Reproductive Medicine

Background: Excess adiposity has been associated with endocrine and metabolic alterations that may affect ovarian physiology and outcomes in assisted reproductive technology (ART). Objectives: The purpose of this study was to evaluate whether body mass index (BMI) was independently associated with ovarian follicular response in women undergoing assisted reproductive procedures. Methods: A cross-sectional study was conducted including 259 women aged 18 to 43 years. Analyses included nutritional status, diet quality, and follicular response. Associations were analyzed using chi-square and Kruskal–Wallis tests and negative binomial regression adjusted for age and indication. Results: Mean age was 32.8 ± 6.3 years, and mean BMI was 24.7 ± 3.2 kg/m². Diet quality was not associated with follicle number or morphological quality. Overall, 47.5% of participants had normal weight, 42.9% were overweight, and 6.9% had class I obesity. Follicular yield differed across BMI categories in unadjusted analyses (p = 0.017), but BMI was not independently associated with follicle count after adjustment (IRR = 1.010; 95% CI: 0.983–1.036; p = 0.488). Age remained the only independent predictor, with each additional year associated with a 5.9% reduction in expected follicle count (IRR = 0.941; 95% CI: 0.920–0.963; p < 0.001). Conclusions: BMI was not independently associated with follicular yield after adjustment, whereas age remained the principal determinant of ovarian response. These findings should be confirmed in prospective studies incorporating ovarian reserve markers and stimulation-related variables. Full article

Background: Endometrial cancer (EC) is one of the most prevalent cancers in women globally, which has recently gained attention as an increase has been noted among premenopausal women. Improving fertility-sparing treatments is crucial to assist women in completing their family planning. Methods: This study aims to explore the current evidence on the mechanisms of action and correlation between Glucagon-like Peptide-1 (GLP-1) and its agonists with EC, as well as the potential application in the conservative therapy for early-stage EC. A narrative review of the worldwide literature was conducted according to Scale for the Assessment of Narrative Review Articles (SANRA) principles, intending to analyze the correlation of GLP-1 receptor agonists (GLP-1RAs) with EC and their precise effect in the fertility-sparing treatment in women with atypical endometrial hyperplasia (AEH) or early-stage EC. Results: Preclinical studies indicate that GLP-1 receptor (GLP-1R) expression on healthy and malignant endometrial tissues of models regulates apoptosis via the AMPK-mTOR pathway. Observational and early clinical studies conclude that their role in the improvement of metabolic and hormonal imbalance increases the risk for the development of EC, as well as anti-tumour and anti-inflammatory effects. Conclusions: GLP-1RAs represent a potentially promising addition to the conservative management of AEH and early-stage EC in premenopausal women; however, further extensive clinical trials are required to ensure their safety and efficacy in future treatment algorithms and preconception exposure. Full article

Background/Objectives: Lipschutz ulcers were first described in 1912 by the Austrian dermatologist Benjamin Lipschutz. The onset presents with flu-like symptoms with consecutive development of painful vulvar ulcers. The term is currently used to describe painful genital lesions associated with an immunological reaction to an extragenital source of infection, usually viral or bacterial infections or certain vaccines. This disease affects predominantly adolescent non-sexually active females and is usually self-limiting. Methods: We searched PubMed, Research Gate and Google Scholar using the keywords “Lipschutz ulcer”, “Ulcus vulvae acutum Lipschutz”, “Acute genital ulcer”, and “Reactive non-sexually related acute genital ulcers”. A total of 24 articles in English between the years 2000 and 2025 were selected in order to mark the latest advancements towards diagnostic and treatment plans. Only 19 provided thorough information about the treatment and follow-up of the patients, encompassing a total of 69 girls and women. Results: This review synthesizes the most common etiological factors for Lipschutz ulcers and explores the mechanism behind their development. Different treatment approaches were also investigated. Based on our findings, we propose a diagnostic and treatment algorithm depending on the patient’s general condition and severity of the ulcers. We reported a 12-year-old girl’s case, diagnosed and treated at our department. Despite our efforts, conservative therapy proved inefficient. Surgery was performed. Conclusions: Lipschutz’s ulcer is a diagnosis often overlooked. Therefore, further research is needed to address the best treatment strategies. Surgery should be reserved only for patients who show no improvement with conservative treatment. Full article

Objective: High sperm DNA fragmentation (SDF) results in fewer euploid embryos. Although sperm retrieved by testicular sperm extraction (TESE) has low SDF compared to the ejaculated sperm, there is little data comparing the prevalence of chromosomal abnormalities in the resulting embryos. The objective of this study was to compare rates of chromosomal abnormalities in blastocysts from sperm obtained either by TESE or ejaculate with high SDF. Methods: The blastocysts were generated by ICSI in both groups. The preimplantation genetic testing for aneuploidy (PGT-A) was performed by next-generation sequencing (NGS). This study utilized 2242 blastocysts from 400 couples; 200 couples in each group. The TESE-retrieved sperm and ejaculated sperm with high SDF had 1037 and 1205 blastocysts, respectively. The sperm DNA fragmentation was determined by the Halosperm G2 assay. The rates of euploid, aneuploid and mosaic embryos were compared by multivariate logistic regression and mixed-effects models that accounted for female age and ovarian reserve. Results: The TESE-derived sperm group had a significantly higher percentage of euploid blastocysts (67.8%) as compared to those derived from ejaculated sperm with high SDF (48.2%, p = 0.003). The multivariate logistic regression indicated that the sperm origin (TESE/ejaculate) was an independent predictor of euploid blastocysts [OR = 1.85; 95% CI = 1.05–3.26; p = 0.034]. The probability of having euploid blastocysts decreased by 6% for every 1% increase in the SDF. The increased age of the female was a major negative predictor [OR = 0.92 per year; 95% CI = 0.88–96; p = 0.001]. Conclusions: The TESE-derived sperm group had significantly higher euploid blastocysts as compared to the ejaculated sperm with high SDF group. Full article

Purpose: This post-marketing surveillance study evaluated the real-world safety and descriptive outcomes of a fixed 2:1 recombinant human follicle-stimulating hormone (r-hFSH) and recombinant human luteinizing hormone (r-hLH) combination among Korean women undergoing assisted reproductive technology with severe LH and FSH deficiency (baseline endogenous serum LH < 1.2 IU/L). Methods: A prospective, multicenter, observational study was conducted across 24 Korean fertility centers between August 2011 and May 2018. Safety outcomes included adverse events (AEs), adverse drug reactions (ADRs), and ovarian hyperstimulation syndrome (OHSS). Descriptive outcomes included endpoint-specific evaluable sets for follicular response and ultrasound-confirmed clinical pregnancy. Analyses were performed in safety (n = 600), follicular-response evaluable (n = 537), and pregnancy-evaluable (n = 486) sets. Results: Among patients in the safety set (mean age, 34.6 years), AEs occurred in 2.7% (16/600; 95% confidence interval [CI], 1.6–4.3), ADRs in 2.2% (13/600; 95% CI, 1.3–3.7), and OHSS in 1.3% (8/600; 95% CI, 0.7–2.6), including one severe case. In the follicular-response evaluable set, follicular response (≥1 follicle ≥17 mm) occurred in 99.3% (533/537; 95% CI, 98.1–99.7). In the pregnancy-evaluable set, clinical pregnancy occurred in 42.0% (204/486; 95% CI, 37.7–46.4), biochemical-only pregnancies in 3.1% (15/486; 95% CI, 1.9–5.0), and total pregnancies (clinical + biochemical-only, reported descriptively) in 45.1% (219/486; 95% CI, 40.7–49.5). Conclusions: In this historically constrained post-marketing surveillance cohort, the fixed 2:1 r-hFSH and r-hLH combination showed a favorable post-marketing safety profile and provided descriptive outcome information within endpoint-specific evaluable sets in women meeting the severe LH-deficiency criterion. Full article

Chronic epididymitis and orchitis represent significant yet frequently under-recognized contributors to male infertility, particularly among men of reproductive age. These conditions arise from persistent inflammatory or immunological processes affecting the epididymis and testis, leading to impaired spermatogenesis, altered sperm maturation and possible obstruction of the male reproductive tract. Infectious aetiologies, especially those linked to sexually transmitted pathogens and uropathogens, remain predominant; however, non-infectious mechanisms, including autoimmune activation, post-vasectomy changes and idiopathic inflammation, also play critical roles. The persistent inflammatory milieu induces cytokine release, oxidative stress and structural tissue remodelling, ultimately compromising the functional and immune-privileged microenvironment necessary for optimal sperm production and transport. Diagnostic evaluation requires a multimodal approach incorporating clinical examination, microbiological testing, semen analysis and scrotal ultrasonography, with advanced imaging and molecular assays reserved for complex or equivocal cases. Management is individualized and may involve antimicrobial therapy, anti-inflammatory treatment, immunomodulation or microsurgical intervention in cases of ductal obstruction. Assisted reproductive technologies provide additional options when natural conception is not feasible. Despite increased recognition of their impact, chronic epididymitis and orchitis remain insufficiently studied, with gaps in standardized definitions, biomarker validation and long-term outcome data. This review provides a focused synthesis and phenotype-driven clinical framework for chronic epididymitis and orchitis through a fertility-preservation lens, bridging urological and andrological perspectives and integrating evidence on subclinical inflammation, contemporary diagnostic biomarkers and a staged therapeutic pathway. Full article

Background/Objectives: Y chromosome microdeletions in the azoospermia factor (AZF) regions are a major genetic cause of severe male infertility, yet their relationship with hormonal profiles in azoospermic men remains unclear. This study aimed to investigate AZF microdeletions and associated hormonal parameters in azoospermic patients. Methods: Azoospermic patients were screened for AZFa, AZFb, and AZFc microdeletions using multiplex real-time PCR targeting sequence-tagged site (STS) markers (sY84, sY127, and sY254). Patients were categorized into AZF-negative and AZF-positive groups, with the latter further stratified according to their deletion subtype. Serum follicle-stimulating hormone (FSH), testosterone, and inhibin B levels were measured. Hormonal parameters were compared between groups using the Mann–Whitney U test, and a logistic regression analysis was performed to evaluate associations between hormonal variables and AZF deletion status. Results: AZF microdeletions were detected in 18.7% (17/91) of patients. Patients without AZF deletions showed a median FSH level of 17.40 (7.12–31.27) IU/L. In contrast, AZFc deletion carriers exhibited an intermediate median FSH level of 21.10 (16.11–26.10) IU/L and lower median inhibin B concentrations (25.50 [25.25–26.00] pg/mL) compared with AZF-negative patients (56.00 [33.50–106.50] pg/mL). Median testosterone levels in AZFc patients (3.61 [2.87–4.35] ng/mL) remained within the expected physiological range. However, no statistically significant differences were observed between the AZF subgroups for age (p = 0.262), FSH (p = 0.506), testosterone (p = 0.615), or inhibin B (p = 0.524). The logistic regression analysis also showed no significant association between hormonal parameters and AZF deletion status. Conclusions: Hormonal parameters alone are insufficient to predict the presence of AZF microdeletions in azoospermic men. These findings highlight the importance of routine genetic screening for accurate diagnosis, clinical management, and reproductive counseling in male infertility. Full article

Background: Male infertility affects millions of couples, accounting for 50 percent of cases. Despite such a major contribution of the male factor, it is not properly evaluated and is often overlooked in infertility assessments. Semen analysis, which is routinely performed to assess infertility status, is unable to assess the defects at the molecular level which are important to assess the fertilizing capacity of the sperm. This study aims to determine the utility of sperm function tests as biomarkers for male infertility in addition to standard semen analysis. Methods: Thirty-five men (aged 25–45 years) were recruited and divided into two groups: those with at least one altered semen parameter (infertile group) and those with normal semen parameters but unable to conceive after more than one year of unprotected intercourse (unexplained male infertility group). The DNA Fragmentation Index (DFI), Nuclear Chromatin Decondensation Test (NCDT) and Hypoosmotic Swelling Test (HOS) were used in diagnosing sperm dysfunction in both groups. The Mann–Whitney U testand Spearman’s rank correlation were used for analyzing the parameters of the groups. A p value < 0.05 was considered statistically significant. Results: While motility and vitality were nearly identical in both groups, the infertile group showed more morphological abnormalities. The DFI was higher in the unexplained male infertility group (UMI) (82%) than in the infertile group (36%). Poor decondensation capacity was present in 27% of the unexplained male infertility group and 60% of the infertile group. Both groups’ hypoosmotic swelling values fell within the usual range. Spearman correlation analysis revealed that the NCDT showed significant positive correlations with sperm vitality (r = 0.36; p = 0.02) and morphology (r = 0.53; p = 0.001). The DFI demonstrated significant negative correlations with vitality (r = −0.45; p = 0.006) and motility (r = −0.39; p = 0.01). HOS was significantly positively correlated with motility (r = 0.56; p = 0.0004) and vitality (r = 0.57; p = 0.0003). Additionally, the NCDT and DFI showed a significant inverse correlation (r = −0.33; p = 0.04). Conclusions: These findings highlight the potential of sperm function tests as valuable diagnostic tools alongside conventional semen analysis for a more comprehensive assessment of male fertility. Full article

Background: Male DSD is a rare disorder in which individuals with an XX chromosomal background present as phenotypic males due to the presence of the SRY gene translocation. We present here cytogenetic and molecular characterization of rare phenotypic male patients with primary infertility involving SRY translocation on the X chromosome, resulting in the absence of Y centromeric sequences. Methods: Routine hormonal analysis, scrotal ultrasonography, karyotype and FISH analysis were performed. Results: Normal male appearing patients presented with a long history of primary infertility. Physical examination revealed bilateral small, soft testes but reportedly normal libido and erectile function. Hormonal analysis revealed hypergonadotropic hypogonadism with very low total testosterone, high FSH and LH. Semen analysis consistently revealed azoospermia, and multiple testicular sperm extraction procedures and bilateral varicocelectomy failed to retrieve sperm. Karyotyping and FISH showed 46,X,der(X)t(X;Y)(p22.1;p11.2), and SRY-positivity on the derivative X chromosome, respectively. Conclusions: These findings expand the spectrum of 46,XX male infertility with SRY-positivity and underscore the necessity of lifelong testosterone replacement therapy for the management of hypogonadism. Future efforts should aim to establish regional registries for DSD to document genetic diversity surveillance in underrepresented populations. Full article

Background: Data on assisted reproductive technology (ART) outcomes among Roma women are virtually absent from the literature, despite Roma being the largest and most socioeconomically marginalized ethnic minority in Europe. This study provides the first structured evaluation of IVF/ICSI outcomes among Roma women at a tertiary fertility center. Methods: A retrospective observational cohort study was conducted at the Clinic for Gynecology and Obstetrics, University Clinical Center Niš, Serbia (May 2010–September 2015). Roma (n = 88) and non-Roma women (n = 1197) undergoing IVF/ICSI were compared on baseline clinical, hormonal, and embryological parameters. Primary and secondary outcomes were clinical pregnancy and live birth, respectively. Multivariable logistic regression, propensity score matching (1:4, by age and AMH), first-cycle sensitivity analysis, and a machine learning pipeline (logistic regression, random forest, XGBoost) with SHAP interpretability analysis were applied. Results: Roma women were significantly younger (31.9 ± 4.0 vs. 34.5 ± 4.7 years; p < 0.001) and had a more favorable ovarian reserve profile (AMH 3.78 vs. 2.90 ng/mL; p = 0.004; FSH 6.87 vs. 8.23 IU/L; p < 0.001), yet had a markedly longer duration of infertility (9.3 vs. 6.3 years; p < 0.001). Clinical pregnancy rates (48.9% vs. 41.3%; p = 0.179) and live birth rates (28.4% vs. 30.9%; p = 0.720) were comparable between groups. In multivariable logistic regression and propensity score-matched analyses, Roma ethnicity was not an independent predictor of either outcome. XGBoost SHAP analysis ranked Roma ethnicity last (11th of 11) in feature importance for both clinical pregnancy (mean |SHAP| = 0.033) and live birth (mean |SHAP| = 0.009). The dominant predictors were the number of embryos transferred, AMH, and age. Only 88 Roma women accessed ART over the decade-long study period, indicating profound underutilization of fertility services. Conclusions: No independent association was detected between Roma ethnicity and IVF/ICSI outcomes within the statistical power afforded by the Roma subgroup (n = 88). An exploratory first-cycle live birth signal (adjusted OR = 0.478; 95% CI 0.249–0.920; p = 0.027), not replicated in primary or propensity-matched analyses, is interpreted as hypothesis-generating. The extreme underutilization of ART services among Roma women remains the most clinically salient observation and a priority for targeted public health intervention. Full article

Background: Sexual health is a fundamental pillar of well-being during the perinatal period. However, many studies suffer from scoring bias associated with zero values by failing to distinguish between women who are sexually inactive and those with physiological dysfunction. This study aimed to identify the distinct sociodemographic and psychological determinants of sexual inactivity versus sexual dysfunction quality in a Romanian perinatal cohort. Methods: An observational, cross-sectional study was conducted with 100 women (52% sexually active, 48% inactive). Participants were evaluated using the Female Sexual Function Index (FSFI), Patient Health Questionnaire-9 (PHQ-9), RSES (Rosenberg Self-Esteem Scale), and Generalized Anxiety Disorder-7 (GAD-7). Data were analyzed using binary logistic regression for activity status and multiple linear regression for functional quality. Results: Among sexually active women, 84.6% met the clinical criteria for sexual dysfunction (median FSFI = 21.6). Binary logistic regression revealed that self-esteem (RSES) was the sole independent predictor of sexual activity status (aOR = 1.144; 95% CI: 1.028–1.217, p = 0.016). Conversely, multiple linear regression showed that depression (PHQ-9) was the only significant independent predictor of functional quality (B = −0.73, p = 0.006). Maternal age, residence, and obstetric history did not significantly predict either outcome. Conclusions: Based on the findings of our preliminary, exploratory study, we propose a conceptual interpretation, framing perinatal sexuality as a potential two-stage process, where self-esteem appears to serve as a primary behavioral barrier for the resumption of intimacy, while depression serves as the primary disruptor of functional quality. Clinical interventions may benefit from moving beyond physical recovery to include psychological screening for body image and mood disorders to restore sexual quality of life. Full article

Background: Pregnancy following liver and kidney transplantation is rare. The presence of a rare genetic disorder and advanced chronic kidney disease (CKD) further complicates clinical management, for which evidence-based guidelines are limited. Case presentation: A 29-year-old woman with Alagille syndrome underwent combined liver and kidney transplantation in early childhood. She had stage 4 CKD, and her baseline creatinine was around 250 umol/L. Her pregnancy was unplanned and diagnosed at 19+1 weeks of gestation. After the diagnosis of pregnancy, immunosuppressive therapy was promptly adjusted, and potentially teratogenic medications were discontinued. At 21+1 weeks’ gestation, creatinine and urea levels rose despite multidisciplinary management, and she started renal replacement therapy. Despite ongoing multidisciplinary care, the pregnancy was complicated by placental abruption at 24+5 weeks, requiring a preterm cesarean section. A live-born female infant weighing 590 g was delivered. Discussion: The coexistence of CKD, long-term immunosuppression, and high obstetric risk requires early multidisciplinary assessment and individualized management. Currently, standardized protocols for monitoring and treatment are lacking in this rare population, making clinical decision-making particularly challenging, especially regarding CKD progression. Conclusion: Pregnancy in women with combined liver and kidney transplantation and advanced CKD carries a high risk of severe renal and obstetric complications. Preconception counseling and early referral to multidisciplinary teams may help improve management in similar rare clinical scenarios. Full article

Male infertility, implicated in nearly 50% of couples’ infertility cases, represents a major medical and sociocultural challenge in Morocco. This narrative review synthesizes available epidemiological, etiological, and genetic data within national and international contexts. In Morocco, male infertility is characterized by the frequent involvement of modifiable factors, notably varicocele, smoking, and occupational exposures. From a genetic standpoint, chromosomal abnormalities, particularly Klinefelter syndrome, together with Y chromosome microdeletions, especially within the AZFc region, represent the main identified etiologies. Emerging technologies, such as next-generation sequencing, offer promising diagnostic perspectives, although their clinical application remains limited and mainly confined to research. Despite advances in medically assisted reproduction, the management of male infertility in Morocco continues to face psychosocial and economic barriers, as well as inequalities in access to care. These findings underscore the need to establish national registries, conduct multicenter studies, and facilitate the translation of innovations (particularly multi-omics approaches) into clinical practice to improve male infertility management in the Moroccan context. Full article

As survival rates among patients with gynaecological cancers continue to improve, fertility preservation has become an increasingly important aspect of comprehensive cancer care, particularly for younger women diagnosed during their reproductive years. The impact of treatment on fertility varies according to cancer type, stage, and modality, necessitating individualised preservation strategies. Fertility preservation is both feasible and safe in carefully selected patients with early-stage gynaecological cancers. Oocyte and embryo cryopreservation remain the most widely accepted techniques, particularly when time allows for ovarian stimulation. Fertility-sparing surgeries, such as radical trachelectomy and conservative management of early endometrial cancer, have shown promising oncological and reproductive outcomes. However, barriers including access, timing, and awareness continue to limit broader implementation. In modern society, fertility-preserving strategies should form an integral part of treatment planning for reproductive-aged women with gynaecological malignancies. Early referral to a fertility specialist, patient-centred counselling, and a coordinated multidisciplinary approach are essential to optimise both oncological and reproductive outcomes. Further research and education are required to refine guidelines and expand access to fertility-preserving care. This review presents the current fertility preservation options available to women with gynaecological cancers, including cervical, ovarian, and endometrial malignancies, and highlights the importance of early multidisciplinary intervention in delivering personalised care. Full article

Background: Bushfire smoke exposure (BFSE) is associated with adverse pregnancy and neonatal outcomes; however, the specific impact of BFSE on pregnancies complicated by asthma is not well characterised. Methods: A retrospective cohort study analysed data from 22,166 pregnant women who gave birth in the Illawarra Shoalhaven region between January 2017 and December 2022. Women with asthma were identified by the ICD-10-AM code for asthma during hospital admission for birth. Exposure was defined using a fixed time-window assumption. Women were considered exposed to bushfire smoke if they experienced at least 4 weeks of their pregnancy between 25 October 2019 and 4 February 2020. Results: Prevalence of asthma in the total population was 8.31%. In the control cohort, outcomes for pregnant women with asthma were poorer than those without. Pregnant women with BFSE had increased odds of postpartum haemorrhage (OR 1.603; 95% CI 1.42–1.81), and decreased odds of gestational hypertension (OR 0.615; 95% CI 0.49–0.77), gestational diabetes mellitus (OR 0.703; 95% CI 0.63–0.79) and preterm birth (OR 0.813; 95% CI 0.67–0.98). Maternal asthma did not confound the relationship between BFSE and any of the primary study outcomes. Conclusions: This study emphasises the independent effects of asthma on pregnancy outcomes. The impact of BFSE on pregnant women with asthma remains unclear. Further research is needed to characterise the true effect of BFSE on pregnancies, uncomplicated and complicated by asthma. Full article

Background: In recent years, time-lapse incubators (TLs), which can maintain a stable culture environment, have been developed for use in in vitro fertilization (IVF) treatment. Methods: In this retrospective cross-sectional study, data from 1200 women who visited the Creation and Love fertility center between April 2021 and October 2023 were reviewed. Among them, the electronic medical records of 400 women aged 22–45 years who underwent IVF treatment were selected and divided into two groups according to the type of incubator used: 100 in the TL group and 300 in the conventional incubator (CI) group, to evaluate differences in embryo development. Among these participants, pregnancy outcomes were assessed in 150 women who underwent day 3 (cleavage-stage) fresh embryo transfer. Controlled ovarian stimulation was performed using a standard antagonist protocol. The primary outcome was a good embryo rate, and the secondary outcomes were the clinical pregnancy rate and live birth rate. Results: The mean age of the study population was 34.6 ± 5.4 years. The groups had similar good embryo rates (67.7% vs. 65.5%, p = 0.84), clinical pregnancy rates (49.0% vs. 52.0%, p = 0.86), and live birth rates (35.0% vs. 42.0%, p = 0.76). Furthermore, subgroup analyses showed that the live birth rate in women aged ≥ 35 years was higher in the TL group than the CI group (38.0% vs. 23.4%, p = 0.03). Conclusions: Based on the comparative analysis of live birth rates between women cultured using TLs and those using the CI during day 3 fresh-embryo transfer cycles, our study demonstrated a statistically significant increase in live birth rates among women ≥ 35 years in the TL group. Full article

Introduction: Ovarian tissue cryopreservation (OTC) has emerged as an important fertility preservation option for women and girls at risk of treatment-induced ovarian failure. However, long-term data on clinical utilization and reproductive outcomes remain limited. This study provides a 30-year regional overview of OTC practice in Western Sweden. Material and Methods: This retrospective observational cohort study included 60 patients who underwent OTC between 1995 and 2025 within a publicly funded regional fertility preservation program. Data on patient characteristics, indications, surgical approach, cryopreservation techniques, and reproductive outcomes were collected from medical records, tissue bank data, and fertility preservation registries. Results: Malignant diagnoses accounted for 51 cases (85%) of indications, most commonly hematologic malignancies and breast cancer, while 9 patients (15%) had benign conditions requiring gonadotoxic therapy. During follow-up, only one patient (1.7%) underwent ovarian tissue transplantation (OTT), resulting in recovery of endocrine function and a spontaneous twin pregnancy. Overall, 15 women (25%) achieved at least one pregnancy. Of these, 8 (13.3%) occurred spontaneously without prior transplantation, 4 (6.7%) were achieved through oocyte donation, 1 (1.7%) occurred after OTT, and 1 patient (1.7%) had both spontaneous and donor-egg pregnancies. Most women (45/60, 75%) had no documented pregnancy or fertility treatment during follow-up. Conclusions: Over three decades, OTC has been successfully implemented as part of a regional fertility preservation program. However, the low rate of tissue utilization and the predominance of spontaneous pregnancies highlight the gap between tissue preservation and clinical use. These findings underscore the need for improved patient selection, structured long-term follow-up, and individualized risk assessment to optimize the clinical impact of OTC. Full article

Background: Infertility is a growing global public health concern associated with reduced quality of life and increased anxiety and depressive symptoms across diverse populations. However, factors influencing mental health in women undergoing infertility treatment remain insufficiently understood. This study aimed to assess psychological distress and identify factors associated with anxiety and depression in women receiving infertility treatment. Methods: A cross-sectional study was conducted at a leading regional infertility referral center. Women with confirmed infertility were consecutively recruited during routine visits. Psychological distress was assessed using the validated Patient Health Questionnaire-4. Demographic, reproductive, and clinical data were collected from self-report and medical records. Associations of infertility duration and age with comorbidities and other demographic variables were evaluated using appropriate parametric and nonparametric tests, and correlations were examined using Spearman’s rank coefficient. Results: The mean age was 34.9 ± 5.9 years and the median duration of infertility was 3 years. Nearly half of participants had mild psychological distress (49.3%), while 16.7% and 2.7% had moderate and severe distress, respectively; 32% screened positive for anxiety and 17.3% for depression. Longer infertility duration was significantly associated with higher depressive symptom scores, whereas other demographic and clinical variables showed no significant associations. Conclusions: Psychological distress is highly prevalent among women with infertility, with depressive symptoms increasing with longer infertility duration. These findings highlight the need for routine psychological screening and integration of mental health support into infertility care in clinical practice and long-term treatment planning, emphasizing a comprehensive, patient-centered approach to reproductive medicine. Full article

Background/Objectives: Hyaluronic acid (HA) has been proposed as a physiological alternative to polyvinylpyrrolidone (PVP) for sperm immobilization during intracytoplasmic sperm injection (ICSI). This prospective sibling-oocyte study aimed to compare embryological outcomes and morphokinetic parameters between HA and PVP. Methods: A total of 811 sibling-oocytes from 51 ICSI cycles were allocated to the HA group (SpermCatch; n = 377) or the PVP group (10% PVP Solution; n = 434). Fertilization outcomes, cleavage, blastocyst formation, and good-quality embryo development were assessed. Embryo morphokinetic parameters (t2–tB) and an AI-derived embryo score were analyzed in a subset of blastocysts with available time-lapse data. Results: The fertilization rates were comparable between the HA and PVP groups (80.9% vs. 85.3%, p = 0.25), as were the cleavage rates (99.0% vs. 97.0%, p = 0.27). However, the HA group had significantly lower rates of good-quality cleavage-stage embryos (33.4% vs. 47.9%, p < 0.01), blastocyst formation (52.3% vs. 69.9%, p < 0.01), and good-quality blastocysts (49.4% vs. 64.1%, p < 0.01). Morphokinetic timings did not differ significantly, whereas embryos in the HA group showed lower AI scores than those in the PVP group (p = 0.04). Conclusions: In this prospective sibling-oocyte cohort, HA-based sperm immobilization did not improve embryological outcomes compared with conventional PVP-assisted ICSI. Differences observed at the blastocyst stage should be interpreted cautiously and require confirmation in larger, randomized studies with clinical follow-up. Full article