevalence, 10.0% (95% CI 8.0% to 14.0%), was found in the studies that used validated tools compared with non-validated tools to measure unintended pregnancy. Between 2006 and 2010, the prevalence was 34.0% (95% CI 28.0% to 40.0%), the highest compared to other time periods . Age, rural areas, education, employment, economic status, parity, gravidity, history of miscarriage, previous pregnancies or abortion, non-use or failure of contraception methods, limited antenatal care, were associated with unintended pregnancies.

Our findings suggest that the MENA region faces a substantial burden of unintended pregnancies, with variations among countries and over time. The results emphasise the need for evidence-based interventions to address this issue, focusing on factors associated with unintended pregnancy.

Weight loss is often recommended as the primary intervention for infertility in individuals with high body mass index. However, focusing on body mass index might overlook other important factors like cardiometabolic health. This study aims to examine cardiometabolic health in patients seeking fertility treatment and its impact on reproductive outcomes.

A cross-sectional analysis of 800 systematically selected participants (400 couples) will be completed on a single visit to the study site. This session will involve taking blood samples to examine metabolic biomarkers, the completion of questionnaires assessing preconception health factors and an exercise ‘step test’ to assess cardiorespiratory fitness. Metabolic panels will be compared with target values and, where available, normative population data. Fitness data will be transformed into normative percentile values based on the participant’s age and sex. Patients will be followed for 2 years to allow yearly data collection related to conception, gestation and parturition. Associations between cardiometabolic health during the preconception phase and reproductive outcomes will be examined.

The Newfoundland and Labrador Health Research Ethics Board has provided ethical approval for this study (HREB #20230825). Each patient will be required to give written consent prior to any data collection. We will share study findings at conferences and submit manuscripts to peer-reviewed journals. Additionally, we will create knowledge translation presentations for Newfoundland and Labrador Fertility Services and Family Practice Clinics.

This study aimed to investigate the relationship between endometrial echo and pregnancy outcome in patients undergoing thawed embryo transfer and explore the effect of different endometrial preparation schemes on endometrial echo.

A retrospective analysis was conducted on data from 2910 patients who underwent freeze-thaw embryo transfer (FET)-assisted pregnancy in the reproductive medicine centre of our hospital from January 2019 to March 2024. Based on the endometrial echo on the transplantation day, the patients were divided into two groups: the endometrial echo uniform group and the endometrial echo uneven group. Based on the endometrial preparation protocol, they were divided into the natural cycle (NC) group, hormone replacement cycle (HRT) group, and downregulated combined HRT (GnRHa+HRT) group. The general data, pregnancy outcome and endometrial echo of those undergoing different endometrial preparation protocols were compared.

The clinical pregnancy rate in the homogeneous endometrial echo group was significantly higher than that in the non-homogeneous endometrial echo group. The equalisation rate of endometrial echo in the NC group and GnRHa+HRT group was significantly higher than that in the HRT group (p

Non-homogeneous endometrial echo on the transplantation day was associated with a decreased clinical pregnancy rate of FET. The endometrial preparation protocol of the NC and GnRHa+HRT cycle can improve homogeneous endometrial echo. In FET, clinicians should develop a personalised endometrial preparation protocol based on patients’ situations.