Search Results (434)

The Breast Cancer (BRCA) genes play an important role in repairing double-strand deoxyribonucleic acid (DNA) breaks. Mutations in these genes are associated with the development of malignancies, most notably breast and ovarian cancer. Carriers of these mutations are often faced with issues that have serious implications for their reproductive choices, including the occurrence and treatment of breast or ovarian cancer, recommendations for preventive mastectomy and salpingo-oophorectomy, and the risk of transmitting the BRCA gene mutation to an offspring. These issues often lead to the search for methods of fertility preservation or assisted reproduction. This review aims to highlight and explain all the ways in which BRCA gene mutations affect fertility in women. Specifically, the effect of BRCA carriage is assessed at the molecular, histological, clinical, and laboratory levels. Next, fertility preservation methods in carriers are analyzed and evaluated in terms of their safety and effectiveness. In addition, the effect of systemic therapies for breast cancer on ovarian reserves is explained. Finally, the possibility of preimplantation diagnosis of BRCA gene carriage is also examined. Full article

In vitro capacitation of boar spermatozoa remains highly variable among laboratories due to differences in media composition, incubation conditions, and previous semen handling. Since capacitation is a dynamic process, identifying how different media modulate specific sperm responses over time is crucial to improving the standardization of porcine in vitro fertilization protocols. This study evaluated the temporal dynamics of membrane lipid disorder, acrosomal integrity, mitochondrial activity, and motility patterns in response to different media. Commercial boar semen doses were centrifuged and resuspended in a non-capacitating control solution or in three capacitation media differing mainly in bicarbonate, caffeine, and energy substrate composition, and evaluated every 15 min using flow cytometry and computer-assisted semen analysis at 38 °C for up to 2 h. Media containing higher bicarbonate and caffeine concentrations induced rapid membrane lipid destabilization and increased acrosomal exocytosis during the initial incubation period. Subsequently, these changes were accompanied by a more rapid decline in cell viability over time. In contrast, the medium containing lower bicarbonate together with lactate and pyruvate preserved higher viability, mitochondrial activity, and a more sustained, linear movement pattern (higher linearity and straightness). Interestingly, training-associated responses were detected immediately at time 0, suggesting that semen storage conditions may prime spermatozoa before incubation. Overall, medium composition and pre-treatment handling conditions should both be considered when standardizing porcine reproductive technologies. Full article

Background: Koalas are a vulnerable marsupial species with unique reproductive traits. Efforts to develop assisted breeding technologies have been hindered by a limited understanding of maternal recognition of pregnancy and physiological changes induced by the foeto-placental unit. Differences in the reproductive physiology of pregnant and non-pregnant koalas were examined to investigate the possibility of maternal recognition and identify potential pregnancy and/or embryonic loss biomarkers. Methods: Koalas were separated into three groups: pregnant (n = 4 cycles from three females), mated but non-parturient (n = 4 cycles from three females), and gonadotropin-releasing hormone (GnRH) agonist-treated females (n = 7). Plasma was collected on day of mating/GnRH injection (D0) and on multiple subsequent days. Progesterone concentrations were measured by enzyme immunoassay, and plasma proteomes were analysed using filter-aided sample preparation followed by liquid chromatography-tandem mass spectrometry (LC-MS/MS), employing sequential window acquisition of all theoretical fragment ion spectra. Results: Ovulation induction mechanisms influenced peri-ovulatory progesterone secretion (pregnant 40.7 ± 3.3 ng/mL vs. GnRH-treated 15.7 ± 1.8 ng/mL), with no significant differences in progesterone that occurred later in the luteal phase. LC-MS/MS identified 158 proteins, representing the first koala plasma proteome. Leucine-rich alpha-2-glycoprotein (LRG1) was significantly elevated at D2 in pregnant females compared to GnRH-treated females, and pregnant D9 and D19. In pregnant females, fibronectin (FN1) was significantly more abundant at D19 compared to D9 but not significantly different between treatments. Conclusions: These preliminary findings provide foundational data for further investigation into maternal recognition and pregnancy/embryonic loss in koalas. Full article

The widespread adoption of in vitro fertilization (IVF) has profoundly transformed the management of infertility and established IVF as the most effective assisted reproductive technology for many clinical indications. Nevertheless, intrauterine insemination (IUI) remains widely used because of its lower invasiveness, reduced treatment burden, lower costs, and broader accessibility. The contemporary role of IUI in an IVF-dominated era remains a subject of ongoing debate. This narrative review aims to critically evaluate the current role of IUI in modern reproductive medicine by examining its clinical indications, effectiveness, limitations, cost-effectiveness, and patient-centered implications in comparison with IVF. A narrative review of the literature was conducted using PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar. Relevant studies, systematic reviews, meta-analyses, randomized controlled trials, and international guidelines published primarily between 2010 and 2025 were identified and synthesized. Particular attention was given to recommendations from the European Society of Human Reproduction and Embryology (ESHRE) and the American Society for Reproductive Medicine (ASRM). Current evidence supports the use of IUI, particularly when combined with ovarian stimulation, as an appropriate first-line treatment in selected couples with unexplained infertility, mild male-factor infertility, and minimal-to-mild endometriosis. Although IVF generally provides higher live birth rates per treatment cycle and remains the preferred option for several infertility diagnoses, IUI continues to offer meaningful clinical benefits in appropriately selected patients. Beyond effectiveness, treatment decisions should also consider cost-effectiveness, accessibility, treatment burden, safety, and patient preferences. Recent evidence increasingly supports individualized and prognosis-based approaches to fertility treatment selection. Evidence also highlights the importance of female age, infertility duration, and ovarian reserve in determining the relative benefit of IUI versus IVF. Despite the clinical dominance of IVF, IUI remains an evidence-based and clinically relevant component of contemporary fertility care. Rather than being viewed as competing interventions, IUI and IVF should be considered complementary treatment options within a personalized infertility management strategy. Appropriate patient selection, particularly considering female reproductive prognosis, remains essential to maximize reproductive outcomes while minimizing treatment burden and healthcare costs. Full article

Background: Sperm DNA fragmentation (SDF) is increasingly recognized as a clinically relevant marker of male reproductive potential and has been associated with impaired embryo development, miscarriage, and suboptimal assisted reproductive technology outcomes, particularly in selected infertile populations. Because conventional sperm-preparation methods do not directly target molecular sperm damage, combined selection strategies such as density gradient centrifugation (DGC) and annexin V-based magnetic-activated cell sorting (MACS) have been proposed to enrich spermatozoa with improved DNA integrity before intracytoplasmic sperm injection (ICSI). Regardless of their more favorable functional characteristics, the optimal sequence for combining these methods remains uncertain. Methods: This study presents a hybrid analysis combining a structured review of 25 published studies with original prospective observational laboratory data. The review examined the effects of DGC, MACS, and sequential combined protocols on SDF, conventional semen parameters, and reported assisted reproduction outcomes, with particular attention to the unresolved question of sequencing order. In parallel, a blinded observational cohort of 67 infertile men with baseline SDF of at least 30% underwent sequential DGC followed by MACS, with SDF measured before and after processing using the sperm chromatin dispersion test (Halosperm ^® assay). Results: Across the reviewed literature, combined DGC/MACS approaches generally reduced SDF more than single-step preparation, although the magnitude of benefit varied across assays, patient populations, and laboratory protocols. Some studies also reported improvements in embryo quality and pregnancy-related outcomes, but these data were derived mainly from retrospective or small comparative cohorts, and no large randomized head-to-head trials were identified comparing DGC→MACS with MACS→DGC for fertilization, miscarriage, or live-birth outcomes. In the observational cohort, DGC→MACS was associated with a significant mean absolute SDF reduction of 19.42% +/− 9.4% (p < 0.0001). Most patients (85.1%) achieved post-treatment SDF values below the 30% threshold. Conclusions: Combined DGC/MACS sperm preparation, supported by the data in our study sequence, appears promising for reducing SDF in selected infertile men, particularly those with elevated baseline SDF. However, the optimal sequencing strategy and its impact on major reproductive endpoints remain uncertain and require better standardized comparative clinical studies. Full article

Yaks are a distinctive livestock species native to the Qinghai–Tibet Plateau. However, the low in vitro maturation rate of their oocytes significantly limits the efficiency of assisted reproductive technologies. Curcumin (CUR), known for its bioactive functions, including antioxidant and anti-inflammatory properties, suffers from low water solubility and bioavailability, which restricts its practical applications. This study aimed to develop a curcumin-loaded bovine milk-derived exosome nanodelivery system (CUR-mEXOs) and investigate its effects on the in vitro maturation of yak oocytes and the embryonic development of parthenogenetic embryos, leveraging its natural biocompatibility and targeted delivery properties. The results indicated that the isolated mEXOs exhibited typical exosome morphology and nanoscale particle size characteristics and were effectively internalized by the oocytes. During in vitro maturation, treatment with 10 μM CUR produced optimal outcomes. Compared to free CUR, CUR-mEXOs significantly enhanced the cumulus expansion index and the rate of first polar body expulsion, reduced intracellular ROS accumulation and mitochondrial superoxide levels, and improved mitochondrial function and spindle morphology, while simultaneously upregulating the expression of factors related to mitochondrial autophagy and oocyte maturation. Following intervention with the mitochondrial autophagy inhibitor CsA, the promotive effect of CUR-mEXOs was significantly diminished, leading to increased blastocyst apoptosis and a decrease in the total cell count. In summary, CUR-mEXOs can enhance the quality of in vitro maturation of yak oocytes and their embryonic developmental capacity following parthenogenesis by regulating mitochondrial autophagy. This study established an experimental foundation for optimizing the in vitro maturation system of yak oocytes and developing strategies for the delivery of natural bioactive substances. Additionally, this study provides a theoretical basis for enhancing the efficiency of assisted reproductive technologies in yaks. Full article

Assisted reproductive technology (ART) is increasingly utilized worldwide, yet concerns remain regarding its potential association with breast and gynecological malignancies and the safety of fertility-preservation strategies in cancer survivors. Ovarian stimulation exposes women to supraphysiologic hormone levels, raising questions about cancer risk, particularly for hormone-sensitive tumors. Current evidence, however, is largely reassuring. Registry-based studies and meta-analyses demonstrate no consistent increase in breast or endometrial cancer following ART, although endometrial cancer risk remains inconclusive despite large new cohorts. Cervical cancer has not been linked to ART exposure. For ovarian cancer, risk appears primarily driven by underlying infertility, parity, and endometriosis rather than ART itself, and no excess risk is observed among BRCA mutation carriers. In parallel, fertility preservation (FP) has become an integral component of gynecologic oncology care for reproductive-aged women. Strategies including cryopreservation of oocytes, embryos, or ovarian tissue, as well as fertility-sparing surgery or hormonal therapy, can be safely pursued in carefully selected early-stage cancers. Pregnancy and livebirth rates vary by diagnosis: outcomes are favorable after breast and cervical cancers, more limited in endometrial cancer due to endometrial receptivity challenges, and possible but less predictable in ovarian cancer, where stage and histology guide feasibility. Available observational evidence does not suggest a clear increase in recurrence risk among carefully selected patients, although evidence remains limited and long-term follow-up is needed. Overall, current data suggest ART is safe when individualized to patient and tumor characteristics, highlighting the importance of proactive fertility counseling, modified stimulation protocols, and multidisciplinary care to optimize oncologic and reproductive outcomes. Full article

Polycystic ovary syndrome (PCOS), newly named as Polyendocrine Metabolic Ovarian Syndrome (PMOS) is the most common endocrinopathy affecting women of reproductive age, which often leads to infertility due to anovulation and poor oocyte quality. Poor oocyte quality is a major reason for women’s infertility in humans and a barrier to efficient assisted reproduction technology (ART) treatment. Supplementation of melatonin, a free radical scavenger, has been reported to show satisfactory results in women undergoing ART. This review investigates whether the endogenous melatonin or supplementation of melatonin impact on oocyte/embryo quality and pregnancy rate in PCOS patients undergoing ART treatment. Articles published between 2010 and 2025 were reviewed to perform a comprehensive search on observational studies and clinical trials that evaluated the use of melatonin in PCOS patients undergoing in vitro fertilization (IVF) or intrauterine insemination (IUI) or intracytoplasmic sperm injection (ICSI). The databases searched included PubMed, Google Scholar, Science Direct, and Cochrane Library. This systematic review indicates that the group that received melatonin had significantly higher clinical pregnancy probabilities than the control group. Similarly, the melatonin administration significantly enhanced the endometrium thickness (p < 0.001) and the chemical pregnancy rate (30% versus 18%, p = 0.012). Additionally, in comparison to the control group that received metformin alone, the group that received melatonin (3 mg) significantly increased the proportion of top-quality embryos (40.3% vs. 29.9%; p < 0.001). According to this systematic review, melatonin significantly improves endometrial thickness, mature oocytes, high-quality embryos, and pregnancy rates, all of which improve ART outcomes in PCOS patients. Because of its safety, affordability, and efficacy, it is a useful supplement to ART procedures. The most popular and well-tolerated dosage is still 3 mg per day, despite variations in research. Full article

Infertility is a complex health issue that extends beyond biological mechanisms, encompassing significant psychological, relational, and social aspects. Advances in assisted reproductive technologies have improved the chances of conception, yet many couples discontinue treatment due to stress, stigma, and reduced quality of life. This narrative review explores the role of rehabilitation as a complementary approach to conventional fertility care, highlighting psychological, physical, and integrated interventions. Psychological rehabilitation strategies, such as cognitive behavioral therapy, mindfulness-based interventions, and couple-focused counseling, have been shown to reduce anxiety and depression, improve coping, and, in some cases, support better adherence to fertility treatments. Physical rehabilitation approaches, including pelvic floor muscle training, structured exercise for women with polycystic ovary syndrome, lifestyle and fitness interventions for men, yoga, and sexual rehabilitation, contribute to reproductive health, reduce pain, and enhance intimacy. Integrated models that combine psychological and physical components show the greatest promise, as they address the interaction between stress, physical function, and reproductive outcomes. Overall, the evidence suggests that infertility care should not focus solely on achieving conception. Rehabilitation offers opportunities to strengthen emotional resilience, improve sexual health, and support relationship stability, ensuring that patients benefit not only medically but also in terms of long-term well-being and quality of life. Full article

Background/Objectives: Oxidative stress is a major cause of impaired oocyte quality and early embryo development, a challenge that still needs to be addressed in assisted reproduction. Mesenchymal stem cell secretomes have been investigated as cell-free therapeutics with antioxidant activity and relevant anti-apoptotic effects. This study aimed to evaluate the effects of human amniotic membrane-derived mesenchymal stem cell-conditioned saline (AMSC-CS) as an injectable formulation on oxidative stress–related markers in ovarian tissue and preimplantation developmental outcomes. Methods: AMSC-CS was administered intravenously to female mice in a dose-dependent manner. Safety assessments were conducted to evaluate systemic and target organ toxicity within the dosage range. In vitro fertilization (IVF) outcomes and oxidative status in ovaries, oocytes, and embryos were evaluated following treatment with low, medium, and high doses of AMSC-CS (1, 3, and 5 μL/g). Results: As an injectable formulation, the safety assessments did not reveal systemic or target organ toxicity of AMSC-CS within the dosage range. Medium-to-high doses of AMSC-CS improved the expression of folliculogenesis-related genes and decreased oxidative stress and apoptosis signaling in ovarian tissue. At the high dose, AMSC-CS promoted preimplantation embryo development to the blastocyst and hatched blastocyst stages, along with improved blastocyst quality and reduced oxidative stress in oocytes and blastocysts. Conclusions: These findings suggest that AMSC-CS at medium-to-high doses, as an injectable formulation with antioxidant activity, may be a promising adjunct for assisted reproductive technologies. Full article

Nili-Ravi buffalo is a core dairy breed for China’s genetic improvement, yet its assisted reproductive technologies are restricted by low ovum pick-up (OPU) efficiency and unstable embryo transfer (ET) pregnant rates. This study established statistically optimized key parameters for OPU procedures in Nili-Ravi buffalo, and evaluated the effects of multiple ET-related protocols. For OPU, 50–55 mmHg vacuum pressure balanced oocyte recovery and usable rate best (p < 0.05). Young and adult buffalo performed significantly better than prepubertal heifers (p < 0.05). Four consecutive weekly consecutive OPU sessions did not significantly reduce oocyte yield (p > 0.05). FSH treatment markedly enhanced oocyte quantity, quality and recovery efficiency (p < 0.05), with no significant difference between two FSH protocols (p > 0.05). For ET, three estrus synchronization protocols showed no significant effects on estrus, ovulation, transferable recipient and pregnant rates in breeding or non-breeding seasons (p > 0.05), though optimized protocols showed a numerical improvement. Combinations of CL grade and embryo quality, as well as post-transfer treatments with vitamin ADE, hCG and progesterone, did not significantly affect pregnancy or early abortion rates (p > 0.05). This study built a practical reference framework for OPU-ET procedures in Nili-Ravi buffalo, with key OPU parameters statistically optimized and ET protocols showing numerical improvements that require further validation with larger sample sizes. Full article

Background/Objectives: Infertility is a multifactorial condition influenced by both medical factors and lifestyle-related determinants, including diet quality and nutritional supplementation. However, it is unclear which dietary patterns are optimal for women requiring assisted reproductive technology (ART). This study had two main objectives: (1) to assess dietary habits and the prevalence of nutritional supplementation among women with fertility disorders preparing for in vitro fertilization (IVF); (2) to develop, based primarily on a review of the scientific literature, a nutritional protocol to support women undergoing assisted reproductive procedures. Methods: A cross-sectional study was conducted among 61 women undergoing IVF treatment. Diet quality was assessed using the original ProFertiMed score (food-based score). Data regarding supplementation practices, anthropometric characteristics, and the number of IVF attempts were collected using a structured questionnaire. Statistical analyses (Chi-square test) were performed to evaluate associations between diet quality, supplementation practices, and clinical outcomes. Results: Only 8% of the respondents demonstrated a high level of dietary adherence according to the ProFertiMed score, suggesting that nutritional intervention should be implemented in the remaining 92% of women. Dietary supplement use was highly prevalent (95%), with participants taking a mean of 7 ± 4 supplements (range: 1–17). No statistically significant association was observed between diet quality assessed using the ProFertiMed score and the number of IVF attempts (Chi-square test, p = 0.85). Conclusions: The ProFertiMed score appears to be a promising tool for assessing diet-related factors in the context of assisted reproduction and may be particularly valuable when applied at the time of female infertility diagnosis, allowing for the early identification and modification of dietary factors that may affect reproductive outcomes. The proposed protocol, which is primarily based on the scientific literature, outlines key aspects of supportive nutritional management that may contribute to preconception preparation; however, its potential impact on IVF outcomes has not yet been empirically confirmed and should be evaluated in future studies. Therefore, further refinement and validation are required before its implementation in clinical practice. Full article

The hallmark feature of empty follicle syndrome (EFS) is failure to retrieve oocytes from apparently mature follicles despite adequate ovarian stimulation and appropriate ovulation triggering. Although considered uncommon, with a reported prevalence ranging from 0.2% to 7%, EFS may have a profound clinical and psychological impact and can recur in assisted reproductive technology (ART) cycles. Modern classification systems divide EFS into genuine and false forms. Genuine EFS is potentially associated with intrinsic abnormalities involving luteinizing hormone/choriogonadotropin receptor (LHCGR) signaling, oocyte competence, and cumulus–oocyte interaction, whereas false EFS is primarily attributed to pharmacokinetic or pharmacodynamic factors resulting in inadequate trigger exposure. Borderline EFS represents a third phenotype characterized by incomplete or partial impairment of final oocyte maturation. This review examines the pharmacodynamics of ovulation-triggering agents, including human chorionic gonadotropin (hCG), gonadotropin-releasing hormone (GnRH) agonist protocols, and dual-trigger strategies, and their roles in regulating final oocyte maturation. The molecular aspects of periovulatory signal transduction and the mechanisms of LHCGR activation, epidermal growth factor (EGF)-like pathways, and meiotic resumption in relation to EFS etiopathogenesis will be described. The impact of patient-dependent conditions like obesity, poor ovarian reserve, polycystic ovary syndrome (PCOS), and pituitary response on trigger response will be assessed. New approaches like post-trigger monitoring of hormones and rescue treatment with gonadotropins represent a valuable method for avoiding cycle cancellation in patients at risk. Overall, EFS is increasingly regarded not as a single disorder but as a heterogeneous spectrum of periovulatory dysfunction arising from pharmacological, endocrine, and intrinsic ovarian factors that impair completion of final oocyte maturation. Full article

Miscarriage is a common adverse reproductive outcome, and recurrent pregnancy loss (RPL) remains a major challenge in reproductive medicine. Despite advances in genetics, immunology, endocrinology, and endometrial biology, many RPL cases remain unexplained. Conventional statistical approaches may be limited in capturing high-order nonlinear interactions among clinical, imaging, immunological, and molecular factors associated with pregnancy loss unless these interactions are explicitly modeled. Artificial intelligence (AI), including machine learning (ML) and deep learning (DL), has therefore been investigated as a potential framework for reproductive risk prediction and patient stratification. This narrative review summarizes current evidence on AI-based prediction of miscarriage and RPL, with emphasis on its possible translational relevance to infertility treatment and assisted reproductive technology (ART). Clinical data-driven models have shown potentially useful discriminatory performance, while biomarker-integrated ML approaches suggest that immune-inflammatory signatures may contribute to risk estimation. Imaging-based AI, including radiomics from multimodal ultrasound, may also support noninvasive assessment of endometrial receptivity and inform embryo transfer planning. In parallel, the broader ART literature suggests increasing interest in AI for embryo selection, embryology laboratory workflow, and ovarian stimulation prediction. However, the evidence remains limited by retrospective study designs, small datasets, inconsistent RPL definitions, inadequate external validation, and concerns regarding interpretability, fairness, and regulation. Further progress will require multimodal, explainable, and prospectively validated systems linked to clinically meaningful outcomes. AI may ultimately support more individualized reproductive care, but routine clinical implementation remains premature. Full article

Assisted reproductive technologies (ART), particularly in vitro fertilization (IVF), are characterized by substantial emotional burden, uncertainty, and repeated decision-making under probabilistic conditions. Although psychological distress is common among individuals and couples undergoing ART, psychosocial care remains inconsistently integrated into fertility pathways and is rarely tailored to individual needs. This narrative review synthesizes evidence concerning infertility-related distress, anxiety and depressive symptoms, couple functioning, treatment discontinuation, psychosocial screening, and psychological interventions across the IVF trajectory. Key phases of treatment, including pretreatment assessment, ovarian stimulation, embryo transfer, the waiting period, cycle outcome, and decisions regarding repetition or discontinuation, are described, and phase-specific psychological vulnerabilities are identified. On the basis of the available literature, we propose a conceptual stepped-care framework ranging from universal psychoeducation and routine monitoring to structured psychological interventions, couple-based care, and specialist psychiatric management. Practical screening thresholds, referral criteria, reassessment intervals, and a safety pathway for suicidal ideation are outlined. Particular attention is given to male-factor infertility, strategies for engaging male partners, and the ethical and data-governance requirements of digital mental health tools. Current evidence supports psychosocial interventions for improving emotional well-being and quality of life and suggests a potential role in treatment continuation, but their effects on pregnancy and live-birth outcomes remain uncertain. The proposed framework should therefore be regarded as a clinically informed conceptual model rather than a validated prediction algorithm. Prospective studies are required to assess its feasibility, predictive performance, cost-effectiveness, and impact on patient-centered outcomes. Full article