Showing papers on "Fertility published in 2021"

Diagnosis and Management of Infertility: A Review.

Abstract: Importance In the US, approximately 12.7% of reproductive age women seek treatment for infertility each year. This review summarizes current evidence regarding diagnosis and treatment of infertility. Observations Infertility is defined as the failure to achieve pregnancy after 12 months of regular unprotected sexual intercourse. Approximately 85% of infertile couples have an identifiable cause. The most common causes of infertility are ovulatory dysfunction, male factor infertility, and tubal disease. The remaining 15% of infertile couples have “unexplained infertility.” Lifestyle and environmental factors, such as smoking and obesity, can adversely affect fertility. Ovulatory disorders account for approximately 25% of infertility diagnoses; 70% of women with anovulation have polycystic ovary syndrome. Infertility can also be a marker of an underlying chronic disease associated with infertility. Clomiphene citrate, aromatase inhibitors such as letrozole, and gonadotropins are used to induce ovulation or for ovarian stimulation during in vitro fertilization (IVF) cycles. Adverse effects of gonadotropins include multiple pregnancy (up to 36% of cycles, depending on specific therapy) and ovarian hyperstimulation syndrome (1%-5% of cycles), consisting of ascites, electrolyte imbalance, and hypercoagulability. For individuals presenting with anovulation, ovulation induction with timed intercourse is often the appropriate initial treatment choice. For couples with unexplained infertility, endometriosis, or mild male factor infertility, an initial 3 to 4 cycles of ovarian stimulation may be pursued; IVF should be considered if these approaches do not result in pregnancy. Because female fecundity declines with age, this factor should guide decision-making. Immediate IVF may be considered as a first-line treatment strategy in women older than 38 to 40 years. IVF is also indicated in cases of severe male factor infertility or untreated bilateral tubal factor. Conclusions and Relevance Approximately 1 in 8 women aged 15 to 49 years receive infertility services. Although success rates vary by age and diagnosis, accurate diagnosis and effective therapy along with shared decision-making can facilitate achievement of fertility goals in many couples treated for infertility.

Births: Final Data for 2019.

Abstract: Objectives-This report presents 2019 data on U.S. births according to a wide variety of characteristics. Trends in fertility patterns and maternal and infant characteristics are described and interpreted. Methods-Descriptive tabulations of data reported on the birth certificates of the 3.75 million births that occurred in 2019 are presented. Data are presented for maternal age, livebirth order, race and Hispanic origin, marital status, tobacco use, prenatal care, source of payment for the delivery, method of delivery, gestational age, birthweight, and plurality. Selected data by mother's state of residence and birth rates by age are also shown. Trend data for 2010 through 2019 are presented for selected items. Trend data by race and Hispanic origin are shown for 2016-2019. Results-A total of 3,747,540 births were registered in the United States in 2019, down 1% from 2018. The general fertility rate declined from 2018 to 58.3 births per 1,000 women aged 15-44 in 2019. The birth rate for females aged 15-19 fell 4% between 2018 and 2019. Birth rates declined for women aged 20-34 and increased for women aged 35-44 for 2018-2019. The total fertility rate declined to 1,706.0 births per 1,000 women in 2019. Birth rates declined for both married and unmarried women from 2018 to 2019. The percentage of women who began prenatal care in the first trimester of pregnancy rose to 77.6% in 2019; the percentage of all women who smoked during pregnancy declined to 6.0%. The cesarean delivery rate decreased to 31.7% in 2019 (Figure 1). Medicaid was the source of payment for 42.1% of all births in 2019. The preterm birth rate rose for the fifth straight year to 10.23% in 2019; the rate of low birthweight was essentially unchanged from 2018 at 8.31%. Twin and triplet and higher-order multiple birth rates both declined in 2019 compared with 2018.

Sperm Parameters Before and After COVID-19 mRNA Vaccination.

Abstract: To address vaccine hesitancy based on concerns about fertility, this study assesses sperm parameters before and after mRNA vaccine administration.

The Great Recession and Fertility in Europe: A Sub-national Analysis.

Abstract: This study investigates how the changes in labour market conditions and economic growth were associated with fertility before and during the Great Recession in Europe in 2002–2014. In contrast to previous studies, which largely concentrated at the country level, we use data for 251 European regions in 28 European Union (EU) member states prior to the withdrawal of the United Kingdom in January 2020. We apply three-level growth-curve model which allows for a great deal of flexibility in modelling temporal change while controlling for variation in economic conditions across regions and countries. Our findings show that fertility decline was strongly related to unemployment increase; this relationship was significant at different reproductive ages. Deteriorating economic conditions were associated with a stronger decline in fertility during the economic recession as compared with the pre-recession period. This evidence suggests the salience of factors such as broader perception of uncertainty that we could not capture in our models and which rose to prominence during the Great Recession. Furthermore, strongest fertility declines were observed in Southern Europe, Ireland and parts of Central and Eastern Europe, i.e. countries and regions where labour market conditions deteriorated most during the recession period. In Western Europe, and especially in the Nordic countries, fertility rates were not closely associated with the recession indicators.

Incidence of Infertility and Pregnancy Complications in US Female Surgeons.

Abstract: Importance While surgeons often delay pregnancy and childbearing because of training and establishing early careers, little is known about risks of infertility and pregnancy complications among female surgeons. Objective To describe the incidence of infertility and pregnancy complications among female surgeons in the US and to identify workplace factors associated with increased risk compared with a sociodemographically similar nonsurgeon population. Design, Setting, and Participants This self-administered survey questionnaire was electronically distributed and collected from November 2020 to January 2021 through multiple surgical societies in the US and social media among male and female attending and resident surgeons with children. Nonchildbearing surgeons were asked to answer questions regarding the pregnancies of their nonsurgeon partners as applicable. Exposures Surgical profession; work, operative, and overnight call schedules. Main Outcomes and Measures Descriptive data on pregnancy loss were collected for female surgeons. Use of assisted reproductive technology was compared between male and female surgeons. Pregnancy and neonatal complications were compared between female surgeons and female nonsurgeon partners of surgeons. Results A total of 850 surgeons (692 women and 158 men) were included in this survey study. Female surgeons with female partners were excluded because of lack of clarity about who carried the pregnancy. Because the included nonchildbearing population was therefore made up of male individuals with female partners, this group is referred to throughout the study as male surgeons. The median (IQR) age was 40 (36-45) years. Of 692 female surgeons surveyed, 290 (42.0%) had a pregnancy loss, more than twice the rate of the general population. Compared with male surgeons, female surgeons had fewer children (mean [SD], 1.8 [0.8] vs 2.3 [1.1];P Conclusions and Relevance This national survey study highlighted increased medical risks of infertility and pregnancy complications among female surgeons. With an increasing percentage of women representing the surgical workforce, changing surgical culture to support pregnancy is paramount to reducing the risk of major pregnancy complications, use of fertility interventions, or involuntary childlessness because of delayed attempts at childbearing.

Sperm DNA fragmentation testing: Summary evidence and clinical practice recommendations.

Abstract: We herein summarise the evidence concerning the impact of sperm DNA fragmentation in various clinical infertility scenarios and the advances on sperm DNA fragmentation tests. The collected evidence was used to formulate 41 recommendations. Of these, 13 recommendations concern technical aspects of sperm DNA fragmentation testing, including pre-analytical information, clinical thresholds and interpretation of results. The remaining 28 recommendations relate to indications for sperm DNA fragmentation testing and clinical management. Clinical scenarios like varicocele, unexplained infertility, idiopathic infertility, recurrent pregnancy loss, intrauterine insemination, in vitro fertilisation/intracytoplasmic sperm injection, fertility counselling for men with infertility risk factors and sperm cryopreservation have been contemplated. The bulk evidence supporting the recommendations has increased in recent years, but it is still of moderate to low quality. This guideline provides clinicians with advice on best practices in sperm DNA fragmentation testing. Also, recommendations are provided on possible management strategies to overcome infertility related to sperm DNA fragmentation, based on the best available evidence. Lastly, we identified gaps in knowledge and opportunities for research and elaborated a list of recommendations to stimulate further investigation.

Fertility preservation for male patients with childhood, adolescent, and young adult cancer: recommendations from the PanCareLIFE Consortium and the International Late Effects of Childhood Cancer Guideline Harmonization Group.

Abstract: Female patients with childhood, adolescent, and young adult cancer are at increased risk for fertility impairment when treatment adversely affects the function of reproductive organs Patients and their families desire biological children but substantial variations in clinical practice guidelines reduce consistent and timely implementation of effective interventions for fertility preservation across institutions As part of the PanCareLIFE Consortium, and in collaboration with the International Late Effects of Childhood Cancer Guideline Harmonization Group, we reviewed the current literature and developed a clinical practice guideline for fertility preservation in female patients who were diagnosed with childhood, adolescent, and young adult cancer at age 25 years or younger, including guidance on risk assessment and available methods for fertility preservation The Grading of Recommendations Assessment, Development and Evaluation methodology was used to grade the available evidence and to form the recommendations This clinical practice guideline leverages existing evidence and international expertise to develop transparent recommendations that are easy to use to facilitate the care of female patients with childhood, adolescent, and young adult cancer who are at high risk for fertility impairment A complete review of the existing evidence, including a quality assessment, transparent reporting of the guideline panel's decisions, and achievement of global interdisciplinary consensus, is an important result of this intensive collaboration

Major Trends in Population Growth Around the World

Abstract: The world's population continues to grow, albeit at a slower pace. The decelerating growth is mainly attributable to fertility declines in a growing number of countries. However, there are substantial variations in the future trends of populations across regions and countries, with sub-Saharan African countries being projected to have most of the increase. Population momentum plays an important role in determining the future population growth in many countries and areas where fertility is in a rapid transition. With declines in fertility, the world's population is unprecedentedly aging, and the numbers of households with smaller sizes are growing. International migration is also on the rise since the beginning of this century. The world's population is also urbanizing due to increased internal rural to urban migration. Nevertheless, there are uncertainties in future population growth, not only because there are uncertainties in the future trends in fertility, mortality, and migration, but also because there are many other factors that could affect these trajectories. International consensus on climate change and ecosystem protections may trigger population control policies, and the ongoing pandemic is likely to have some impact on mortality, migration, or even fertility.

The impact of advanced maternal age on pregnancy outcome.

Abstract: Advanced maternal age is becoming an increasingly relevant issue in high-income developed countries Lower fertility, greater need for assisted reproductive therapy, and an increase in comorbidities, such as hypertension and diabetes, are some of the reasons for the rise in adverse maternal and fetal outcomes This chapter reviews and summarizes the recent publications on the impact of advanced maternal age on pregnancy outcomes

Beyond the Economic Gaze: Childbearing During and After Recessions in the Nordic Countries

Abstract: During the 2010s, fertility rates fell across the Nordic region. The onset of these declines seems linked to the Great Recession of 2008-2009, but their continuation cannot easily be linked to subsequent economic change. The 1990s, too, brought episodes of economic crises to the Nordic region that were followed by different degrees of fertility decline. In this study, we provide an empirical overview of parity-, age- and education-specific fertility developments in the five Nordic countries in the wake of the economic recessions in 2008 and the early 1990s, respectively. We demonstrate a high degree of heterogeneity in fertility developments across countries after 1990, whereas after 2008, the trends are much more similar across the five countries. Likewise, the educational differences in birth hazards that characterized the developments after 1990 were much smaller in the initial years after 2008-2009. This reversal from heterogeneity to homogeneity in the fertility response to recessions calls for an expansion of theories on the cyclicality of fertility in relation to uncertainty and economic and social change. In our discussion, we consider the role of a set of factors that also incorporates the state, crisis management, and perceptions of economic and welfare uncertainty.

COVID-19 vaccine hesitancy linked to increased internet search queries for side effects on fertility potential in the initial rollout phase following Emergency Use Authorization.

Abstract: The Emergency Use Authorization (EUA) of the COVID-19 vaccine on December 11, 2020 has been met with hesitancy for uptake with some citing potential impacts on future fertility. We hypothesised that irrespective of sex, fertility-related queries would markedly increase during the 48 days following EUA of the coronavirus vaccine. We sought to objectively identify trends in internet search queries on public concerns regarding COVID-19 vaccine side effects on fertility that might impact vaccine uptake. We used Google Trends to investigate queries in Google's Search Engine relating to the coronavirus vaccine and fertility between 10/24/2020 and 1/27/2021. The five most queried terms were identified as: 'COVID Vaccine Fertility', 'COVID Vaccine and Infertility', 'COVID Vaccine Infertility', 'COVID Vaccine Fertility CDC', and 'COVID 19 Vaccine Infertility' with an increase of 710.47%, 207.56%, 264.35%, 2,943.7%, and 529.26%, respectively, all p < .001. This study indicates that there was an increase in online COVID-19 vaccine-related queries regarding fertility side effects coinciding with the Emergency Use Authorization (EUA) on December 11, 2020. Our results objectively evidence the increased concern regarding the vaccine and likely demonstrate a major cause for hesitancy in vaccine uptake. Future studies and counselling with patients should be undertaken to help mitigate these concerns.

Fertility, pregnancy and neonatal outcomes of patients with adenomyosis: a systematic review and meta-analysis

Abstract: This study aimed to investigate the association of adenomyosis with fertility, pregnancy and neonatal outcomes. An electronic search was conducted using the MEDLINE, PubMed and Cochrane databases up to April 2020. Seventeen observational studies were included. Adenomyosis was significantly associated with a lower clinical pregnancy rate (odds ratio [OR] 0.69; 95% confidence interval [CI] 0.51-0.94) and higher miscarriage rate (OR 2.17; 95% CI 1.25-3.79) after treatment with assisted reproductive technology (ART). The lower clinical pregnancy rate was more significant in the subgroup of patients with short down-regulation protocols. Similar associations were recorded after age adjustment. Adenomyosis was also significantly associated with an increased risk of pre-eclampsia, preterm delivery, Caesarean section, fetal malpresentation, small for gestational age infancy and post-partum haemorrhage, which was confirmed after correction for age and mode of conception. In conclusion, adenomyosis is associated with negative effects on fertility after ART. The potentially protective role of the ultra-long down-regulation protocols needs further evaluation in randomized controlled studies. Adenomyosis is also associated (independently of the mode of conception) with adverse pregnancy and neonatal outcomes. Proper counselling prior to ART and close monitoring of pregnancy in patients with adenomyosis should be recommended.

Effects of COVID-19 and mRNA vaccines on human fertility.

Abstract: The coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has precipitated a global health crisis of unprecedented proportions. Because of its severe impact, multiple COVID-19 vaccines are being rapidly developed, approved and manufactured. Among them, mRNA vaccines are considered as ideal candidates with special advantages to meet this challenge. However, some serious adverse events have been reported after their application, significantly increasing concerns about the safety and efficacy of the vaccines and doubts about the necessity of vaccination. Although several fertility societies have announced that COVID-19 mRNA vaccines are unlikely to affect fertility, there is no denying that the current evidence is very limited, which is one of the reasons for vaccine hesitancy in the population, especially in pregnant women. Herein, we provide an in-depth discussion on the involvement of the male and female reproductive systems during SARS-CoV-2 infection or after vaccination. On one hand, despite the low risk of infection in the male reproductive system or fetus, COVID-19 could pose an enormous threat to human reproductive health. On the other hand, our review indicates that both men and women, especially pregnant women, have no fertility problems or increased adverse pregnancy outcomes after vaccination, and, in particular, the benefits of maternal antibodies transferred through the placenta outweigh any known or potential risks. Thus, in the case of the rapid spread of COVID-19, although further research is still required, especially a larger population-based longitudinal study, it is obviously a wise option to be vaccinated instead of suffering from serious adverse symptoms of virus infection.

Is fertility reduced in ovulatory women with polycystic ovary syndrome? An opinion paper.

Abstract: Polycystic ovary syndrome (PCOS) is the most common cause of anovulatory infertility; however, whether women with PCOS and spontaneous or drug-induced ovulatory cycles have the same reproductive potential as non-PCOS controls is a matter of debate. In the present opinion paper, the author takes the opportunity to summarize the collective evidence supporting the hypothesis of reduced fertility potential in women with PCOS, regardless of ovulatory status, and speculate that reduced reproductive potential may be caused by altered oocytes, embryo and endometrial competence, and infertility-related co-morbidities as well as an increased risk of pregnancy complications.

Does COVID-19 affect male fertility?

Abstract: Multiple cases of pneumonia caused by a novel corona virus (SARS-COV2) have been reported in Wuhan city in China in December 2019 [1]. Since then, the infection has spread world-wide, leading to acute respiratory distress syndrome (SARS) named as “COVID-19” by the World Health Organization (WHO) [1]. On 11/03/2020, the disease has been declared as a global pandemic by WHO [1]. Angiotensin converting enzymes 2 (ACE2) receptors play a key role in pathogenesis of COVID-19. Binding of SARS-COV2 virus to ACE2 receptors facilitate its cell entry and replication [2]. Therefore, cells that show high level of ACE2 expression have the potential to be targeted and damaged by the virus [2]. Multiple studies detected high ACE2 expression level in testicular cells, mainly in seminiferous duct cells, spermatogonia, Leydig cell and Sertoli cells [2–4]. Based on the results of these studies, it is concluded that the testis could be a potential target for direct damage by SARS-COV2 virus. Another study performed following the outbreak of SARS-COV infection in 2002 showed that orchitis was a recognised complication of SARS [5]. The main question is whether COVID-19 has the potential to cause testicular damage and infertility in male patients. So far there is no definitive answer as a follow-up of reproductive function of recovered male patients is required. SARS-cov2 virus binds to ACE2 receptors and enter the cells to complete its replication cycle [2]. This is considered as the main pathological mechanism of direct cell infection and damage by the virus. Therefore, cells with increased ACE2 expression are potential target of viral invasion [2]. Among different body tissues, testis shows nearly the highest level of ACE2 mRNA and protein expression [2]. At the level of testicular cells, four main cell types; seminiferous duct cells, spermatogonia, Leydig cells and Sertoli cells, show higher rate of ACE2 mRNA expression [2–4]. If the virus causes damage to these cells, the process of spermatogenesis could be affected which might pose risk to male fertility. Interestingly, the testicular expression of ACE2 is age related [4]. The highest expression recorded in patients aged 30, which is higher than those in their twenties, whereas 60-year-old patients show the lowest level of expression [4]. This might indicate that young male patients are at higher risk of testicular damage by COVID-19 than older patients. In one study, examination of autopsy specimen of testis of six patients who died due to SARS-Cov infection in 2002 showed an evidence of orchitis [5]. Histopathological examination revealed inflammatory infiltrates, mainly in seminiferous tubules [5]. Immunohistochemistry showed IgG deposition mainly in seminiferous epithelium, interstitium, degenerated germ cells and Sertoli cells [5]. These are almost the same cell types that show high ACE2 expression [2–4]. Interestingly, in-situ hybridization does not detect viral genomic materials in the testicular tissue specimens [5]. This indicates that testicular damage is due to inflammatory and immunological response rather than direct damage by the virus. There is a theoretical possibility of testicular damage and subsequent infertility following COVID-19 infection. The possibility of testicular damage is caused by either direct viral invasion through binding of SARS-COV2 virus to ACE2 receptors or secondary to immunological and inflammatory response. Follow-up studies of reproductive function of recovered male patients is required to investigate this possibility.

Sperm Count and Hypogonadism as Markers of General Male Health.

Abstract: Background Some evidence suggests that infertile men, who are at increased risk for hypogonadism, metabolic derangements, and osteoporosis, have higher long-term morbidity and mortality than controls, but data are scarce and not conclusive. Objective We tested whether semen quality and reproductive function could represent a marker of general male health. Design, setting, and participants A retrospective study of 5177 individuals from a prospectively collected database of 11 516 males of infertile couples who had semen analysis in a tertiary university center. Outcome measurements and statistical analysis Of them, 5177 had all data for reproductive hormones, testis ultrasound, and biochemical determinations for glucose and lipid metabolism. Hypogonadism was defined as testosterone 9.4 IU/l. Individuals with a total sperm count of Results and limitations Men with a low sperm count ( Conclusions This is the largest study with comprehensive evaluation of semen quality and reproductive function, etiology and risk factor determination, and metabolic, cardiovascular, and osteoporosis risk assessment, performed in men referred for fertility evaluation. A low sperm count is associated with poorer metabolic, cardiovascular, and bone health. Hypogonadism is mainly involved in this association, but a low sperm count in itself is a marker of general health. Patient summary This large study evaluated semen quality, reproductive function, and metabolic risk in men referred for fertility evaluation, and showed that a man’s semen count is a marker of his general health. Men with low sperm counts are more likely than those with normal sperm counts to have greater body fat, higher blood pressure, higher “bad” (low-density lipoprotein) cholesterol and triglycerides, and lower “good” (high-density lipoprotein) cholesterol. They also have a higher frequency of metabolic syndrome and insulin resistance, a condition that can lead to diabetes. Men with low sperm counts had a 12-fold increased risk of hypogonadism or low testosterone levels, and half of them had osteoporosis or low bone mass. Fertility evaluation gives men the unique opportunity for health assessment and disease prevention.

Fertility and Modernity

Abstract: We investigate the historical dynamics of the decline in fertility in Europe and its relation to measures of cultural and ancestral distance. We test the hypothesis that the decline of fertility was associated with the diusion of social and behavioral changes from France, in contrast with the spread of the Industrial Revolution, where England played a leading role. We argue that the diusion of the fertility decline and the spread of industrialization followed dierent patterns because societies at dierent relative distances from the respective innovators (the French and the English) faced dierent barriers to imitation and adoption, and such barriers were lower for societies that were historically and culturally closer to the innovators. We provide a model of fertility choices in which the transition from higher to lower levels of fertility is the outcome of a process of social innovation and social in‡uence, whereby late adopters observe and learn about the novel behaviors, norms and practices introduced by early adopters at the frontier. In the empirical analysis we study the determinants of marital fertility in a sample of European populations and regions from 1830 to 1970, and successfully test our theoretical predictions using measures of genetic distance between European populations and a novel data set of ancestral linguistic distances between European regions.

SARS-CoV-2 pandemic and repercussions for male infertility patients: A proposal for the individualized provision of andrological services.

Abstract: The prolonged lockdown of health facilities providing non-urgent gamete cryopreservation-as currently recommended by many reproductive medicine entities and regulatory authorities due to the SARS-CoV-2 pandemic will be detrimental for subgroups of male infertility patients. We believe the existing recommendations should be promptly modified and propose that the same permissive approach for sperm banking granted for men with cancer is expanded to other groups of vulnerable patients. These groups include infertility patients (eg, azoospermic and cryptozoospermic) undergoing medical or surgical treatment to improve sperm quantity and quality, as well as males of reproductive age affected by inflammatory and systemic auto-immune diseases who are about to start treatment with gonadotoxic drugs or who are under remission. In both scenarios, the "fertility window" may be transitory; postponing diagnostic semen analysis and sperm banking in these men could compromise the prospects of biological parenthood. Moreover, we provide recommendations on how to continue the provision of andrological services in a considered manner and a safe environment. Our opinion is timely and relevant given the fact that fertility services are currently rated as of low priority in most countries.

Employment Instability and Fertility in Europe: A Meta-Analysis.

Abstract: The relationship between employment instability and fertility is a major topic in demographic research, with a proliferation of published papers on this matter, especially since the Great Recession. Employment instability, which most often manifests in unemployment or time-limited employment, is usually deemed to have a negative effect on fertility, although different fertility reactions are hypothesized by sociological theories, and micro-level evidence is fragmented and contradictory. We used meta-analytic techniques to synthesize European research findings, offer general conclusions about the effects of employment instability on fertility (in terms of direction and size), and rank different sources of employment instability. Our results suggest that employment instability has a nonnegligible negative effect on fertility. Men's unemployment is more detrimental for fertility than men's time-limited employment; conversely, a woman having a fixed-term contract is least likely to have a child. Next, the negative effect of employment instability on fertility has become stronger over time, and is more severe in Southern European countries, where social protection for families and the unemployed is least generous. Finally, meta-regression estimates demonstrate that failing to account for income and partner characteristics leads to an overestimation of the negative effect of employment instability on fertility. We advance the role of these two factors as potential mechanisms by which employment instability affects fertility. Overall, this meta-analysis provides the empirical foundation for new studies on the topic.

Use of menstruation and fertility app trackers: a scoping review of the evidence

Abstract: Introduction There has been a phenomenal worldwide increase in the development and use of mobile health applications (mHealth apps) that monitor menstruation and fertility. Critics argue that many of the apps are inaccurate and lack evidence from either clinical trials or user experience. The aim of this scoping review is to provide an overview of the research literature on mHealth apps that track menstruation and fertility. Methods This project followed the PRISMA Extension for Scoping Reviews. The ACM, CINAHL, Google Scholar, PubMed and Scopus databases were searched for material published between 1 January 2010 and 30 April 2019. Data summary and synthesis were used to chart and analyse the data. Results In total 654 records were reviewed. Subsequently, 135 duplicate records and 501 records that did not meet the inclusion criteria were removed. Eighteen records from 13 countries form the basis of this review. The papers reviewed cover a variety of disciplinary and methodological frameworks. Three main themes were identified: fertility and reproductive health tracking, pregnancy planning, and pregnancy prevention. Conclusions Motivations for fertility app use are varied, overlap and change over time, although women want apps that are accurate and evidence-based regardless of whether they are tracking their fertility, planning a pregnancy or using the app as a form of contraception. There is a lack of critical debate and engagement in the development, evaluation, usage and regulation of fertility and menstruation apps. The paucity of evidence-based research and absence of fertility, health professionals and users in studies is raised.

COVID-19 May Affect Male Fertility but is Not Sexually Transmitted: A Systematic Review.

Abstract: Objective To determine if SARS-CoV-2, which has led to the rapidly spreading COVID-19 global pandemic, is sexually transmitted Since the putative receptor for the virus is identified in reproductive organs, it is also important to examine if COVID-19 may affect human fertility Evidence Review A systematic review of English publications was conducted up to December 11, 2020 in PubMed, NIH iCite COVID-19 portfolio, Cochrane Library, and Google Scholar databases, searching for SARS-CoV-2 in the testes; seminal, prostatic, and vaginal fluids; and cervical smears A total of 1,997 records were identified, duplicates were removed, and 1,490 records were reviewed for eligibility by examining titles and abstracts Subsequently, 202 full-text relevant articles were reviewed by 2 independent reviewers Forty-seven studies (literature reviews, editorials, and guidelines) were assessed qualitatively, and 23 studies that tested the male and female reproductive tracts of patients with COVID-19 for SARS-CoV-2 were quantitatively analyzed Results No epidemiological investigations to date have described evidence suggesting that COVID-19 is an STD While angiotensin-converting enzyme 2 receptor is found in the reproductive organs, the lack of co-expression of the TMPRSS2 modulatory protein, required for SARS-CoV-2 cell entry, in testicular cells, sperm, or oocytes, argues against the hypothesis that gametes transmit SARS-CoV-2 Molecular detection studies of SARS-CoV-2 RNA in the male and female reproductive tracts were summarized: 980% (293/299) of the seminal fluids, 16/17 testicular biopsies, all 89 prostatic fluids, 983% (57/58) of the vaginal fluids, all 35 cervical smears, and all 16 oocyte samples tested negative for SARS-CoV-2 None of the studies confirmed sexual transmission of SARS-CoV-2 Nonetheless, COVID-19 may have detrimental effects on male reproduction by inducing orchitis and/or decreasing testosterone levels, sperm counts, and motility Conclusion On the basis of the current worldwide published information, COVID-19 is not an STD This information is important for clinicians, proposed guidelines for public health, US Food and Drug Administration guidelines for gamete and tissue donor eligibility, and fertility treatments Universal precautions, currently practiced worldwide, are adequate and sufficient at this time to prevent the transmission of known or unknown viral infections We suggest that recovered patients of COVID-19, especially those with infertility, should be evaluated for their ovarian and testicular function

Psychological distress and postponed fertility care during the COVID-19 pandemic.

Abstract: To evaluate perceptions of delayed fertility care secondary to the COVID-19 pandemic. This was a cross-sectional anonymous survey of N = 787/2,287 patients (response rate = 42.6%) from a single academic fertility center. Participants were randomized 1:1 to receive supplemental educational explaining the rationale behind recommendations to delay fertility treatments due to the COVID-19 pandemic. Assessment of well-being was conducted via the Personal Health Questionnaire Depression Scale, the Generalized Anxiety Disorder-7, the Ways of Coping-Revised, the Appraisal of Life Events Scale, and influence of supplemental education on agreement with ASRM COVID-19 Taskforce recommendations and associated distress. Participants in the education v. no education groups were 35.51 (SD = 4.06) and 37.24 (SD = 5.34) years old, married (90.8% v. 89.8%), had a graduate degree (53.9% v. 55.4%), > 1 year of infertility (73.4% v. 74.4%), and were nulliparous (69.0% v. 72.6%), with moderate to high distress (64.9% v. 64.2%) (ns). Distress was related to age, duration of infertility, and engagement in social support seeking and avoidant coping strategies (P < 0.001). Agreement with recommendations was related to receipt of supplemental education, history of pregnancy loss, and use of cognitive coping (P = 0.001). Most participants were distressed by the delay of treatments. Supplemental education increased acceptance of recommendations but did not decrease distress. Future treatment delays should include education related to and assessment of understanding of recommendations, and inclusion of mental health professionals in patient care.

Does mRNA SARS-CoV-2 vaccine detrimentally affect male fertility, as reflected by semen analysis?

Abstract: Research question Does Pfizer's coronavirus disease 2019 (COVID-19) vaccination detrimentally affect semen analysis parameters? Design A prospective cohort study was conducted at a single large tertiary centre in Israel between February and March of 2021. Semen samples from 75 fertile men were analysed 1–2 months following their second dose of Pfizer's COVID-19 vaccine. The semen parameters were compared with the World Health Organization (WHO) reference ranges. The primary outcome was the percentage of abnormal semen parameters in those who were vaccinated, i.e. the rates of oligozoospermia, reduced percentage of motile spermatozoa and abnormal sperm morphology. Results The interval from the time of the second vaccination to the date of participation was on average 37 days, with most subjects describing either mild or no side effects after the first or second dose. The mean sperm concentration was 63.2 ± 33.6 × 106/ml, with only a single participant (1.3%) with a sperm count of 12.5 × 106/ml, considered by the WHO to be oligozoospermic. The mean sperm motility percentage was 64.5 ± 16.7%, with only a single man (1.3%) displaying reduced motility. No notable morphological abnormalities were observed. This constituted a lower percentage of abnormal semen parameters compared with the 5% rates reported in fertile men by the WHO. Conclusions The semen parameters following COVID-19 vaccination were predominantly within the normal reference ranges as set by the WHO and do not reflect any causative detrimental effect from COVID-19 vaccination. The results strengthen the notion that the Pfizer's severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine is safe and should be recommended to men wishing to conceive.