Spermatozoon is a motile cell with a special ability to travel through the woman’s reproductive tract and fertilize an oocyte. To reach and penetrate the oocyte, spermatozoa should possess progressive motility. Therefore, motility is an important parameter during both natural and assisted conception. The global trend of progressive reduction in the number and motility of healthy spermatozoa in the ejaculate is associated with increased risk of infertility. Therefore, developing approaches for maintaining or enhancing human sperm motility has been an important area of investigation. In this review we discuss the physiology of sperm, molecular pathways regulating sperm motility, risk factors affecting sperm motility, and the role of sperm motility in fertility outcomes. In addition, we discuss various pharmacological agents and biomolecules that can enhance sperm motility in vitro and in vivo conditions to improve assisted reproductive technology (ART) outcomes. This article opens dialogs to help toxicologists, clinicians, andrologists, and embryologists in understanding the mechanism of factors influencing sperm motility and various management strategies to improve treatment outcomes.

Fertility preservation (FP) is a vital issue for individuals in either reproductive or prepubescent stage of life when future fertility may be compromised. The objective of any FP intervention is to minimize or eliminate primary disease burden and to ensure maintaining or preserving reproductive health. Fertility potential can be affected by cancer therapy and numerous other factors, including advancing age, metabolic conditions, autoimmune diseases, specific surgical interventions, and sex affirmation procedures. A paradigm shift focusing on quality-of-life issues and long-term survivorship has emerged, especially because of advances in cancer diagnostics and treatment. Several FP techniques have been widely distributed, while others are still in the research stage. In addition, specific procedures and some potentially fertoprotective agents are being developed, aiming to minimize the hazards of gonadal damage caused by cancer therapy and decrease the need for more costly, invasive, and time-consuming FP methods. This review highlights the advances, indications, and options for FP, both experimental and well-established, in females of various age groups. An electronic search in PubMed, Embase, and Google Scholar databases was conducted, including retrospective studies, prospective clinical trials, meta-analyses, original reviews, and online abstracts published up to June 30, 2019. The search terms used included fertility preservation, oncofertility, embryo cryopreservation, oocyte cryopreservation, and ovarian tissue cryopreservation. The meeting proceedings of the American Society for Reproductive Medicine and the European Society of Human Reproduction and Embryology were also hand searched.

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Background: Thin endometrium could be a major contributing factor in decreasing pregnancy rates with in-vitro fertilization. Several treatments have been studied in patients with thin endometrium, like hormonal therapy by GnRH-agonist and estrogen. Additionally, vasoactive measures like aspirin, a mix of pentoxifylline, vitamin E, l-arginine, sildenafil, and intrauterine infusion of a growth factor such as G-CSF, and the recent application of regenerative medicine were reported in previous trials. Main body of the abstract: We discuss here a new modality for thin endometrium treatment using platelet-rich plasma (PRP) administered as an intrauterine infusion. The purpose of this review is to evaluate the effectiveness of PRP in cases of infertility. All relevant articles addressing the use of PRP, published from January 2000 to September 2018, were reviewed and analyzed. The studies published on the PRP treatment model for thin endometrium in the gynecology field were mainly case series, pilot studies, or case reports. Conclusion: In the current review, we found that the local administration of PRP is significantly effective in increasing pregnancy rates of infertile women with thin endometrium < 6 mm.

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Purpose Fertility is a quality of life outcome adversely affected by cancer therapy. Many childhood cancer patients, however, are not offered options to preserve their fertility. Providers acknowledge difficulty discussing impaired fertility to patients due to lack of knowledge of available options. Our objective was to review the impact of a pediatric multidisciplinary fertility preservation program on providers' fertility preservation counseling and discussion of options. Methods A retrospective medical chart review was conducted for pediatric cancer patients prior to and following program establishment. Fertility preservation discussions, consults, and incidence were noted. Following filtering and stratification, 198 and 237 patients were seen prior to and following program establishment, respectively. Results Following program establishment, provider-patient discussions of impaired fertility (p = 0.007), fertility preservation consults (p = 0.01), and incidence of fertility preservation procedures (p < 0.001) increased among patients. Furthermore, the number of patients who received fertility preservation consults after receiving gonadotoxic treatment decreased (p < 0.001). This trend was particularly noted in pre-pubertal and female patients, for whom fertility preservation options are limited without an established program. ConclusionThe establishment of a formal program greatly improved access to fertility preservation consults and procedures in children with cancer.

To determine the effectiveness of personalized embryo transfer (pET) versus frozen embryo transfer (FET) or fresh embryo transfer (ET) in infertile patients undergoing IVF at their first appointment. In pET, embryo transfer is performed within the optimal window of implantation identified by the endometrial receptivity analysis (ERA).DESIGN: Multicenter randomized clinical trial. Participants aged % 37 years scheduled for IVF with elective blastocyst transfer at the first appointment were randomized to undergo pET, FET or ET.MATERIALS AND METHODS: Setting: 16 reproductive medicine centers in Europe, America and Asia with a common reference genetic laboratory.Patient(s): We recruited 569 women, and 458 were randomly assigned to pET (N¼148), FET (N¼154), or ET (N¼156) groups.Intervention(s): The ERA test was performed using hormone replacement therapy guiding embryo transfer in the pET arm. Blastocyst vitrification was performed in the pET and FET arms. Blastocyst transfer in all groups.Main outcome measure(s): The primary outcome was live birth. Secondary outcomes were pregnancy and implantation rates as well as clinical miscarriage, biochemical pregnancy, and obstetric and neonatal outcomes. We performed intention-to-treat and per protocol analyses.RESULTS: In the per protocol analysis, live birth rates at the first embryo transfer were 45 of 80 (56.2%) in the pET group, 39 of 92 ( 42.4%) in the FET group, and 43 of 94 (45.7%) in the ET group (pET versus FET relative risk [RR] 1.35, 95% confidence interval (CI) 0.97-1.86; p¼0.09; pET versus ET [RR] 1.26, 95% (CI) 0.91-1.74; p¼0.17). Cumulative live birth rates after 12 months were 57 of 80 (71.2%) in the pET group, 51 of 92 (55.4%) in the FET group, and 46 of 94 (48.9%) in the ET group (pET versus FET [RR] 1.47, 95% (CI)1.01-2.13; p¼0.04; PET versus ET [RR]1.71, 95% (CI) 1.17-2.49; p¼0.003).Pregnancy rates at the first embryo transfer in the pET, FET and ET were 72.5%, 54.3% and 58.5% respectively (RR 1.56 pET versus FET, 95% CI 1.07 to 2.29, p¼0.01; pET versus ET 1.42, 0.98-2.08, p¼0.05). Implantation rates at the first embryo transfer were 57.3%, 43.2% and 38.6%, respectively (pET versus FET RR 1.37, 95%CI 1.03-1.82, p¼0.03; pET versus ET RR 1.54, 95%CI 1.15-2.05, p¼0.004).No differences between groups were found for clinical miscarriage, biochemical pregnancy or any other secondary outcomes. Obstetrical outcomes, type of delivery and neonatal outcomes were similar in all groups.CONCLUSIONS: In this RCT, we found a statistically significant improvement in cumulative live birth rates in pET compared to FET and ET. Pregnancy and implantation rates after pET over FET and ET at first attempt as well as in cumulative rates were significantly higher. These findings indicate the potential of pET with the ERA test at the first appointment that should be confirmed in larger randomized clinical trials. (ClinicalTrials. gov NCT 01954758).