Fertility patterns among women aged 30 years and above have undergone substantial changes in India, reflecting the country's ongoing demographic transition. However, evidence on the diversity and distribution of age-specific fertility across states and urban-rural settings remains limited. The study examines the diversity-index using age-specific fertility rates (ASFR) among women aged 30-49 years across 16 major Indian states and the Union Territory of Delhi, with particular focus on urban-rural differentials over five rounds of the National Family Health Survey (NFHS) from 1992-93 to 2019-21. Regional and temporal variations in fertility diversity were evident across India. Southern and western states indicates the lower diversity indices, representing more concentrated fertility patterns, whereas northern and eastern states, particularly Bihar, Uttar Pradesh, and Rajasthan, showed greater fertility heterogeneity. Urban areas consistently demonstrated lower fertility diversity than rural areas. Overall, most states experienced a decline in fertility diversity over time, reflecting increasing concentration of childbearing within specific age groups. The findings indicate that fertility beyond age 30 is becoming increasingly concentrated across India, although substantial regional and rural-urban disparities persist. These results highlight the need for region-specific reproductive health and family planning strategies and provide valuable evidence for understanding fertility transitions and informing demographic and women's reproductive health policies.
Obesity is a significant risk factor for female infertility, representing a growing global health concern. Body mass index (BMI) has traditionally been used as the standard measure of obesity; however, the weight-adjusted waist index (WWI) has recently appeared as a novel metric that may provide a more accurate assessment of obesity. This study aims to investigate the association of both BMI and WWI with female infertility. The "2015-2018 National Health and Nutrition Examination Survey" (NHANES) was utilized to derive the data. The study included 2393 women between the ages of 20 and 50 years. Among them, 251 were diagnosed with infertility. Multivariate logistic regression, subgroup analysis, interaction testing, smooth curve fitting, and receiver operating characteristic curve analysis were conducted to examine the associations of WWI and BMI with infertility. Among women, the infertility's prevalence was positively associated with both WWI and BMI levels. Higher WWI was significantly related with raised infertility prevalence (OR = 3.63, 95% CI: 1.96-6.73), as was higher BMI (OR = 2.27, 95% CI: 1.29-4.01). In the WWI subgroup analysis, the association was consistently observed in most subgroups, except for age, race, and education level. In the BMI subgroup analysis, the association was consistent across all subgroups. In the population-based cross-sectional data of this study, WWI and BMI were positively associated with the odds of infertility among US women. This finding suggests that obesity-related measures may have potential value in clinical practice and may help to identify potentially high-risk groups of women with infertility. In addition, the existing results suggest that weight management-related interventions may have potential effects on fertility outcomes, but whether they can reduce the infertility rate, explain the biological mechanism, and guide clinical decision-making needs to be verified by prospective, mechanistic, and interventional trials in the future.
Endometriosis is a common, chronic inflammatory condition characterized by the presence of endometrium-like tissue outside of the uterus that can impact fertility through multiple mechanisms. In this review, the diagnosis, classification, staging, and surgical management of endometriosis for fertility enhancement is discussed. Surgery for patients seeking to optimize fertility or for whom infertility is the only symptom is complex. In patients with superficial endometriosis, laparoscopy may enhance fertility for unassisted pregnancy, but current guidelines recommend against routine surgery prior to ART. In patients with deep endometriosis, surgical intervention depends on multiple factors, including patient age, ovarian reserve, fertility goals, and the presence of other infertility factors. While there may be potential improvements in fertility-related outcomes, this must be weighed against potential impacts to ovarian reserve. Surgical techniques that minimize damage to the ovaries, fallopian tubes, and uterus are essential when fertility is the goal. While there is increasing interest in regenerative therapies for treatment of endometriosis (e.g., stem-cell based therapies, platelet-rich plasma, or extracellular vesicles), these remain investigational and are not yet utilized clinically for fertility enhancement in patients with endometriosis.
To identify the specific support needs of Black women navigating infertility care and generate strategies to improve access, patient experience, and outcomes. Mixed-methods observational study SUBJECTS: Black women aged 18-45 years in the US who were currently seeking or had recently sought infertility care EXPOSURE: Online survey and semi-structured interviews MAIN OUTCOME MEASURE: Quantitative data on demographics and fertility care experiences; qualitative data on perceived support needs and recommended solutions RESULTS: 176 women responded to the online survey; of these, 41 women provided consent to participate in semi-structured interviews with the study team. Most participants (74.3%) were 35-45 years of age, married or partnered, held an advanced degree, worked full-time, and had insurance that covered some or all fertility services. 25.5% of participants reported feeling under-supported by friends, family, doctors, or others during their infertility journey, with 31.3% identifying this lack of support as a barrier to initiating treatment. Participants described feelings of loneliness and isolation, with few affirming spaces or communities to find resources and connect with other Black women with infertility. They also shared examples of racism, discrimination, and a lack of compassionate care that led to dismissal of health concerns and delays in referral to reproductive endocrinologists that complicated their infertility journeys. Study participants provided several suggestions for clinics and providers to improve the support of Black women seeking infertility care, from enhancing patient-centered care to increasing access to Black reproductive medicine and mental health providers. Understanding the specific support needs of Black women seeking infertility care will inform patient-centered, compassionate, and culturally responsive care that improves the patient's experience and outcomes.
Teenage pregnancy is a significant public health challenge that may contribute to cycles of poverty in the context of social inequality. In Latin America and the Caribbean, Ecuador ranks third in terms of fertility rates. The objective of this study is to describe temporal trends and territorial patterns of adolescent fertility in Ecuador between 2015 and 2024, differentiating early adolescents (10-14 years) and late adolescents (15-19 years), and identifying priority territories for public health monitoring. A descriptive observational study was conducted using anonymized databases from the National Institute of Statistics and Census (INEC). Fertility rates were calculated for two groups: early adolescents (10-14 years) and late adolescents (15-19 years). Data were analyzed by province, area of residence, and social variables. Monotonic temporal trends were assessed using the non-parametric Mann-Kendall test. The national fertility rate declined steadily, from 40.75 per 1,000 (95% CI: 40.44-41.08) in 2015 to 20.53 in 2024 (95% CI: 20.30-20.75). Despite this overall progress, geographic heterogeneity in fertility rates was observed, with the highest rates and slowest declines concentrated in Amazonian and Coastal provinces. Fertility rates remained consistently elevated among adolescents in early unions, those with lower educational attainment, and within Indigenous and Mestizo populations. Mann-Kendall analyses identified priority provinces with non-significant downward trends, particularly among early adolescents. The study identified declining adolescent fertility rates alongside persistent territorial disparities across Ecuador. Differences observed by province, age group, ethnicity, educational attainment, and early unions underscore the importance of complementing national indicators with disaggregated analyses. This perspective may contribute to a more nuanced understanding of adolescent fertility patterns and may guide territorial surveillance and public health planning.
Hereditary angioedema (HAE) is a rare, potentially life-threatening disorder caused by autosomal dominant mutations in the SERPING1 gene, leading to deficiency or dysfunction of C1 esterase inhibitor. Recent estimates of global HAE prevalence are 1.22 per 100,000 individuals. With total fertility rates (TFRs) decreasing worldwide, several developed countries are now well below the population replacement rate in an "ultra-low fertility" group. With the decrease in fertility, how rare diseases are approached should be re-examined. In this letter, we describe how continued and sustained declines in total fertility rate and population may influence the future number of new HAE cases. We also address disease-specific factors that may further influence future case count, including reproductive hesitancy related to autosomal dominant inheritance, estrogen-associated exacerbation of angioedema attacks, and potential fertility effects of complement dysregulation. These demographic considerations are relevant to clinicians, researchers, and pharmaceutical companies involved in HAE care. Better characterizing population changes in the context of reduced fertility rates may help inform long-term clinical planning and the development of novel therapies for HAE and other rare diseases.
Male infertility is significant, and part of it is associated with prenatal drug exposure. While prenatal glucocorticoid treatment is widely used, its long-term effects on male offspring fertility and the underlying programming mechanisms remain unclear. Based on a clinical-based PDE rat model (0.4 mg/kg dexamethasone, b.i.d.) during late pregnancy (gestational day 18-19), the fertility of male offspring was evaluated. Transcriptome sequencing was employed to identify potential targets. The epigenetic regulation of lysosomal protease Cathepsin L (CTSL) was analyzed using chromatin immunoprecipitation (Ch-IP) and co-immunoprecipitation (co-IP). Rescue experiments were performed using the TRPML1 agonist ML-SA1 and genetic CTSL overexpression to validate the signaling pathway. Multiple prenatal exposure models were used to verify the generalizability of this mechanism. The subfertility of PDE male offspring originated in the fetal period. Then, a specific autophagic flux blockade in spermatogonia was identified, and was driven by the persistent downregulation of CTSL. Mechanistically, the activated Glucocorticoid Receptor (GR) recruited Histone Deacetylase 6 (HDAC6) to the Ctsl promoter, leading to reduced H3K27 acetylation and subsequent transcriptional silencing. Importantly, reactivating lysosomal signaling via ML-SA1 or genetically restoring CTSL expression reversed the autophagic flux blockade and rescued fertility outcomes. Furthermore, this GR/HDAC6/CTSL axis might be a shared pathway underlying a subset of other glucocorticoid-related prenatal exposures. These findings provide potential intervention targets for the early prevention and treatment of fetal-origin male subfertility and offer a theoretical basis for guiding rational drug use and healthy lifestyles during pregnancy.
Transgender and gender-diverse (TGD) individuals face significant barriers to fertility preservation, yet existing guidance from ESHRE, ASRM, WPATH, and the Endocrine Society remains too general for translation into implementation-ready national pathways. This review synthesizes evidence on the reproductive effects of gender-affirming hormone therapy, clinical outcomes of fertility preservation in TGD populations, the intersection of neurodiversity and gender diversity, and the structural, interpersonal, and intrapersonal barriers to equitable reproductive care-translating this evidence into a trans-inclusive clinical pathway. We present TransFertility, a dysphoria-informed service model developed at Guy's and St Thomas' NHS Foundation Trust, London. Over 39 months, the model achieved a greater than 19-fold increase in referrals, 100% consultation attendance, over 90% treatment initiation, and 96.7% treatment completion, with no serious adverse events. The absence of a UK national pathway for trans-inclusive fertility preservation represents a critical equity gap. We propose that the evidence synthesized here, together with TransFertility's outcomes, provides a robust foundation for national consensus guideline development. This work's principal contribution is demonstrating that dysphoria-informed care can move from theoretical framework to functioning clinical reality: a reproducible, multidisciplinary pathway showing that structural redesign of administrative, clinical, and psychosocial components improves access, engagement, and treatment completion for TGD individuals.
Infertility can cause significant distress to women, increasing the risk of anxiety and depression. This systematic review examined the influence of self-compassion interventions on mental health and well-being among women experiencing infertility. The review was conducted in accordance with Joanna Briggs Institute (JBI) methodology and reported following PRISMA guideline. Databases searched included Medline, Embase, Ovid nursing database, Emcare, PsycINFO and Cochrane Library from inception to November 2024. Quality assessment was conducted using JBI critical appraisal tools. Title and abstract screening was conducted by three reviewers, and data extraction was performed independently by two reviewers. Sixteen studies met the inclusion criteria, seven intervention studies (n = 591 participants) and nine cross-sectional studies (n = 3005 participants). Intervention studies reported a reduction in depression, anxiety, shame and feelings of defeat, alongside improvements in self-compassion, well-being, quality of life (QoL), self-efficacy, emotion regulation difficulties and coping strategies. Meta-analysis was not undertaken due to substantial clinical, methodological and outcome heterogeneity across included studies. Cross-sectional studies indicated that higher self-compassion was associated with lower fertility-related stress and better psychological outcomes. Overall, the findings suggest that self-compassion interventions, including education-based approaches, may improve psychological health and resilience in women experiencing infertility. Incorporating multi-faceted education-based strategies to enhance self-compassion may provide further support and resilience for this population.
Environmental stress is increasingly recognized as an important determinant of reproductive performance in breeding stallions, particularly in the context of rising temperatures, climate variability, and increasingly intensive management systems. Stallions are especially susceptible because spermatogenesis is highly sensitive to temperature and reproductive activity is regulated by seasonal physiological changes. This review critically evaluates the current understanding of the molecular and cellular mechanisms through which environmental stress affects stallion fertility, with particular emphasis on heat stress, oxidative imbalance, endocrine dysregulation, and sperm functional competence. The available evidence indicates that oxidative stress is currently supported by the strongest stallion-specific data linking environmental stress with impaired reproductive function. In contrast, apoptosis, mitochondrial dysfunction, epigenetic regulation, and fertilization-related signaling pathways are supported primarily by mechanistic studies in other mammalian species and remain insufficiently validated under equine-specific conditions. Environmental stress may compromise not only spermatogenesis but also sperm functional competence, including processes required for successful fertilization, potentially resulting in subfertility despite apparently normal conventional semen parameters. Although mechanistic understanding has advanced considerably, important evidence gaps remain because stallion-specific studies are limited and many proposed mechanisms rely on carefully interpreted cross-species evidence. At present, management-based strategies, including optimization of thermal conditions, housing, and breeding management, provide the strongest evidence for mitigating the adverse effects of environmental stress in stallions. By comparison, antioxidant supplementation, nutritional interventions, molecular biomarkers, and other targeted approaches remain promising but require further validation under equine-specific conditions. Future progress will depend on well-designed stallion-specific studies integrating molecular biomarkers, endocrine profiling, thermophysiological assessment, and comprehensive evaluation of sperm functional competence. Such studies will be essential for improving early detection of reproductive dysfunction and for developing evidence-based strategies to maintain stallion fertility under increasingly challenging environmental conditions.
Limosilactobacillus reuteri Y15 (LRY15)-derived polyunsaturated fatty acids (PUFAs) restore follicular cell-cell junctions and fertility. LRY15, isolated from the intestine of alginate oligosaccharides (AOS)-dosed mice, improves ovarian function and fertility in cisplatin-induced subfertile mice. LRY15 produces PUFAs, whereas deletion of holo-acyl carrier protein synthase (AcpS) in LRY15 reduces PUFA synthesis and weakens its protective effects. Docosahexaenoic acid (DHA) supplementation recapitulates LRY15-mediated improvements in follicle and embryo development. Stereo-seq analysis reveals that LRY15 restores ovarian cell-cell junctions, suggesting junction remodeling as an important cellular process associated with LRY15 treatment. The Fads2-deficient mouse model further validates that LRY15-derived PUFAs restore follicular junction integrity and improve fertility.
Fertility-sparing treatment (FST) is an accepted option for selected women with endometrial carcinoma (EC) or atypical endometrial hyperplasia (AEH) wishing to preserve fertility. However, the impact of FST on subsequent endometrial function remains poorly understood. Oocyte donation (OD) offers a unique model to evaluate endometrial receptivity independently of oocyte quality. We assessed reproductive outcomes after OD in women aged ≥40 years with a history of FST for EC or AEH. This retrospective case series included women aged ≥40 years with histologically confirmed Endometrioid endometrial carcinoma (EEC) or AEH who achieved complete response after FST and subsequently underwent blastocyst transfer through OD. All cycles involved vitrified-warmed donor oocytes, intracytoplasmic sperm injection, blastocyst culture, and elective single embryo transfer. The primary outcome was live birth rate (LBR) per embryo transfer. Sixteen patients underwent 27 embryo transfer cycles. Median age at first transfer was 45.5 years. Embryological outcomes were excellent, with a 96.8% oocyte survival rate and 80.4% top-quality blastocysts. Despite adequate endometrial preparation in all cases, reproductive outcomes were poor. The cumulative LBR per embryo transfer was 18.5% (5/27), while the cumulative LBR per patient was 31.2% (5/16). Patients with disease recurrence showed lower live birth rates than those without recurrence. Endometrial thickness was not associated with implantation outcomes. Women aged ≥40 years undergoing OD after FST for EC or AEH experience reduced reproductive success despite optimal embryo quality. These findings are consistent with the hypothesis of persistent endometrial dysfunction after FST and highlight the need for improved assessment of endometrial receptivity and timely integration of assisted reproductive treatment following complete response.
Rice straw is rich in organic matter and essential nutrients, an important resource for improving soil fertility and enzyme activity. However, its high carbon-nitrogen ratio leads to slow decomposition, affecting nutrient transformation efficiency. The small molecular carbohydrates released during microbial enzymolysis not only serve as an energy source but may also act as signaling molecules, participating in the regulation of soil microbial community structure and plant root development. This review discusses the effects of straw return to the field on soil organic carbon (SOC) stability, microbial activity, and plant-soil feedback mechanisms, with particular emphasis on its role in carbon sequestration and CO2 emission mitigation. By enhancing SOC storage and aggregate stability, rice straw returning transforms agricultural waste into a long-term carbon sink, potentially offsetting a portion of anthropogenic CO2 emissions despite short-term increases in soil respiration and greenhouse gas (GHG) fluxes during decomposition. Optimized integration with water-nitrogen management and microbial inoculants can maximize net carbon benefits while sustaining soil fertility. This review highlights the key role of microbial-mediated straw decomposition in agricultural ecosystems and waste valorization. Future research needs to focus on the receptor recognition pathways of specific carbohydrate signals (fiber oligosaccharides, lignin oligosaccharides), the spatiotemporal dynamics of interspecies signaling between microorganisms and plants, the regulatory effects of environmental factors (soil pH, moisture) on signaling pathways, and quantitative modeling of long-term CO2 reduction potentials at regional and global scales.
Aligning with the 2026 World Population Day theme that emphasizes "Realizing the Hopes and Aspirations of Young People - Today and for the Future," the Chinese national theme specifically focuses on "Caring for Early Pregnancy, Empowering Healthy Beginnings" (he hu zao yun, guan ai fu neng) to address declining birth rates. Early pregnancy is the critical golden window for preventing birth defects and mitigating maternal risks, yet historical care models disproportionately focus on later gestational stages. This article examines structural gaps in early pregnancy care, including unequal resource distribution, insufficient mental health services, and limited social support networks. These challenges are closely interconnected and collectively limit the effectiveness, accessibility, and continuity of early pregnancy care. To address these challenges, we propose reconstructing a multidimensional collaborative support network. Key strategies include establishing standardized multidisciplinary clinics, leveraging digital health technologies for equitable access, and integrating medical care with supportive national social policies. Strengthening early pregnancy care through coordinated physiological, psychological, and social support can not only improve pregnancy outcomes but also help alleviate fertility anxiety among young couples, contributing to healthier families and high-quality population dynamics during China's demographic transition.
Artificial intelligence (AI) is increasingly promoted as a transformative innovation in in vitro fertilization (IVF), particularly for embryo selection. This article examines how discourses surrounding AI in IVF reflect broader shifts in medical paradigms and market logics. Drawing on a comparative critical discourse analysis of clinic websites, media texts and professional publications in the Netherlands and the United Kingdom, we explore how stakeholders frame the promise and potential of AI-enabled embryo selection. Our findings reveal three interconnected dynamics. First, UK discourses predominantly construct a paradigm shift from evidence-based medicine (EBM) toward data-driven care, positioning AI as a solution to the perceived limitations of randomised controlled trials. Dutch sources, by contrast, largely sustain EBM principles, framing caution as a safeguard against false hype and escalating costs. Second, UK clinics and technology developers predominantly employ promissory narratives that create self-fulfilling prophecies about an AI-driven future, while Dutch actors largely resist the inevitability of technological fixes. Third, the meaning of patient choice diverges: in the UK, choice is increasingly conflated with consumerism, enabling clinics to market unproven add-ons at additional cost; in the Netherlands, patient choice remains more insulated from market forces, though globalised imaginaries exert growing pressure. These findings illuminate how commercial interests and sociotechnical imaginaries shape reproductive care beyond clinical evidence, raising ethical concerns about equity, regulation and the commodification of hope. The IVF sector offers a critical lens on the wider implications of AI-driven medicine for healthcare governance in an era of marketisation.
Endometriosis is a chronic disease associated with pain, fertility difficulties, and reduced quality of life (QoL). Beyond clinical symptoms, health-related and lifestyle behaviors may influence the long-term impact of the disease. This study aimed to assess multiple QoL dimensions in women with endometriosis and examine their associations with disease-related symptoms, body mass index (BMI), and lifestyle characteristics. A cross-sectional online survey was completed by 153 women aged ≥ 18 years with self-reported endometriosis. Data included sociodemographic characteristics, body weight, physical activity, diet, smoking, and digestive symptoms, including painful defecation. The Endometriosis Impact Questionnaire evaluated physical, psychological, social, sexual and intimate, fertility, educational, employment and financial, and lifestyle QoL across three recall periods. Non-parametric tests and multivariate linear regression models assessed group differences and factors associated with QoL dimensions and overall impact. The greatest burden was observed in fertility, physical, and psychological dimensions, particularly during the previous 12 months. Body-weight change since symptom onset was associated with poorer outcomes across all QoL domains. BMI showed coding-dependent associations: continuous BMI predicted greater physical and psychological impact, whereas BMI ≥ 25.0 kg/m2 was linked to lower impact in physical (β=-0.42; p = 0.005), sexual and intimate (β=-0.31; p = 0.044), and employment and financial QoL (β=-0.31; p = 0.049). Painful defecation was associated with greater psychological and sexual and intimate impact and higher overall impact. Smoking was associated with greater lifestyle impact (β=0.38; p < 0.001) and higher overall impact (β=0.17; p = 0.042). Dietary supplement use was associated with lower fertility impact (β=-0.18; p = 0.049), whereas following a dietary regimen was associated with higher fertility impact (β=0.22; p = 0.014). Endometriosis substantially affects multiple life domains, particularly fertility and physical and psychological well-being. Weight change, painful defecation, and smoking were linked to poorer QoL, while BMI demonstrated complex domain-specific associations. Integrated medical and lifestyle approaches may improve long-term disease impact.
Psychological resilience is an adaptive capacity that enables individuals to maintain or regain equilibrium following stress. Infertility treatment represents a significant psychological stressor for many couples. Although higher resilience has been associated with better psychological well-being in patients undergoing medically assisted reproduction, its relationship with embryological outcomes remains unknown. This study aimed to determine whether psychological resilience in couples undergoing infertility treatment is associated with blastocyst quality. In this prospective observational study, a total of 126 infertile couples who underwent intracytoplasmic sperm injections, with fresh autologous gametes, were included. Psychological resilience in both partners was assessed using the 10-item Connor-Davidson Resilience Scale. The number of mature oocytes retrieved, semen parameters, and sperm histone retention were evaluated. The primary outcome was the Day 5 good-quality blastocyst development rate. Higher psychological resilience in men, but not in women, was independently associated with a higher good-quality blastocyst development rate (B = 0.06, 95% CI 0.01-0.11, p = 0.02) and remained significant in sensitivity analyses. Male resilience was also positively correlated with sperm morphology (ρ = 0.28, p = 0.001) and inversely correlated with sperm histone retention (ρ = -0.26, p = 0.02). Psychological resilience in men, but not in women, was associated with sperm characteristics and blastocyst quality in couples undergoing infertility treatment. These findings suggest that psychological factors may be reflected in biological parameters relevant to reproduction. Further studies are needed to investigate underlying mechanisms and reproductive outcomes beyond embryo development. Psychological resilience is the ability to adapt to and recover from stressful situations. Infertility treatment can be emotionally challenging for couples, but it is not known whether resilience is related to laboratory outcomes during treatment. In this study, we assessed psychological resilience in 126 couples undergoing intracytoplasmic sperm injection, a fertility treatment in which one sperm is injected into each mature egg. We found that higher resilience in men was associated with better sperm characteristics and a higher rate of good-quality embryos reaching the blastocyst stage on Day 5. This association was not observed in women. These findings suggest that psychological factors in men may be linked to biological features relevant to reproduction. However, this was an observational study and cannot prove cause and effect. Larger studies are needed to confirm these findings and to understand the biological mechanisms involved.
Robot-assisted surgery has been introduced into several male reproductive diseases, including male infertility-related reconstructive or microsurgical procedures, testicular cancer-related retroperitoneal lymph node dissection, and penile cancer-related inguinal lymph node surgery. However, unlike robot-assisted radical prostatectomy, these non-prostate male reproductive applications remain scattered across small clinical series, technical reports, and procedure-specific reviews. This study mapped the global research landscape and thematic evolution of robot-assisted surgery for male reproductive diseases excluding prostate disease. Publications were retrieved from the Web of Science Core Collection using a disease- and procedure-bound search strategy focused on robot-assisted microsurgery, vasovasostomy, vasoepididymostomy, varicocelectomy, sperm retrieval, azoospermia, testicular cancer/RPLND, and penile cancer/inguinal lymphadenectomy. The search was conducted on June 12, 2026. Articles and reviews in English were retained. Bibliometrix and CiteSpace were used to analyze publication trends, countries, institutions, authors, sources, cited references, keyword co-occurrence, clusters, bursts, and thematic changes. A total of 228 records were initially retrieved. After excluding 67 records outside the retained document types and 8 non-English records, 153 publications were included, comprising 110 articles and 43 reviews. The literature covered 2001-2026, involved 59 sources, 952 authors, 298 author keywords, and 3016 cited references, with an annual growth rate of 6.2%. Annual output remained low before 2013, increased after 2019, and peaked in 2025 (n = 18), whereas 2026 represented partial-year data (n = 9). The United States was the dominant contributor and citation center, while Italy, China, India, England, Germany, Canada, France, Switzerland, and Australia formed the main international network. Keyword analysis identified three principal domains: testicular cancer/RPLND, penile cancer/inguinal lymphadenectomy, and male infertility-related robotic microsurgery. Robot-assisted surgery for male reproductive diseases is a small but expanding field organized around distinct oncologic and reproductive surgery applications. Publication and citation activity is more extensive for testicular cancer/RPLND and penile cancer nodal surgery than for fertility-directed microsurgical reconstruction; however, bibliometric prominence should not be interpreted as greater clinical maturity, quality of evidence, or superiority. Future research should emphasize standardized indications, multicenter outcome reporting, fertility and oncologic endpoints, learning-curve assessment, and cost-effectiveness evaluation.
Small size of follicle, which may be due to summer, and high progesterone (P4) could hamper the ovulatory response to gonadotropin-releasing hormone (GnRH) at the beginning of GnRH-based protocols for estrus synchronization (GnRH-1), thus decreasing fertility. Accordingly, the objective of this study was to evaluate the effects of two-day extension in interval between presynchronization (Ovsynch) and breeding (Heatsynch) protocols and administration of prostaglandin F2α (PGF2α) two days before breeding protocol on size of the largest follicle (LF) and P4 concentration (PC) at GnRH-1, respectively, and fertility of cows during summer. Cows were randomly assigned to four experimental groups, including: 1) O7DH (cows with 7-day interval between Ovsynch and Heatsynch; n = 153), 2) O7DH+PG (cows with 7-day interval between Ovsynch and Heatsynch plus administration of PGF2α two days before Heatsynch; n = 156), 3) O9DH (cows with 9-day interval between Ovsynch and Heatsynch; n = 147), and 4) O9DH+PG (cows with 9-day interval between Ovsynch and Heatsynch plus administration of PGF2α two days before Heatsynch; n = 154). Further, cows were subjected to ultrasonographic examination and blood sampling at GnRH-1. Extension of the interval between Ovsynch and Heatsynch did not affect size of LF at GnRH-1 (P > 0.05); however, it decreased pregnancy risk (P < 0.05). Administration of PGF2α two days before Heatsynch decreased PC at GnRH-1 (P < 0.05), but it did not affect pregnancy risk (P > 0.05). In conclusion, the present study revealed that additional two days before breeding protocol did not increase follicle size at GnRH-1 and reduced fertility. Furthermore, PGF2α administration before breeding protocol could not improve fertility of cows despite reducing PC at GnRH-1.
Leydig cell tumors (LCTs) are rare, usually benign testicular tumors for which frozen section examination is commonly recommended during testis-sparing surgery (TSS). We report a 27-year single-center experience, emphasizing the role of imaging for conservative surgery decision-making. It shows our experience using expert radiology assessment to direct TSS without frozen section examination. In this retrospective observational study, we reviewed our institutional database of testicular tumors treated between 1998 and 2025. Patients with histologically confirmed LCTs were included. Clinical presentation, hormonal profile, imaging characteristics, surgery type, and intraoperative frozen section use were analyzed. Among 481 testicular tumors, 68 (14.14%) were LCTs. Within the histologically confirmed LCTs cohort, preoperative expert radiology assessment achieved 97% (66/68) concordance with the final pathology. Partial orchiectomy was performed in 62 cases (91.18%), total orchiectomy in 6 (8.82%). Median age was 36 years. Median follow-up was 75 months. No malignant LCTs were observed. All patients remained in complete remission. The most common reasons for consultation were infertility (n=41, 60.29%) where systematic ultrasound screening discovered the lesion, gynecomastia (n=4, 5.88%), Klinefelter syndrome work-up (n=4, 5.88%; 2 additional cases identified within the infertility group, total n=6) and palpable nodule (n=4, 5.88%). Median ultrasound tumor size was 7 mm (range: 2 to 32 mm). Radiological characteristics effectively differentiated LCTs, suggesting that direct TSS without frozen section examination might be feasible when expert radiological evaluation is available. Our findings reflect radiology-pathology concordance within histologically confirmed LCTs rather than diagnostic accuracy in an unselected population. This approach optimizes surgical workflow, preserves endocrine function and fertility. No recurrence was observed. Frozen section examination should be maintained where expert radiology consultation is unavailable or diagnostic uncertainty exists. Prospective validation is required before omitting frozen section examination outside expert centers.