Search Results (524)

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

The endometrial microbiome has been implicated in implantation success, and intrauterine peripheral blood mononuclear cell (PBMC) therapy has been proposed to improve endometrial receptivity; however, its effects on the endometrial microbial environment remain poorly understood. This prospective study evaluated changes in endometrial microbiome composition following PBMC therapy in 26 in vitro fertilization (IVF) patients. Paired endometrial biopsies were collected before and after intrauterine administration of autologous PBMCs, and 16S rRNA gene sequencing (V4–V5 region) was performed. Microbiome composition was analyzed at genus and species levels, and alpha and beta diversity metrics were compared between paired samples. No significant changes in microbial composition or diversity were observed across the entire cohort following treatment. However, patients with lower baseline Lactobacillus abundance exhibited greater microbiome responsiveness, showing larger increases in Lactobacillus after treatment. This association remained significant after adjustment for age and BMI (ρ = −0.457, p = 0.019; β = −0.367, p = 0.047). Moreover, subgroup analysis identified two distinct response patterns based on Lactobacillus dynamics: a Lactobacillus-increase group (n = 14) and a no-increase group (n = 12). Baseline Lactobacillus dominance (LD: >90% relative abundance) was less frequent in the increase group (14%) than in the no-increase group (50%). In Lactobacillus-increase patients, the median relative abundance rose from 17.6% to 95.5% (p < 0.001), 64% achieved LD, and Shannon and Simpson diversity indices decreased significantly (p = 0.04 and p = 0.02, respectively). In the no-increase group, Lactobacilli remained the most abundant taxon, and the diversity indices were unchanged following treatment. These findings suggest that baseline endometrial microbiome composition may influence responsiveness to PBMC therapy and could support future patient stratification strategies in IVF treatment. Whether these microbiome changes translate into improved clinical outcomes requires evaluation in future studies. 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

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

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

Background/Objectives: Infertility is an important public health problem. It is the source of considerable psychological load, negatively affecting the quality of life, social relations, and psychological health. Stress in infertility plays the role of both a risk factor and a consequence of reproductive disorders, exerting an effect through hormonal, inflammatory and oxidative mechanisms, which may reduce the effectiveness of treatment. The aim of the study is assessment of the frequency of occurrence of depression, anxiety, and stress in infertile women. Methods: The study included 300 women treated due to infertility, and 50 women in the control group. The evaluation was carried out using an author-constructed socio-demographic questionnaire and the Depression Anxiety Stress Scales-42 (DASS-42) for the measurement of depression, anxiety, and stress. In addition, selected hormones were determined in blood serum. Results: Hormonal analysis showed significantly higher levels of prolactin (PRL) in women treated due to infertility, especially in the group without the use of assisted reproductive technology (non-ART), whereas higher levels of the follicle-stimulating hormone (FSH), and luteinizing hormone (LH) were noted in the control group. The level of anti-mullerian hormone (AMH) was lower in the therapeutic group, with no differences observed between the methods of treatment, and the levels of thyroid-stimulating hormone (TSH) did not differ between groups. Psychological evaluation according to the DASS-42 showed a significantly higher intensity of depression, anxiety, and stress in patients treated due to infertility, this intensity being the highest in the in vitro fertilization (IVF) group. Weak, but significant, correlations were found between PRL, FSH and LH, and the intensity of the symptoms of depression, anxiety, and stress, and the overall result according to the DASS-42. Conclusions: Infertile women experienced higher levels of depression, anxiety, and stress, compared to fertile women. The study suggests a relationship between the level of psychological stress in persons treated for infertility, and their hormonal status. The study demonstrates that integration of psychological support and infertility treatment may bring about important benefits for psychological health and the quality of life of patients. Full article

The pineal gland regulates circadian physiology through the periodic production of melatonin (MLT). In addition to its established role as a chronobiotic agent, MLT regulates redox homeostasis and mitochondrial physiology. Mitochondria and redox-active molecules, particularly reactive oxygen species (ROS), play essential roles in reproduction, including gamete physiology, fertilization, and early embryonic development. Although excessive oxidative stress (OS) impairs fertility, controlled ROS signaling is necessary for normal reproductive function. This comprehensive review synthesizes current evidence regarding MLT as a key intermediary linking circadian signaling with mitochondrial physiology and redox homeostasis. We discuss molecular pathways through which MLT regulates mitochondrial function, including activation of the Nrf2 signaling pathway, modulation of mitochondrial permeability transition, regulation of electron transport chain (ETC) efficiency, and apoptotic signaling. Furthermore, this study investigates MLT’s ability to scavenge free radicals and activate antioxidant defense mechanisms. Moreover, we review novel findings regarding the effects of MLT in experimental animals and humans, assisted reproductive technologies (ART) such as in vitro fertilization (IVF), and consider the translational significance of the hormone as an enhancer of fertility. We also highlight gaps in the literature, including methodological inconsistencies, supraphysiologic doses, and insufficient data from large human cohorts. Lastly, we discuss an integrative model whereby MLT may function as an important regulator of mitochondrial redox balance, with potential implications for reproductive physiology and reproductive outcomes, and propose new avenues for investigation. Full article

Health tourism represents a dynamic sector operating at the intersection of medical services, international patient mobility, and tourism development. Despite its growing prominence, the academic literature frequently conflates health tourism with medical and wellness tourism—a conceptual ambiguity that complicates the establishment of robust, sustainable legal frameworks. Addressing this gap, the present paper conceptualizes health tourism as an overarching framework that encompasses recovery, wellness, and medical sub-sectors. Within this comprehensive paradigm, we explore the contemporary landscape of health tourism in Northern Cyprus through a stakeholder-driven qualitative lens. Utilizing a qualitative case study design, data were gathered via semi-structured interviews with 40 key respondents representing healthcare, travel, public administration, academia, and related professional domains, and subsequently subjected to thematic analysis using NVivo 15 software. The findings reveal that the sector in Northern Cyprus is heavily skewed toward medical tourism, with a concentrated focus on in vitro fertilization (IVF), cosmetic surgery, dental care, and bariatric procedures. Conversely, wellness and rehabilitation tourism remain largely untapped strategic niches. The analysis further indicates that sectoral growth is constrained by structural bottlenecks, including fragmented governance, limited international recognition, transport and accessibility barriers, inadequate accreditation systems, lack of stakeholder synergy, and ethical concerns regarding advertising and patient safety. Moving beyond standard environmental sustainability, this research underscores that long-term destination resilience requires ethical governance, clinical quality controls, patient-rights advocacy, transparent legal frameworks, and community-level economic integration. Ultimately, this study proposes an integrated, stakeholder-centric paradigm tailored to the unique socio-political and structural realities of Northern Cyprus, offering actionable policy recommendations that enrich the discourse on sustainable medical tourism from a small-island perspective. Full article

Advanced maternal age is a significant social and clinical issue associated with the natural decline in a woman’s ovarian reserve. This prospective, single-center study included women with primary infertility who presented to the Gyncentrum Clinic in Katowice and analyzed 77 ovarian follicles. The study group consisted of patients of advanced reproductive age with diminished ovarian reserve, who underwent hormonal stimulation in preparation for oocyte retrieval. Each metaphase II (MII) oocyte was fertilized in vitro and cultured individually in a time-lapse incubator. Follicular fluid obtained during oocyte retrieval was collected separately from each follicle and used for non-invasive biochemical analysis of prognostic factors using a Multiplex assay. The concentrations of interleukin 10 (IL-10), granulocyte colony-stimulating factor (G-CSF), granulocyte–macrophage colony-stimulating factor (GM-CSF), and C-type natriuretic peptide (CNP) were evaluated. The analysis showed that lower concentrations of GM-CSF and CNP were associated with an increased probability of oocyte fertilization, whereas higher levels of IL-10 and G-CSF had the greatest impact on blastocyst formation. This model was supported by continuous embryo monitoring. An eightfold increase in the likelihood of blastocyst formation was observed when early embryo cleavage occurred between 25 and 27 h after insemination. Furthermore, prolonged duration of the first cytokinesis reduced the probability of blastocyst development, while an extended cell cycle at the two-blastomere stage significantly affected further embryo development. These findings may support non-invasive embryo selection strategies. Full article

Background: Women undergoing in vitro fertilization (IVF) often experience poor well-being. Social support and family resilience are considered protective factors, but their combined roles in the anxiety–fertility-related quality of life (FertiQoL) relationship remain unclear. Design: A cross-sectional study was conducted with women undergoing IVF at the reproductive medicine department of a tertiary hospital in Shanghai, China, between March and December 2024. Methods: Participants completed validated measures of anxiety, social support, family resilience, and QoL. Associations and indirect effects were examined using mediation analysis, and sensitivity analyses were conducted. Results: A total of 419 women participated in the study (response rate = 98.6%; mean age = 33.3 ± 4.7 years). Anxiety was negatively associated with social support, family resilience, and FertiQoL (all p < 0.001). The total indirect association between anxiety and FertiQoL involving social support and family resilience was statistically significant (B = −0.15, p = 0.03). However, the specific indirect effects, including the hypothesized sequential pathway through social support and family resilience, were not statistically significant. The total association between anxiety and FertiQoL was significant (β = −0.32, p < 0.001). Conclusions: Anxiety was associated with poorer FertiQoL among women undergoing IVF. Although the findings suggest an overall indirect association involving social support and family resilience, the hypothesized sequential mediation pathway was not supported. Therefore, the results should be interpreted cautiously, and longitudinal studies are needed to clarify the temporal and causal relationships among these psychosocial factors. Full article

Background and Objectives: The optimal oocyte yield in gonadotropin-releasing hormone (GnRH) antagonist in vitro fertilization (IVF) cycles remains debated, and data specific to antagonist protocols are limited. This study evaluated the discriminative and independent predictive performance of oocyte count for clinical pregnancy in GnRH antagonist IVF cycles. Materials and Methods: This retrospective cohort included 1171 women undergoing their first GnRH antagonist IVF cycle with fresh embryo transfer at a single tertiary center (September 2007–December 2021). The primary outcome was an institutional composite pregnancy outcome (sustained β-hCG positivity with subsequent ongoing intrauterine pregnancy or live birth; biochemical and ectopic pregnancies were negative). Patients were grouped by oocytes retrieved (1–5, 6–10, 11–15, ≥16). Performance was assessed with logistic regression, ROC with 2000-iteration bootstrap, integrated discrimination improvement (IDI), continuous net reclassification improvement (NRI), and restricted cubic spline. Predefined subgroup analyses by age, regimen, and antral follicle count tertile were performed. Results: A positive outcome occurred in 430 patients (36.7%). After adjustment, oocyte count was not an independent predictor (adjusted odds ratio 0.999, 95% CI 0.979–1.020; p = 0.96). The full model (AUC 0.564, 95% CI 0.529–0.598) did not outperform oocyte count alone (AUC 0.532; bootstrap p = 0.11). IDI (0.011) and NRI (0.135) were statistically detectable but clinically trivial. Spline regression showed no non-linearity (p = 0.47). Findings were consistent across subgroups, and the narrow confidence interval excluded per-oocyte effects ≥1.10. Conclusions: In GnRH antagonist IVF cycles, oocyte count showed weak discriminatory performance and was not independently associated with fresh-cycle pregnancy. Oocyte yield should be interpreted alongside—rather than as a substitute for—established parameters such as age and ovarian reserve. The principal clinical value of a higher oocyte response may lie in cumulative rather than fresh-cycle success. Live-birth outcomes were not available, and the source institution was permanently closed in 2025; these limitations define the boundary of inference. Full article

Objectives: Oocyte pick-up (OPU) is commonly performed under propofol-based sedation during in vitro fertilization (IVF). However, considerable interindividual variability in propofol requirement has been observed. Controlled ovarian hyperstimulation results in supraphysiological levels of ovarian steroid hormones, which may influence anesthetic sensitivity. This study aimed to evaluate the relationship between preprocedural serum estradiol and progesterone levels and propofol requirement during OPU performed under bispectral index (BIS)-guided sedation. Methods: In this prospective observational study, 96 women undergoing OPU were included. Serum estradiol and progesterone levels measured on the day of the procedure were recorded. Sedation was performed using a standardized protocol with midazolam, fentanyl, and propofol titrated to maintain BIS values between 40 and 60. Propofol consumption was normalized to body weight (mg/kg) and procedure duration (μg/kg/min). Correlation analyses and multivariable linear regression models were used to evaluate associations. Results: Mean propofol consumption was 157.3 ± 53.1 mg (2.41 ± 0.83 mg/kg), corresponding to an infusion rate of 125.7 ± 69.6 μg/kg/min. In multivariable analysis, estradiol levels were independently associated with propofol requirement (β = 0.238, p = 0.014), whereas progesterone levels were not significantly associated with anesthetic dosing after adjustment. BMI (β = −0.305, p = 0.002) and procedure duration (β = 0.224, p = 0.021) were also identified as independent predictors. Conclusions: Estradiol levels were associated with propofol requirement during OPU performed under BIS-guided sedation. However, given the observational design and the modest magnitude of the observed associations, these findings should be interpreted cautiously. BMI and procedure duration appeared to be more consistent predictors of propofol administration. Full article

Background and Objectives: Robotic-assisted tubal reanastomosis (RATR) remains a clinically relevant option for selected women seeking fertility after sterilization. In the era of IVF, surgical reversal continues to be discussed because it may restore the possibility of spontaneous conception rather than offering only cycle-dependent treatment. However, the available evidence on RATR is heterogeneous and derives predominantly from observational studies. The aim of this narrative review with a structured literature search was to synthesize the published evidence on the operative, reproductive, and economic outcomes of RATR and to contextualize its role in contemporary fertility counseling. Materials and Methods: A structured literature search of PubMed/MEDLINE, Scopus, and Google Scholar was performed from database inception to 20 December 2025. Data were synthesized descriptively without meta-analysis. Primary robotic clinical studies were interpreted separately from secondary and contextual publications. Results: In total, 16 studies were included in our study. The evidence base comprised predominantly retrospective cohorts and case series; no randomized controlled trials were identified. Reported tubal patency endpoints in robotic cohorts ranged from 81.0% to 94.1%, although denominators differed across studies and were reported either per patient or per tube. Reported pregnancy outcomes ranged from 25% to 80%, reflecting substantial heterogeneity in patient selection, follow-up duration, and outcome definitions. When woman-level delivery or live-birth outcomes were explicitly reported, they were generally encouraging in selected series, although not uniformly defined. Estimated blood loss was usually minimal when reported, and conversion to laparotomy was uncommon. Any comparison with IVF was indirect because no contemporary head-to-head comparative studies were identified. Economic data were sparse, institution-specific, and methodologically heterogeneous. Conclusions: Available observational evidence suggests that RATR is a feasible minimally invasive option for fertility restoration in carefully selected women after sterilization. However, the evidence base remains limited by retrospective design, small cohorts, heterogeneous outcome reporting, variable follow-up, and indirect comparison with IVF. RATR should be considered within individualized fertility counseling rather than as a universal alternative to IVF. Prospective comparative studies with standardized outcome definitions, transparent reporting of prognostic factors, and robust economic evaluation are needed. Full article

Early mammalian embryos are highly sensitive to environmental, metabolic, hormonal, and genomic stress, yet embryo assessment during In Vitro Fertilization (IVF) relies largely on morphology and ploidy for embryo assessment, but these tests incompletely predict miscarriage. We present a transcriptomics based framework to classify and quantify lineage-specific stress in early embryos by benchmarking human preimplantation embryos against dose-, time-, and quality-dependent stress programs defined in Embryonic and placental Trophoblast Stem Cells (ESCs, TSCs) from the implanting blastocyst. Human embryos and stressed ESCs and TSCs are screened using transcriptomic markers from eleven biologically distinct stress Gene Ontology (GO) groups that define functional stress states and enable quantification of pathway presence and upregulation, pathway activity, and downstream outcomes. This framework determines whether the Integrated Stress Response (ISR), once initiated, resolves to enable the Developmentally Associated Stress Response (DASR). High-throughput screening (HTS) titrates stress to define increasingly risky yet biologically equivalent doses for levels of diminished stem cell growth across mechanistically diverse stressors. Then bulk RNA seq derives lineage specific transcriptomic markers putatively respond to common levels of diminished growth and that distinguish weak vs. strong stress and resolved vs. unresolved ISR. These stem cell transcriptomic signatures are applied to bulk RNA seq data from IVF embryos graded for morphology or adhesion, enabling quantitative inference of stress burden, lineage vulnerability, and developmental trajectory. Full article

Background/Objectives: Maternal intake of methyl-group donors (MGD) during pregnancy may influence fetal development, yet its role in in vitro fertilization (IVF) pregnancies remains poorly understood. The aim of the present study was to investigate maternal intake of MGDs during late pregnancy and its association with neonatal outcomes in IVF versus spontaneously (S) conceived pregnancies. Methods: We assessed third-trimester, daily maternal intake of MGD (folate, betaine, choline, methionine, and folic acid) using a validated food-frequency questionnaire, and maternal supplement intake using a structured questionnaire. Methyl-donor nutrient score (MDNS) was calculated based on deciles of MGD intake. Serum folic acid and vitamin B12 concentrations were measured using standardized immunochemical assay. Predefined inclusion and exclusion criteria were applied. Anthropometric data were measured from singleton newborns (weight, length, head- and waist circumference, body composition) and mothers (height, weight, body composition) after delivery. Statistical analysis was conducted using R (4.1.2v). Results: 265 mother–child pairs were included in the study (IVF n = 83). Daily dietary intake of MGDs was similar between groups, but IVF mothers reported significantly higher daily folic acid (668.7 ± 1050.9 vs. 418.8 ± 419.2 µg, p = 0.0034) and vitamin B12 (11.07 ± 31.58 vs. 7.95 ± 29.00 µg, p = 0.0078) supplementation. Serum analyses were available in a subgroup (n = 131, IVF n = 61) of mothers, showing higher postpartum folate (IVF: 10.96 ± 5.54 vs. S: 8.29 ± 4.72 µg/L, p = 0.0064) and vitamin B12 (IVF: 288.22 ± 113.82 vs. S: 233.70 ± 78.23 ng/L, p = 0.0053). Maternal daily dietary choline intakes were significantly below recommendations (IVF: 251.9 ± 98.5 mg, S: 243.8 ± 106.8 mg). Among 151 singleton neonates (IVF n = 57), anthropometric parameters did not differ between IVF and spontaneously conceived groups and were not associated with MDNS tertiles. Conclusions: Maternal MGD intake during third trimester of pregnancy was not associated with neonatal anthropometric outcomes in singleton pregnancies. Consistently low dietary choline intake highlights a potential nutritional gap warranting improved dietary guidance and supplementation strategies. Full article