Studies have shown that couples of childbearing age are increasingly aware that diet and nutrition may be related to reproductive performance in both men and women . Still, surprisingly they do not seem to be aware of how these lifestyle-related factors affect their fertility. Although infertility has long been a public health issue of widespread concern, the link between college students and infertility has been understudied . They also considered age a significant factor affecting fertility; however, they overestimated the optimal period of human fertility and the age at which fertility begins to decline. Only one study discussed the effect of age on FA, and the results showed that older participants had higher FA and a deeper understanding of fertility issues than younger participants . Also, patients have a high chance of taking their healthy baby successfully home. They have helped many patients in achieving top treatments and outcomes. It is the best IVF clinic in Nairobi with high success rates in different procedures. They have successfully performed various treatments for patients’ conditions. It is also one of the best male fertility clinics in Nairobi. Hair mercury concentrations and in vitro fertilization (IVF) outcomes among women from a fertility clinic. Maternal fish intake during pregnancy, blood mercury levels, and child cognition at age 3 years in a US cohort. A systematic review and meta-analysis of the evidence. Although the social fertility shows an opposite trend with the Gross Domestic Product, the economy plays a role in improving the fertility rate. Although the exact prevalence of hyporesponse to COS is difficult to estimate, it issupposed to range between 40% and 45%, thus highlighting that a remarkable number ofwomen with normal ovarian reserve tests attending an IVF center might end upexhibiting an abnormal ovarian response after COS.74,75 Furthermore, identification ofsuboptimal responders cannot be made a priori, given the lack ofassociation between the presence of SNPs and AMH/AFC.76 Whether FSH or LH receptor SNPs screening should be offered to all women withadequate ovarian reserve prior to their first IVF treatment is currently underdebate as it depends on the prevalence of such SNPs in this particular IVFpopulation and their clinical impact. In the Poseidon population, around 55% falls into group 4 (patients ⩾ 35 years withpoor ovarian re-serve prestimulation parameters, namely, AFC 29 However, in today’s society, with the increasing age at first maternity wish,the percentage of patients among POR who fall into group 4 can be up to 76%.30 The following sections encompass the main aspects regarding the management ofexpected PORs. In this context, in yet another attempt to overcome the shortcomings of the BC, amodified definition of impaired ovarian response has been proposed by the PoseidonGroup (Patient-Oriented StrategiesEncompassing IndividualizeD OocyteNumber).25 This new classification introduces a better stratification of the “lowprognosis patient” and suggests four subgroups based on (i) quantitative andqualitative parameters such as age and the expected aneuploidy rate; (ii) ovarianreserve biomarkers (AFC and/or AMH); and (iii) ovarian response—provided a previousstimulation cycle has been performed. Further, the molecular mechanisms underlying the positive and negative effects of many chemical and trace elements involved in male fertility are not clear. Proper nutrition is essential for spermatogenesis, good sperm motility and quality, and the development of Sertoli and interstitial cells. Conversely, NPs of silver, TiO2, zinc oxide (ZnO), copper, and nickel induced oxidative stress in male reproductive organs (144–147). However, exposure to certain essential elements is beneficial for semen quality because these elements are involved in maintaining normal spermatogenesis and sperm maturation. As a proof of concept, the Italian market of supplements generated 3.3 billion euros in 2019, with an increase of 4.3% compared to 2018 . Since a medical prescription is not necessary to purchase dietary supplements, subjects seeking fertility may have easy access to these products 10,57. Nevertheless, these products are commonly administered to infertile patients 8,56. Ingredients without clinical evidence in the improvement of sperm parameters (no RCT or meta-analyses) are listed in Table 2. Active ingredients with evidence of efficacy, references, evaluated sperm parameters, employed daily doses and minimal effective dose (mED). Fertility concerns remain a contributor to depression risk, with each additional contributor increasing the likelihood of depression by 2.423 times (35). The news of a tumor diagnosis is extremely upsetting for the patient and can result in decreased quality of life, fewer social opportunities, and increased financial burden—all of which can quickly lead to depression. The guidelines and practicing physicians suggest the use of embryo cryopreservation, cryopreservation of unfertilized oocytes, ovarian transposition and suppression, and ovarian tissue cryopreservation and transplantation for fertility preservation (34). Hypertensive disorders of pregnancy F.R., S.M., R.O.-S.; Study conception anddesign, data interpretation, and drafting of the manuscript.All authors approved the final version of this manuscriptfor publication. It could also help to predict the personalizedchance of an ART outcome before the treatment procedure.This would assist clinicians decide whether it is worth tostartan ART procedure and would also provide infertilecouples information about the chances for success. However,the results from a large number of studies mentioned thatthe role of PCOS in ART success mainly depended onobesity, insulin resistance, and other metabolic syndromefeatures (36, 37). These results imply a higheramount of ovarian capacity in PCOS women and thecompensatory impact of this capacity (34, 35). Patients older than 40 yearshad a disadvantaged IVF outcome and increased numbersof miscarriages. It provides a successful outcome as the healthy eggs use. Because IVF treatment is for various problems. It involves top-notch technologies and stages. You can choose IVF (In Vitro Fertilization) for a successful pregnancy outcome. Accordingly, treatment of RIF should be targeted to the abnormality detected, and the correction of any potential malfunction that might contribute to the failure of implantation 61, 93.By excluding sperm with higher probabilities of DNA fragmentation and abnormal chromatin condensation, sperm sorting for IMSI can yield embryos with a higher developmental capacity.JM, DL, and WG performed the literature search and data extraction and played a major role in writing the manuscript.The ASPR and ASYR also demonstrated an upward trend between 1990 and 2019, albeit with some fluctuations along the way (Fig. 1).As per the WHO estimates 60–80 million couples worldwide currently suffer from infertility.In developing societies especially, having children may be the key to women achieving adult status and gaining acceptance in the community (Hollos 2003).Therefore, further studies evaluating the realrole of SNPs and their association with reproductive outcomes are expected, andspecific polygenetic traits may tailor IVF treatment in the future. A 2001 study evaluated 1039 couples ≤43y who underwent 3,479 IUI cycles with natural cycles or ovulation induction with gonadotropins or clomiphene citrate (CC) to determine the prognostic factors for achieving pregnancy rate . Intrauterine insemination (IUI) is a commonly used method of assisted reproduction for patients with mild male factor infertility, anovulation, endometriosis, and unexplained infertility . Approximately 12–18% of couples in the United States struggle with infertility, with 20% of infertility caused solely by male factors and 30–40% of infertility caused by a combination of male and female factors 1, 2. In women, the quality and quantity of eggs decrease during aging, resulting in a decreased ovarian reserve (57), which leads to a longer time to conceive, decreased fertility, and a higher risk of pregnancy-related complications (58, 59). Whereas some studies did not report whether the recruited infertile patients were novices or have prior infertility treatment experience (18, 19, 22, 25–27, 29) (Table 6). In some studies, infertile patients have already been exposed to infertility treatment in the past (7, 30). The study designs that were employed for studies involving male subjects only are case-control prospective studies (17–20), with a total of 400 subjects involving age-matched, healthy fertile controls and infertile subjects. As a result, any change in hormonal levels in healthy fertile women might affect uNK cell levels without having any impact on pregnancy outcome . It was determined that the levels of peripheral NK cells were relatively equal in women whose next pregnancy resulted in both biochemical pregnancy and miscarriage, suggesting here that these immune cells might not affect only implantation but may also involve an additional mechanism in pregnancy. Maternal smoking was more commonly linked to spontaneous miscarriage with normal fetal karyotype than abnormal karyotype, suggesting that the toxic effects of carbon monoxide and nicotine might be the principle factors causing harm. Fuentes et al. also demonstrated that female smokers with higher serum cotinine levels (a nicotine metabolite) had significantly fewer ova retrieved during IVF cycles, though cotinine levels had no significant impact on rates of implantation in IVF cycles . Recently, the pivotal role that lifestyle factors play in the development of infertility has generated a considerable amount of interest. It may support male reproductive health and improve sperm quality. In their study, clinical pregnancyand implantation rates were similar to those who were30-35years of age. They observed that male causeof infertility was linked to lower chances of successfulpregnancy in patients who did not receive ICSI. Substantial research has been conducted to improve IVF results by taking intoconsideration its influencing factors; however, there is still a lack of knowledge about thepredictors of IVF outcomes while the overall pregnancy rates have only reached approximately30% (1, 2). The consequences of severe NEB are an increased risk of metabolic diseases (see below), that largely occur within the first month of lactation, reduced immune function and a reduction in subsequent fertility (Roche et al., 2009).The studies from different perspectives all emphasized the correlation between social factors and women's fertility intentions and the influence of media use on social factors.As a result of fat loss and the resulting hormonal imbalance, there is an increased risk of fertility problems.They were candidates for hysterectomy, but not representative of the typical patient population suffering from infertility and recurrent pregnancy loss.This dietary supplement helps people with infertility to conceive a baby, improves their semen quality and volume without causing any harmful side-effects.Descriptive and random-effects meta-analysis models were used to examine range of estimates and generate estimates of pooled lifetime and period prevalence of 12-month infertility, respectively, among representative populations.The experience of infertility is shaped by patriarchy, but the degree of male dominance and the range of roles other than motherhood open to women vary from society to society. Healthcare workers must develop targeted nursing interventions, provide professional counseling services to reduce the level of stigma in female infertility patients, alleviate fertility stress, and improve their quality of life. Infertility stigma can bring heavy mental pressure and psychological burden to female infertility patients and affect their quality of life. This study found that social support, living environment, education level, occupation, and fertility awareness were the major influencing factors of infertility stigma. An additional study in 2007 used a murine model and transplanted male-donor derived bone marrow cells into female bone marrow (21). Proof that endometrial cells can be derived from bone marrow mesenchymal stem cells comes from the study of female allogenic bone marrow transplant recipients who received marrow from a single antigen mismatched related donor, allowing the cells to be identifiable by HLA type. These cells secrete cytokines and growth factors (IL- 1,6 and 8, TNF, RANTES, VEGF) into the peritoneal milieu, which then recruit surrounding capillaries and leukocytes (17–19). In women with endometriosis there are increased numbers of leukocytes and macrophages in and around endometrial implants and in the peritoneal fluid. These include improving sperm count, regulating hormones, and boosting overall fertility. This means it might support men’s reproductive health in many ways. Early research also suggests Fertility Factor 5 might do more than just improve sperm quality. This approach can lead to better reproductive health and overall well-being. Before trying it, talk to a doctor about your health and fertility goals. Selenium helps sperm move better and protects against damage. Discussion about appropriateness of fertility‐sparing surgery should therefore balance potential risks with a realistic discussion about the chance of achieving a pregnancy on an individual basis. These women should be informed that standard surgical treatment for endometrial cancer/atypical hyperplasia has excellent survival results, but prevents fertility. Young nulliparous women with endometrial carcinoma may be interested in fertility‐sparing treatment. Once progesterone is added, estradiol treatment dose can be lowered, or switched again from the vaginal to the oral route. Our approach is to freeze embryos when a thin endometrium is noticed, and to transfer them in a natural cycle, if possible; or alternatively, in an artificial cycle, while applying increased dosages of estradiol, for as long as three weeks before progesterone is added. Similarly, treatment with low dose aspirin or vaginal sildenafil , which presumably increases blood flow to the uterus, consequently improving the response to estradiol, were rather disappointing . Treatment with high dose oral estrogen or vaginal estradiol application, intended to increase the estradiol level in the serum, as well as in the vicinity of the endometrium, has demonstrated only marginal success 22, 107. The minimal adequate endometrial thickness for successful implantation, as measured in the late proliferative phase, varies between studies, with a range of 6–8 mm. In summary, prolonged culture to the blastocyst stage appears beneficial, but whether D5 or D6 blastocysts provided optimal results requires further investigation. Overall, most evidence indicated that post-PGT transfer of euploid D5 blastocysts maximized the chances of pregnancy success. These findings further supported our research conclusion that Day 5 blastocysts might demonstrate more preeminent viability outcomes compared to Day 6 blastocysts. These are by-products of cellular respiration that are necessary for certain cellular activity, including sperm capacitation; however, an overabundance of ROS may compromise sperm function, including sperm motility, altering DNA and decreasing membrane integrity . Consuming lower amounts of both proteins and fats were more beneficial for fertility . Eating a healthy and varied diet may be a key part of maintaining good overall health. Given high rates of multiple pregnancies with gonadotropins, oral induction agents are typically preferred first line.Fertility treatments can offer hope to many couples.GH is beneficial to the repair of oocytes and quality improvement of ova in older patients because it can upregulate expression of IGF-I in the ovary and stimulate production of oocyte-derived growth and differentiation factor and bone morphogenetic protein-15 (84).The studies were assessed using the Critical Appraisal Skills Program (CASP).In fact, the association between semen quality and the amount of alcohol consumed is still controversial.They were between 23 and 32 years old with an average age of 26 years, and almost all were university students or had a university degree.It is reported that an estimated 35% of infertility cases involve only women, 20% both women and men, 30% involve problems only on the part of the man, and 15% of infertility cases remain unexplained .Also, the participants overestimated both the chances of spontaneous pregnancy and the success rates of assisted reproduction techniques.Patients with infertility International Classification of Diseases, Ninth Revision (ICD-9) diagnoses seen by a reproductive endocrinologist were included in the cohort; these patients were identified by analyzing the BMC Clinical Data Warehouse database. Women's age is considered among the most importantelements affecting the likelihood of achieving pregnancyin ART programs. In Table 1, we present a summary of factors that affectthe failure and success of IVF. The reference lists of review articles andrelevant studies were hand-searched to identify other potentially eligible studies. It utilizes clinically proven nutrients like zinc, folate, and antioxidants, which all directly influence reproductive functions. By providing an easy yet scientifically formulated product, this Supplement is becoming the go-to choice for guys seeking to naturally enhance fertility and well-being. It’s not just about increasing reproductive opportunity but also about encouraging confidence, energy, and wellness in general life. Clinic Success Metrics The women who did undergo surgery had a 25% rate of delivery and a clinical pregnancy rate of 33%, compared to 12% and 15% in the nonsurgical group (37). Specifically, submucosal and intramural fibroids had notably higher rates of spontaneous abortion, and notably lower rates of live births. However, fibroid regression after live birth has been demonstrated in 72% of women, with over a 50% reduction in fibroid volume between early gestation and 3-6 months postpartum (22). Fibroids during pregnancy are more likely to be encountered in patients who are 35 years of age and older, nulliparous, or African American (12, 18, 21). Dietary and feed supplements can improve the male reproductive performance and help eliminate infertility. Chemical elements play important roles in male reproduction because imbalance of micronutrients or macronutrients may lead to spermatogenesis defects and decreased libido, resulting in male infertility. Genetic abnormalities can lead to spermatogenic disorders and account for 15–30% of male infertility (2, 5). It seems that according to the definition of pregnancy (treatment successful), woman age, infertility duration, kind of infertility, sperm quality and pelvic surgery are important effective factors before ART treatment. Despite findings from a small study suggesting that soy supplements could improve ovulation,105 a large cross-sectional analysis with retrospective diet assessment of women participating in the Adventist Health Study found that women with the highest intake of soy isoflavones (~25 times higher than typical intake in Western populations) were 13% (95% CI 2, 26%) more likely to have never been pregnant.94 However, a prospective cohort study of pregnancy planners in the US found no relation between female urinary isoflavones (a biomarker of soy intake) and fecundity among couples trying to become pregnant (adjusted FORs ranged from 1.02 to 1.05 for a 1 log nmol/L increase in various urinary isoflavones).106 Furthermore, all published studies evaluating soy intake or phytoestrogen supplements among couples undergoing infertility treatments to date have found them to be beneficial. Some studies showed an association between obesity and decreased pregnancy and live-birth rates in infertile women seeking fertility treatments (23, 24), indicating that weight loss in these obese women can be considered an appropriate strategy before infertility treatment (3). A study found that nearly all men with low sperm counts saw benefits from ingredients in this formula. Thinking about ways to boost male fertility? Tips aim to boost reproductive health and increase conception chances. Fertility Factor 5 and its rivals offer various formulas aimed at making sperm healthier. In a qualitative study of males who are infertile and have discontinued IVF, Throsby and Gill (2004) discuss what they see as the influence of hegemonic masculine culture on spousal relations. While patriarchy may be less striking in developed societies, it is by no means irrelevant to the experience of infertility in them. Because fertility is so central to women’s identities in developing countries women and men with fertility problems may resist labeling themselves infertile (Barden-O’Fallon 2005). Bhatti et al. (1999) discuss the importance of fertility to the female role in squatter settlements in Pakistan. Conclusions and a Pragmatic Approach to Management of Fibroids Prior to IVF/ICSI This systematic review provides a comprehensive evaluation of the impact of environmental factors, particularly those related to climate change, on reproductive health and pregnancy outcomes. The review consistently highlights the significant impact of environmental factors on reproductive health, particularly among women living near high-traffic areas and those exposed to air pollutants and extreme temperatures. Women living near high-traffic areas demonstrated lower success rates in IVF, reduced implantation and live birth rates, and a higher risk of infertility, likely due to chronic exposure to traffic-related pollutants and noise. Quraishi et al. reported a significant decrease in live birth rates among women residing near major roadways, particularly those with specific infertility diagnoses like diminished ovarian reserve. Notably, there are significant differences in the reproductive outcomes when evaluating patients within different age categories; thus, emphasizing the importance of taking into account quantity as well as the quality of oocytes (Bozdag et al., 2017). As a consequence, low pregnancy and live birth rates are obtained, varying from 3% to 14% (Tarlatzis et al., 2003; Ulug et al., 2003; Polyzos et al., 2012; 2013; La Marca et al., 2015; Drakopoulos et al., 2016; Humaidan et al., 2017). Indeed, the number of oocytes retrieved during an IVF treatment is of utmost importance to overcome two critical problems related to female infertility, namely, oocyte competence and ovarian aging. This study was the first systematic review and meta‐analysis to directly compare follitropin α/β with follitropin δ, analyzing focused datasets from RCTs to assess the efficacy and safety of follitropin δ. Considering these factors, we can understand how globozoospermic cells have difficulties adhering and fusing with the oocyte membrane, ultimately causing infertility. Another absolute predictor for male infertility is the detection of globozoospermia on semen analysis. Furthermore, the Cagnacci et al. study demonstrates the diurnal variation of semen quality in human males contributing to the reported variability in semen parameters. The type of clothing a man chooses to wear, may have effects on reproductive health. Kelly-Weeder and Cox also concluded from their study that when a woman reports her health status as good, she is more likely to be fertile. Mercer et al. concluded that the low amount of males seeking treatment is most likely due to lack of awareness of treatment and guidance . Future efforts should concentrate on solidifying emerging evidence and jointly considering female and male diets. Higher intake of long chain omega 3 fatty acids appears to improve female fertility although it remains unclear whether environmental contamination of fish, their most common food source, can dampen (or even counteract) this benefit. 155, 158 “Unhealthy” diets (rich in red and processed meats, potatoes, sweets and sweetened beverages) have had the opposite relation. While concerns regarding adverse effects of maternal alcohol intake on fetal development are warranted,149, 150 as are also concerns of increased risk of pregnancy loss with caffeine intake,39, 151, 152 whether intake of these substances have a deleterious effect on the ability to become pregnant is questionable. If studies reported only per‐cycle data, we attempted to contact the study authors for per‐woman data. Where data to calculate risk ratios were not available, we utilised the most detailed numerical data available that facilitated similar analyses of included studies (e.g. test statistics, P values). Two review authors (MSK and SKS) independently assessed the included studies for risk of bias using the Cochrane 'Risk of bias' tool, according to the criteria outlined in the Cochrane Handbook for Systematic Reviews of Interventions (Higgins 2011). Where studies had multiple publications, we collated multiple reports of the same study so that each study, rather than each report, was the unit of interest in the review; such studies had a single study ID with multiple references. Two review authors (one a methodologist (MSK) and one a topic‐area specialist (SKS)) independently extracted data from the included studies using a data extraction form designed and pilot‐tested by the review authors. This raises the question of what kind of intervention and lifestyle change would be most appropriate for women with a BMI below 35.0 kg/m2. Data processing was performed separately for two groups according to the initial BMI level, namely for subjects with a BMI below 35.0 kg / m2 and a BMI above 35.0 kg / m2. During an additional literature review conducted in December 2022, 498 journal articles were screened. Meta-regression for patient-related and training variables of different subscales to predict intervention effect on pregnancy. According to a recent meta-analysis, M. Genitalium antibodies and ectopic pregnancy (80). A serological case-control study by Jurstrand and coworkers showed no significant correlation between M. Genitalium infection could constitute a major public health problem (75). The difference may stem from the disparate impact of plant and animal protein on insulin and IGF-I secretion. On the other hand, Wise et al. (66) did not confirm that the consumption of high-fat dairy is correlated with increased fecundity, and they did confirm that consuming lactose and low-fat dairy did not negatively affect fertility. Studies investigating the influence of dairy-derived fats on fertility are interesting, although the results are often contradictory. Conversely, MUFAs can bind with the PPAR-γ receptor, thus decreasing inflammation and positively affecting fertility. On the other hand, according to the study by Stanhiser et al. (60), no association was observed between concentration of ɷ-3 FAs and the probability of becoming pregnant naturally. This could allow us to avoid oocytes that would be immature and therefore responsible for fertilization, blastulation, and pregnancy failures. Furthermore, it would be conceivable to propose the idea of a time sequence of techniques that could be used in daily practice to refine the evaluation of oocyte quality before use in in vitro fertilization. For example, Raman spectroscopy was used to study oocytes in mice in a non-invasive manner. We limited this mini review to research in humans, but by extending the field to other mammals, it is possible to find new ways of exploring the human oocyte and especially metaphase II oocytes. A controlled study found no significant benefit for premature ejaculation but some measures of sexual performance can still improve. VigRX Plus users in studies reported much better hardness and satisfaction versus placebo, and most said they'd use it again. Independent reviews note that both clinical findings and user reports point to meaningful improvements, aligning with scientific and user validation. You’ll also get nutrients that target oxidative biomarkers and supply dietary antioxidants like vitamins and CoQ10 to calm damage. Feeling stuck because your sperm numbers look okay on paper but the shape and movement aren’t where they should be? In the past decade, we have seen a number of reports newly demonstrating the association of various genes with male infertility. A recent study of CNVs via SNP array demonstrated various individual CNVs in multiple male germ cell–specific genes . These studies note that infertile men usually do not have an increased number of CNVs, suggesting that their infertility is likely due to specific defects in single or multiple gene(s). Carriers of balanced aberrations are otherwise healthy but often present with infertility 15,20,21. Also, various metabolic defects (e.g., galactosemia) and mutations in mitochondrial energy pathways (POLG1 and mitochondrial DNA genes) cause toxic effects and lead to secondary female or male infertility. This review adhered to Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. A systematic search of all papers published prior to February 2017 was conducted in four electronic databases (PubMed/MEDLINE, PsycINFO, Web of Science and Cochrane Library). The patients' demographic and clinical variables for 6071 cycles during March 21, 2011 to March 20, 2014 were collected. AH and MC helped with the reviewing and editing of the manuscript. In addition to country-specific demographic characteristics (vital rates, initial age structure), the model can incorporate country-specific measures of the role of natural resources in aggregate production and the openness of the capital market. The answer to this question will be very different from simply observing the natural coevolution of fertility and economic development, because in our thought experiment we hold constant all the unobserved factors that in reality affect both fertility and economic growth. We apply the model to examine the effect of a change in fertility from the UN medium-variant to the UN low-variant projection, using Nigerian vital rates as a baseline. Dietary supplements Key advancements include the use of computer-assisted sperm analysis and DNA fragmentation testing, which enhance the accuracy and consistency of semen quality assessments across different laboratories 35-36. Artificial intelligence and machine learning algorithms are being integrated into semen analysis, offering automated and highly accurate assessments of sperm motility, morphology, and concentration. They are essential for an understanding of oxidative stress and its effects on the spermatogenic process and male fertility, as well as on the female genital organs 23-24. High-quality semen samples are accurately categorized as normal or abnormal by following the manual's comprehensive, step-by-step procedure for evaluating sperm morphology 19-20. The WHO's sixth edition manual recommends comprehensive semen analysis to diagnose fertility or infertility parameters . How Does Vigrx Fertility Factor 5 Work? Furthermore, the pooling of prevalence data is necessary for generating global and regional estimates based on the best available evidence. Limiting their findings to 12-month estimates did not fully account for this variation, a finding consistent with an earlier (non-systematic) review by Boivin et al. (2007). They attributed this heterogeneity to variation in defining the numerator and denominator and other study characteristics. Prior systematic reviews have concluded that definitional and methodological considerations influence comparisons across populations. Copper is an essential element for many metalloenzymes involved in energy or antioxidant metabolism and protects sperm cells from oxidative damage. The manganese exposure level ranged from 0.56 to 34.25 mg/L and the average concentration was 15.92 ± 8.49 mg/L among 84 male workers and 92 referents. Manganese supplementation can maintain thiol concentrations by reducing oxidative stress in human sperm and can enhance the quality and motility of sperm by activating adenylate cyclase activity (120). Women and couples of lower socioeconomic status in all racial groups also tend to encounter financial barriers to treatment (Bell, 2014; Greil, McQuillan, Shreffler, Johnson, & Slauson-Blevins, 2011). Estimates indicate that IVF results in live births in 38% of cases in the United States and 28% of cases in Europe (Baker et al., 2010). Contrary to these qualitative studies, quantitative studies do not always support the insights from the mostly clinic-based studies described. Wu et al. reported that age-affected testicular atrophy is a result of Hypothalamic-Pituitary-Testicular Axis alterations that disturb the functions of various reproductive hormones . A negative association between increasing paternal age and testicular volume was noted by several studies 35, 59. A recent study confirmed that aging reduces fertility and the numbers of Sertoli and germ cells in mice with complete absence of either catalase (CAT-null (Cat−/−) or superoxide dismutase 1 (SOD1-null (Sod−/−) . We concluded that maca is strictly required for male fertility, but not for female fertility. Macanull/null, macanull/Df, macaR1/R1, and macaR1/Df did not exhibit any significant changes in female fertility compared with the controls (S1B and S1C Fig). This maca-EGFP transgenic allele fully rescued male fertility in the macanull/null and macaR1/R1 backgrounds (Fig 2A). To confirm that male sterility is due to loss of maca, not due to any unintended secondary mutations, we tested if a maca transgene can rescue male fertility in the macanull/null and macaR1/R1 backgrounds. Sonohysterography (SHG), in which spillage of contrast from the fallopian tubes is introduced into the uterine cavity and assessed with ultrasound, can be used to assess tubal patency with a sensitivity and specificity of 76% and 67%, respectively.20 Laparoscopy with chromopertubation, in which indigo carmine is inserted transcervically into the uterus and evaluated directly for tubal spillage with laparoscopic visualization, is considered the gold standard for evaluating tubal disease. The severity of tubal abnormalities helps determine the most effective treatment. A Y chromosome defect in a man is transmissible to his male offspring, and genetic counseling should be considered before undertaking ART. VigRX Fertility Factor 5 may help sperm count, movement, and shape. You’ll hear many user experiences about better sperm motility, volume, and sex drive. Good dietary habits like zinc, selenium, and omega‑3s help sperm. The model is parameterized using a combination of microeconomic estimates, data on demographics and natural resource income in developing countries, and standard components of quantitative macroeconomic theory. Our simulation model allows for effects that run through schooling, the size and age structure of the population, capital accumulation, parental time input into child-rearing, and crowding of fixed natural resources. We assess quantitatively the effect of exogenous reductions in fertility on output per capita. Although a comprehensive search was made for existing literature regardless of date, language and peer review status, it is possible that some data were not captured. This systematic scoping review is the first to provide a broad overview of the landscape of the reported indicators of infertility and fertility care globally, and thus can act as the foundation for further work to select a core set of indicators through the identification of a consensus view across subject experts and stakeholders. The loss to follow up of ART pregnancies significantly influences the ability to report and interpret delivery rates and the number of healthy babies born at term (the gold standard for measuring ART success). In the assessment of the quality of included primary reports, we judged most reports to be of high quality, although there were some concerns related to the incomplete reporting of data from fertility clinics (Supplementary Table SIII). Several studies evaluating the impact of obesity on endometrial development, uterine receptivity, implantation, and miscarriage, have documented inconsistent results; some showed a reduction in the implantation rate among obese women (20, 44, 45), whereas others reported no such effect (41, 46).Finally, the main themes related to the topic were defined, clarified, and categorized as a comprehensive set of factors affecting the couples’ desire to have children (Table 4).One of the reasons for polygamy is to overcome infertility and increase the probability of having children.Less irritable, more engaged.The concern relating to this finding is that women may be starting IVF treatment with an unrealistic idea of how likely they are to have a baby, which in turn may limit their ability to weigh up the costs and risks of treatment against chance of success.In numerous studies, no association, or insufficient evidence, has been observed (39, 43, 53–56).This is where this Supplement comes in as a revolutionary supplement meant to enhance men’s reproductive well-being.In addition, health-care services and sexual education programmes should be more inclusive of adolescents with low socioeconomic status and young adults with low education, given the findings that suggest these groups have low FA.In traditional societies, childbirth and procreation are determinants of social status in society and the family and are seen as the main tasks of women, and women who fail to perform this responsibility are blamed and ostracized (Keskin and Babacan Güm, 2014).In 2000, an updated comprehensive meta-analysis was done, which also confirmed the falling trend in sperm count. The pooled rate of fertility desire of the higher educated participants in China (0.31) was lower than in developed countries (0.35) but higher than in developing countries (0.27). Characteristics of included studies on fertility intention among PLHIV These factors were categorized based on the level of development of the country (China, developing country, and developed country), and the relatively robust correlation factors derived from the meta-analyses were reported. In a recent review (LeBlanc, 2010) readers are urged to critically evaluate studies that have made conclusions on the association between level of milk production and fertility based on incomplete or biased datasets.A study shows that a higher number of cumulus cells undergoing apoptosis correlates with oocytes at the germinal vesicle stage or in metaphase I, meaning oocytes that are not mature (in metaphase II) .This leads to a high proportion (up to 80%) of unbalanced spermatozoa 20,21.Recent research suggests that the risk of certain cancers and of leukaemia may be increased among children born after IVF (Källén et al., 2010; Petridou et al., 2012).Written informed consent for this study was not required in accordance with local legislation and national guidelines.Similarly, there does not appear to be a significant difference in the rate of preterm birth between IVF twin vs. naturally conceived twin pregnancies, likely due to the higher risk of both hypertension and preterm birth in twin pregnancies in general.A Mediterranean diet—rich in fruits, vegetables, fish, and whole grains—improves egg quality and implantation. Geographically, three studies originated from the United Kingdom and the other three from the Netherlands, followed by two studies each from the United States and Canada. This suggests robust methodology and reporting practices in these cohort studies, enhancing the reliability of their findings. On the other hand, the NOS assessment for cohort studies resulted in consistently high scores across the studies evaluated. While some, like Nandi et al. and Goldman et al. , showed low risk in most domains, others like Van Rumste et al. and Foong et al. exhibited unclear or high risk, suggesting potential biases. Some studies showed a decreased rate of fertilization in overweight or obese women, compared to normal-weight ones (38-40), whereas others reported no such effect (41, 42). Obese women often have higher circulating levels of insulin and androgen; androgen is aromatized to estrogens at higher rates in the periphery due to the excess of adipose. Studies on polycystic ovary syndrome (PCOS) support the association of obesity with hyperandrogenism and anovulation among reproductive-aged women. Obesity impacts neuroendocrine and ovarian functions, leading to reduced ovulatory cycles and fertility rates (26). Data analysis In another study, Torkian Valashani and colleagues (2019) articulated that preventive reasons for refraining from parenthood encompass concerns about future education, employment circumstances, economic challenges stemming from raising new children, and insufficient income . Abbasi et al. (2022) demonstrated that weak cultural investment, socioeconomic status, and virtual networks, particularly the Internet, negatively impact attitudes toward parenthood . Another pivotal social factor that plays a role in this regard is couples’ housing status. Notably, individuals residing in rural areas demonstrated a greater propensity toward parenthood . As such, the goals of many family policies which have an explicitly (or implicitly) pronatalist component is to raise the fertility rate.Accidental renal abnormalities are common, and women with rudimentary horns are at increased risk of developing endometriosis or chronic pain because of hematometra (Fedele et al., 1987; Reichman et al., 2009).Scrotal ultrasonography is indicated in patients with infertility and risk factors for testicular cancer (eg cryptorchidism, atrophic testis, first-degree relative with testicular neoplasm), and can be useful in clarifying physical examination findings.The likelihood of live births and spontaneous abortions were similar in both groups.Limited by the cross-sectional study design, we need to develop more qualitative studies to explore barriers among populations who do not intend have a third child.They concluded that PCOS and IVM cycles rescued from stimulated cycles have higher implantation rates, better quality embryos, and acceptable clinical pregnancy rates. We hope that, by showing how behavioral effects that are often studied in isolation can be integrated to answer macroeconomic questions, we can reorient the academic discussion of population and development along more quantitative and practical lines. The simulation approach also permits an analysis of the strength of the various mechanisms at work. The model we build takes proper account of general equilibrium effects, the dynamic evolution of population age structure, accumulation of physical and human capital, and resource congestion. We use the United Nations (UN 2010) medium-fertility population projection as our baseline, and the UN low-fertility population projection as our alternative scenario.2 Because we want to realistically model high-fertility developing countries in which fertility will likely be falling over the next several decades, both our baseline and alternative scenarios involve falling paths of fertility; the difference is that fertility falls faster in the alternative scenario. NK cells in the uterus (uNk cells) account for over 70% of all endometrial leukocytes in early pregnancy (28, 29) and possess unique functions that differentiate them from peripheral NK cells. Though a good quality embryo is foundation for successful implantation, the state of mother is also crucial, which we will focus on, Therefore, couples trying to conceive are advised to quit drinking before pregnancy (23). Furthermore, when BMI was ≥ 30 kg/m2, patients undergoing IVF-ET had significantly decreased odds of implantation (17). Here, a good-quality embryo means day 3 embryo ≥ 8 cells, symmetric, with 8), or blastocyst with a grade ≥ 3BB (13). In our review, the majority of studies reported an estimate of the prevalence of 12-month infertility suggesting that population-level estimates can be generated globally using this definition. In contrast, we found that more studies conducted in LMIC relative to HIC used the constructed infertility measure approach, which is an indirect approach for ascertaining infertility among respondents (i.e. relies on assumptions regarding the participant’s risk of pregnancy). Pooled lifetime and period infertility prevalence estimates and multivariable odds ratios associations for region and methodological approach, adjusting for definitional factors and risk of bias. We excluded non-representative studies from the systematic review, thus the studies rated as high risk for this item represent clinic-based studies and/or studies that restricted their sample to pregnant women. Over the past 25 years, SDF’s several testing strategies have beenproposed to diagnose the aetiology of infertility. It’s testing came into existence because of the limitations of theconventional methods in explaining infertility in normozoospermic infertileindividuals. ForDNA condensation during spermatogenesis, constrained DNA nicking is required,which if increased beyond certain level results in infertility in men. Together with DNA changes introduced by oxidative damage and inflammatory cytokines, this mechanism may increase the risk of abnormal cell division, of impaired DNA replication, and of excessive telomere length interfering with the development and health of the offspring. However, Mara et al. (52) concluded that myomectomy seems to have better reproductive outcomes at least in the first 2 years.The mobile phone has been suggested as a source of damaging radiation to the male reproductive organs.Quantitative part of the study is based on the latest TDHS-2003 ever married women data.Moreover,they noted that the risk of non-live births among thosewith tubal disease and male factor was higher than thosewith unexplained infertility.Decreased manganese concentrations in seminal plasma have been reported to produce adverse effects on semen volume and normal sperm morphology.One of the studies reported the subjects’ duration of the marriage, which was ranging from 8.03 ± 4.68 to 8.47 ± 5.83 years (23).Since 2011, the FAC clinic in Copenhagen, Denmark has provided personalized fertility assessment and guidance based on clinical examination and evaluation of individual risk factors.Other parameters such as multiple births, ectopic pregnancy, gestational diabetes, placenta previa, abortion in the first trimester, abortion in the second trimester, and low birth weight were extracted from the files and compared between the two groups. Moreover, it provides objective estimation, with improved accuracy and precision of sperm morphology assay. This system can efficiently classify normal and abnormal sperm by overcoming technical variations. Different fixation and smear preparation methods are adopted for the assessment of sperm morphology. Abnormal types are categorized according to the sperm morphology, including defective head, neck, spacer, and default queue . However, it might not be an appropriate method for the assessment of sperm samples with low concentrations and volume . Morley et al, in a recent Cochrane review, found that metformin alone compared with placebo may have higher rates of ovulation, clinical pregnancy and live birth, but superiority to CC alone was inconclusive.32 New international guidelines suggest that metformin can be used alone in women with PCOS, but patients should be informed that there are more effective ovulation induction agents.10 Therefore, this review aims to explore the literature on the impact of deep endometriosis surgery on reproductive outcomes and pregnancy rates in women with and without prior proven infertility. Therefore, this review aims to explore the literature on the impact of deep endometriosis surgery on reproductive outcomes and pregnancy rates in women with and without prior infertility. These models can predict the optimal timing for embryo transfer and identify high-risk patients. The multifactorial nature of implantation requires an integrative approach to treatment. By focusing on the immunological aspects of implantation, clinicians may better address unexplained RIF and enhance pregnancy outcomes in women undergoing ART. Fine CGP represents the best OQ with the highest 2PN rate and a higher pregnancy and live birth rate compared to the others. Concerning SA alone, one study elaborates on using SA as a single tool in assessing the cellular level of the mitotic cell cycle with 113 oocytes. This study also found a significant relationship between women’s age, the basal Follicular Stimulating Hormone (FSH), and the overall clinical outcome . What is the contemporary prevalence of infertility in world populations and how do they differ by methodological and study characteristics? These include the rising importance of data augmentation, feature extraction, explainability, and the need to revisit the meaning of an effective system for fertility analysis. Therefore, more well-designed studies are needed to address the effects of male and female obesity on reproduction in different populations, in particular obese donor oocyte/sperm recipients. Several guidelines recommend lifestyle changes before infertility treatments, such as IVF (74). In addition, bariatric surgery cannot be recommended as a first-line fertility treatment for obese women. A 2022 study in Fertility and Sterility found that women over 38 needed 3–4 cycles on average for a live birth, compared to 1–2 for those under 35. This increases miscarriage risk (20% at 35, 40% at 40) and lowers implantation rates. For women under 35, IVF live birth rates are 30–35% per cycle, per CDC’s 2023 ART Report. A 2023 study in Fertility and Sterility found that smoking cessation improved embryo quality, raising success rates by 15%. That infertility is a major concern is evident from the high proportion of hospital admissions, but the care women receive is often inappropriate (Sundby et al. 1998, Sundby and Jacobus 2001). An important factor influencing the experience of infertility, even in developed societies, is access to care (Beckman and Harvey 2005). Alongside the literature on the experience of infertility exists another body of research that focuses on the experience of infertility treatment both in developed and developing societies. There is evidence that stress levels and coping strategies have an impact on sperm quality (Pook and Krause 2005, Pook et al. 1999). Guerra et al. (1998) present evidence suggesting that many infertility patients who could benefit from counseling are not referred. Males with poor quality sperm could conceive when their relative subfertility is compensated by a young female with a high probability of conception . The study analysed the semen analysis data from 1953 men from five studies across three continents. The goal of the present review is to discuss the role, reliability and limitations of semen analyses in the evaluation of infertility, as well as the disadvantages of using a single threshold value to distinguish abnormal and normal parameters. Therefore, we urge that infertility should be considered as an essential component of reproductive health policies and programmes. The government can establish a public provider to manage and treat infertility, as well as a testing centre and treatment options for sailors. Throughout, we try to demonstrate the importance of making use of non-clinic-based samples if we are to progress in our understanding of the experience of infertility. We note further that there has been progress in certain lines of inquiry, including cross-cultural studies of infertility, the possible long-term consequences of childlessness, the relationship between infertility and stress and the importance of infertility in men’s lives. He found support for the conclusion that infertility is a fundamentally different experience for women than for men. About 10 years ago Greil (1997) published a review and critique of the literature on the socio-psychological impact of infertility. Firstly, no matter how medical practitioners may define infertility, couples do not define themselves as infertile or present themselves for treatment unless they embrace parenthood as a desired social role. For the current study the paternal factors of age, race/ethnicity, and educational attainment were assessed. Mounting research has been dedicated to identifying maternal risk factors for these adverse birth outcomes. To determine the contribution of paternal factors to the risk of adverse birth outcomes. Summary of results of treatment options with regard to implantation rate, clinical pregnancy rate, and live birth rate In addition to maternal factors playing a role in RIF, male factor, particularly spermatozoal morphology also can play a part. Talking to a urologist or reproductive health expert before starting is a must. This helps the reproductive organs and may improve erectile function, supporting fertility efforts. L-Arginine supports male fertility by improving blood flow and nitric oxide levels. With zinc, selenium improves sperm quality and function. Selenium is a mineral that fights oxidative damage in sperm. Additional studies on larger populations are warranted to validate the role of protein biomarkers in the clinical practice of male infertility . Studying the seminal plasma is a novel approach that supports the management of male infertility since it is rich in protein biomarkers at a concentration of 35–55 mg/mL, with semenogelins and kallikrein 3 being two examples of highly abundant seminal proteins 70,71. Additionally, a study by Yao et al demonstrated 396, 395, and 378 microRNAs that were differentially expressed in the spermatogonia, pachytene spermatocytes, and round spermatids, respectively, between NOA and patients with obstructive azoospermia. Practically, this has helped in the understanding of several male infertility states; for instance, several genes have been identified in the context of non-obstructive azoospermia (NOA), including FANCA, PLK4, WKN3, MEI1, ADAD2, and TEX11 66,67. Fertility Factor 5 is an effective way to improve male fertility at any age. The development of artificial gametes generated in vitro has resulted in live births in animal models, although no study has reported the birth of human offspring from artificial gametes. Advances in DNA sequencing have generated large data sets that may prove useful in developing personalized treatments. While less well-studied, data suggest that semen quality also declines with age. Tobacco smoke contains several substances such as nicotine, cadmium, lead, superoxide, and hydroxyl radicals that can adversely affect reproductive health. The exact mechanisms underlying the impact of smoking on sperm quality is not completely understood. Infertile women are therefore counseled to maintain a healthy eating habit to avoid the accumulation of body fats with may impair ovulation (van Oers et al. 2016). Studies have suggested that reproductive health can be enhanced by modification of dietary intakes such as fruits and vegetables, legumes, and fish. In females, reproduction involves much greater energy expenditures than for males and as a protective mechanism against under-nutrition, ovarian activity is suppressed in women with eating disorders and exercise-induced amenorrhea through pathways in the hindbrain. Funnel plot ‐ Preganacy rate per woman randomised in poor responder group. Also, the funnel plot could indicate publication bias (Figure 10), and this can skew the results of the review. Consequently, the definitions of a 'poor responder' are varied, ranging from age to poor responders to gonadotrophin stimulation on previous IVF cycles. These included ectopic pregnancy, multiple pregnancy and congenital abnormality. Cadmium is thought to reduce sperm counts and concentration, and increase sperm DNA damage (56). It is a known reproductive toxin that is thought to disrupt the HPG axis, directly impair Leydig cell function, and induce cellular apoptosis and cytoplasmic damage within Sertoli cells through disruption of tight junctions and alteration of cell signaling pathways. However, the remaining four studies reported no associations with various parameters, aside from an association of increased BPA with decreased progressive sperm motility (50,51). Studies on the effect of BPA on human reproductive health have produced incongruent results. This systematic evaluation found no direct correlation between fertility intentions and the only child status, suggesting that the one-child policy exerted a minor role in controlling the birth rate. These findings suggested that the degree of knowledge about fertility policies may be a factor directly affecting the fertility intentions of young people of childbearing age. In terms of fertility policy, all three studies showed that a minority of young people of childbearing age were not aware of fertility policies. Of these, 9 were considered high quality, while nine studies were rated moderate. Commonly, RT carriers are healthy but have a high risk of infertility, aberrations in offspring, and spontaneous abortions. Constitutional chromosome aberrations are the most frequent cause of male infertility, detected in up to 20% of infertile men with semen defects; i.e., azoospermia, and oligozoospermia 6,11,12,15. Genetic syndromes that manifest male or female infertility are fragile X syndrome, Kartagener's syndrome, myotonic dystrophy, Noonan syndrome, Fanconi anemia, sickle cell anemia, β-thalassemia, etc. The genetic causes remain unexplained for the vast majority of male or female infertility patients. Filali et al.(89) reported a retrospective study on the efficacy of (two culture media-199 and IVM-Medicult). Culture media used in in vitro oocyte maturation is the cornerstone of IVM cycles, but trials on the efficiency of the culture media and studies to develop much better cultures are unfortunately limited. The major determinant of embryonic development is the quality of the oocyte, which is the GV oocyte in IVM. OHSS, which is a complication of IVF drugs, is a life-threatening condition and the risk is almost zero in IVM cycles, although it has been attempted to resolve the complication related to the drugs used in IVF with another drug instead of IVM. The quality and consistency of the culture media used for in vitro oocyte maturation remains a dilemma in the era of extensive gonadotropin use. Happier men and women prefer to become parents sooner (Spéder & Kapitány, 2009). The tendency to have two or three children is less in women who had a caesarean delivery (CD) compared with those who had a vaginal delivery (Kjerulff et al., 2013). The mode of the first delivery can affect childbearing intention in women. On this regard, weight excess and other conditions such as metabolic syndrome, alcohol abuse, cigarette smoking, exposure to environmental pollutants etc. have been strongly related to a decrease in sperm quality and fertility. DS marketed in Italy for male infertility frequently includes effective ingredients but also a large number of substances at insufficient doses or with no reported efficacy. Dietary supplements (DS) represent a possible approach to improve sperm parameters and male fertility. This guidance is intended for any provider evaluating women for infertility. The advent of new technologies has revealed differentialexpression patterns of various genes in testicular cellsand spermatozoa which opened a new window to maleinfertility etiology. More importantly, ARTtechniques may transmit epigenetic modifications to the next generation and cause thebirth of children with a higher risk of infertility and other congenital abnormalities.Therefore, more efforts are necessary to optimize current ART techniques. Therefore, the highly condensed structureof nucleoprotamine must be unpacked and rearranged intoa nucleosomal structure during the fertilization process.Incorrect epigenetic modifications during each stage ofthese processes can lead to severe male infertility. Mutations in calcium/calmodulin-dependent protein kinase 4 (CaMK4),which is involved in phosphorylation of protamine 2,causes impaired spermiogenesis and consequently, maleinfertility (56). The morphokinetic, cleavage and embryoquality was found to decrease when SDF is greater than 15% (Wang et al., 2022).Couples undergoing ART with male partners having low sperm DNA high birthrates (Osman et al.,2015). Both the guidelines recommended SDF testing, in cases of unexplainedinfertility, varicocele, RPL (recurrent pregnancy loss), failed but unexplainedIntra-Uterine Insemination (IUI), IVF and ICSI and in patients exposed to lifestylerisk factors and environmental toxicants (Agarwalet al., 2020; Esteves et al., 2021). Cooper et al.(2010) elaborated conventional semen analysis to be a crucial diagnosismethod for male infertility factors all across the world. Male infertility is a great matter of concern as out of 15% of infertile couplesin the reproductive age, about 40% are contributed by male factors alone. Similarly, the presence in the cervical flora of Gram-negative bacteria, Chlamydia trachomatis and Gardnerella vaginalis, and the eventual coexistent lack of Lactobacillus is linked with infertility condition. A complex interaction of the Lactobacillus species plays a pivotal role for the equilibrium of the normal vaginal flora and in particular appropriate levels of Lactobacillus crispatus are involved as protective factor for asymptomatic BV (mostly sustained by Ureaplasma and Gardnerella vaginalis) that is recognized as a potential impairing factor of fertility. The available data suggest a not negligible role of the genital microbiome in infertile women and further, dysbiosis and the lack of Lactobacilli can potentially impair ARTs and partially explain implantation failures. These couple of studies represent a proof of concept for the characterization of the microbiome at the time of embryo transfer and could potentially be prospectively employed to understand the need of probiotics in a subsequent successful pregnancy event. In our simulations, we use labor force participation rates reported by the International Labour Organization (2011) for Nigeria in 2005. Where Ni,t is the number of individuals of age i in the population in period t, LFPRi,t is their labor force participation rate, and hi,ts and hi,te are, respectively, their levels of human capital from schooling and experience. We model an individual's effective labor as a function of his or her age-specific labor force participation rate and level of human capital. We consider the sensitivity of our results to both the share of land in national income and the elasticity of substitution between land and other factors of production. The factor inputs are land (which we use as a short hand for all fixed factors of production), physical capital, and effective labor, so that aggregate output in period t, Yt, is In addition, valid informed consent must be granted by patients through suitable legal frameworks for data protection. Obesity and metabolic syndrome are known to have a negative impact on fertility in both men and women, even after using ART 87,88,89. Idiopathic or unexplained infertility affects 30% of couples worldwide. In addition, there is multimodal SA that uses data from SA video frames, patients’ serum levels of sex hormones, lifestyle habits, and semen parameters, so these data sets will be very practical for applying AI to investigate patterns that lie within . Due to release from negative feedback on the hypothalamus, and temporary increase of intraovarian androgens, an increase in pituitary secretion of FSH, and follicular sensitivity to FSH occur, with subsequent improved ovulatory rates (Fig. 2).28 Preferably, randomized controlled trials and systematic reviews including randomized controlled trials and/or cohort studies were included. It is hypothesized that PCOS results from a vicious circle of androgen excess favoring abdominal and visceral adipose tissue deposition, that induces insulin resistance (IR) and compensatory hyperinsulinemia, further facilitating androgen secretion by the ovaries and adrenal glands.4 This cyclical pathogenetic interaction between IR, hyperinsulinemia, and hyperandrogenism, in combination with hypothalamic-pituitary dysfunction, leads to further ovarian dysfunction that can result in anovulation and infertility.4 Using the aforementioned good and poor genetic prognostic factors, we can make more confident decisions on FST in ES-EC.