DR. ELIRAN MOR, MD

 Studies demonstrate an increased risk for active disease during pregnancy if active disease is present at conception.33 Because active disease in pregnancy is associated with a higher risk of complications, it is important to counsel patients on the importance of achieving remission even before conception. Additionally, patients with IBD may have misperceptions about safety of medications during pregnancy and may discontinue or decrease their medications once they conceive, which increases the risk of IBD flare. For these reasons, preconception counseling for patients with IBD is essential, and can optimize disease control during conception and throughout pregnancy with the goal of reducing disease-related maternal and birth complications. We recommend that patients undergo endoscopic restaging before conception with the goal of endoscopic remission at time of conception. In addition to preconception counseling by the gastroenterology provider, all patients with IBD should have a consultation with a high-risk obstetrician or maternal and fetal medicine provider to discuss the routine management of ulcerative colitis during pregnancy, the safety of medical therapy, and a management plan in case bowel disease worsens in the setting of pregnancy.

 Rates of infertility, defined as the inability to conceive within 1 year of having unprotected intercourse, in people with ulcerative colitis are overall similar to the general population. For those females with ulcerative colitis who are unable to conceive, studies suggest that infertility treatments (such as in vitro fertilization) are successful at similar rates to the general population,34 including in those patients with a history of IPAA.35

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 More couples are delaying childbearing, which unfortunately can negatively influence the health of their child. Using reproductively old mice at 12 months old, we examined the characteristics of the offspring of older mothers at birth, and then followed them to adulthood and measured markers of adult health, namely growth, glucose tolerance, immune function and behaviour. This study provides insights into how maternal age influences the health and development of their offspring. Image by Macarena B. Gonzalez.

 The optimization of sperm freezing and storage program has an important impact on reducing breeding costs, improving reproductive efficiency, overcoming reproductive diseases, and protecting germplasm resources. In this paper, we have included two potential additives, sodium alginate (SA) and bovine serum albumin (BSA), which can effectively improve sperm motility after cryopreservation. This is of great significance for improving the quality of pig semen, improving reproductive ability and the development of modern pig breeding industry. Image by Jing Wang using Figdraw.

 In the past decade, flow cytometry has emerged as a crucial tool for assessing cellular viability in non-domestic animals, including non-human primates, marine life, and birds. Its application in sperm-quality assessments could revolutionize how we evaluate sperm concentration and viability, enhancing efficiency and reliability. This study validated the effectiveness of flow cytometry in assessing amphibian sperm, demonstrating its viability when compared with traditional, time-consuming methods. Such advancements highlight the potential of flow cytometry to significantly streamline conservation efforts for amphibians. Photograph by Ingrid Niesman, SDSU EM Facility.

 To clarify mechanisms of age-related infertility, we evaluated the decreased expression of CSF2, one of the most extensively studied embryokines, in aged bovine uteri compared to young ones. We observed suppressed CSF2 expression and increased myofibroblasts, which may contribute to fibrosis, in the uterine epithelium of older cows compared to young heifers. These findings suggest that decreased CSF2 alongside fibrosis may play crucial roles in age-related infertility, opening avenues for further research into potential therapies targeting fibrosis in reproductive health. Image by Hiroya Kadokawa.

 Exercise is suggested to have a beneficial role in improving the declining fecundity in humans, which is partly due to poor sperm parameters. Literature reports on the benefits of exercise for male reproductive function are, however, equivocal. This review summarises some of the reports and concludes that low-to-moderate intensity exercises, particularly those that do not increase testicular temperature or oxidative stress, are beneficial to male reproductive function. Image by authors

 Subfertile cows that get pregnant late in the breeding season are less productive. We found that fertile cows had more fat and muscle, greater circulating concentrations of metabolic hormones, healthy follicles with more granulosa cells and higher insulin-like growth factor 1 in the follicular fluid. Fertile cows had fewer circulating concentrations of progesterone but the sensitivity of the endometrium to progesterone and adiponectin was greater than in subfertile cows. Fertility was associated to the cow metabolism, that regulates uterine function to reduce embryo losses. Diagram adapted from Meikle et al. (2018).

 Plant extracts can be an alternative to treat some female infertility. Female fertility is a complex process regulated by hypothalamic–pituitary-ovarian unit involving both negative and positive feedback mechanisms. Because this hypothalamo–pituitary-ovarian axis is crucial in the regulation of female fertility, this review highlights mechanisms of action of various plant extracts on this axis. Diagram by J. Dupont using BioRender software.

 In this review, we explore the limitations on current genetic testing methods for embryos used in assisted reproductive technologies. We highlight the need for new solutions to address these clinical and technological challenges. Furthermore, we discuss a promising approach, metabolic imaging, which could potentially meet these clinical needs and improve the current issues faced by genetic testing for embryo selection. Image by Fabrizzio Horta.

 Resistin belongs to adipokines – the group of hormones secreted mainly by the adipose tissue that can regulate not only energy homeostasis but also reproductive functions. We determined the presence of resistin in the uterus and its impact on the uterine steroidogenesis of pigs, an important farm animal. The obtained results suggest that resistin may interconnect metabolism and reproduction, and in the long-term perspective, these results may help improve farm animal breeding efficiency. Image by the authors

 This study explores how a mother’s physical activity and diet during pregnancy can shape the long-term health of her offspring, using a rat model. We found that swimming during pregnancy helped protect against weight gain in the offspring, but when combined with a high-fat, high-sugar diet after birth, it disrupted important antioxidant defenses in the offspring’s ovaries. These findings highlight the complex impact of maternal habits on the future health of the next generation. Image by Cristiane Matté using BioRender.

 Poor egg (oocyte) quality is a leading cause of reduced fertility in humans and animals. Large vesicles within oocytes appear to be important for oocyte quality in animals but their composition is unknown. Our study has identified that these vesicles, which appear empty in electron micrographs, contain lipid that differs to that contained in classical lipid droplets. This knowledge may be used to improve in vitro maturation media to enhance oocyte quality. Image by K L Reader.

 Bacteria and human spermatozoa share similar surface proteins. This unexpected connection could be key to understanding certain types of unexplained infertility. This study found that a bacterial protein, sperm immobilization factor (SIF), can damage spermatozoa by binding to it. This protein also binds to the bacteria Shigella flexneri. By isolating the SIF binding receptor from Shigella flexneri, this study opens new avenues for treating infertility, offering hope for many affected couples. Diagram by Thomson Soni and Vijay Prabha.

 Understanding the intricate dance of hormones in the ovaries is crucial for women’s health and fertility. This review highlights the roles of two short peptides, endothelin-1 and endothelin-2, which govern the life cycle of the corpus luteum – a key gland for maintaining pregnancy. Our findings reveal that while endothelin-2 promotes the formation of this gland, endothelin-1 triggers its demise, together shedding light on the control and regulation of the reproductive cycle and potential treatments for reproductive disorders. Diagram by Magdalena Szymanska, Raghavendra Basavaraja and Rina Meidan.

 Identifying methods to improve animal health, production, and resilience is critical to create a sustainable food supply to meet global nutritional demand. Recent advancements in gene editing tools, cell culture methods, and in vitro phenotyping can accelerate the identification of variants or novel alleles that are transformative for livestock health and resilience. The use of organoids and gene editing can provide a model to link the genome to the phenome and decrease the number of animals needed for research. Image by Eun Su Jeon and the University of Missouri Molecular Cytology Core.

 We acknowledge the Traditional Owners of the land, sea and waters, of the areas that we live and work on across Australia. We acknowledge their continuing connection to their culture, their contribution to our shared knowledge, and pay our respects to their Elders past and present.

 BMJ Sexual & Reproductive Health is an international journal that promotes evidence-informed practice for contraception, abortion and all aspects of sexual and reproductive health. The journal publishes research papers, topical debates and commentaries to shape policy, improve patient-centred clinical care, and to set the stage for future areas of research. It is the official journal of the Faculty of Sexual and Reproductive Healthcare.

Dr Eliran Mor

 Selected categories of FSRH members have online access to the journal included in their membership. For full text access to the journal, please log in to the members' area of the FSRH website and follow the links to the journal.

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 Infertility affects 1 in 6 people1. With 1/3 of infertility problems caused by female factors, 1/3 male factors, and 1/3 that remains unexplained or due to both partners2, or factors that cannot be determined, every situation is unique. While nearly 56% of those facing infertility reach out for help, only 22.4% get the specialised care they need for treatments like in vitro fertilisation (IVF)3. That’s why having a well-rounded fertility team is so important. This group—made up of fertility specialists, nurses and other experts—works together to provide the personalised support and advice that can make all the difference in someone’s journey to parenthood. By teaming up, they can help to tackle the ups and downs of infertility, offering hope and practical solutions to those looking to start or grow their families.

 Knowing when to visit a reproductive health professional can make a big difference in starting the journey towards parenthood. If a couple has been trying to conceive for 12 months without success—or for 6 months if they are over 35—it’s a good idea to seek help11.

 Women should also visit a doctor if they have irregular, absent, or painful periods, have experienced one or more miscarriages, or show symptoms of conditions like endometriosis or polycystic ovary syndrome (PCOS)5. For men, it's important to consult an andrologist if they’re facing any sexual health issues, urological conditions, or hormonal imbalances that could affect fertility12.

 On the path to fertility treatment, a team of professionals — like fertility specialists, nurses, embryologists, and andrologists—come together to offer holistic care. Each specialist brings their own expertise, making sure every part of the fertility journey is supported. From diagnosing the cause of infertility to guiding you through treatments like IVF, this multidisciplinary approach helps to tailor the treatment plan to each person’s unique needs.

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 The Journal of Family and Reproductive Health (JFRH) is the quarterly official journal of Reproductive Health Research Center, Tehran University of Medical Sciences. This journal features fulllength, peer reviewed papers reporting original research, clinical case histories, review articles, as well as opinions and debates on topical issues. Papers published cover the scientific and medical aspects of reproductive physiology and pathology including genetics, endocrinology, andrology, embryology, gynecologic urology, fetomaternal medicine, oncology, related infectious disease, public health, nutrition, surgery, menopause, family planning, infertility, psychiatry–psychology, demographic modeling, perinatalogy–neonatolgy ethics and social issues, and pharmacotherapy. A high scientific and editorial standard is maintained throughout the journal along with a regular rate of publication.

 Maria Isabel do Nascimento , Lara Miranda Marchesi ORCID , Wender Emiliano Soares ORCID , Jenaine Rosa Godinho Emiliano ORCID , Maria Auxiliadora Nogueira Saad ORCID , Glaucimara Gonzaga Nunes Hacar ORCID , Gabriel Eijiro Chiracava ORCID

 Fatemeh Golshahi ORCID , Fatemeh Rahimi-Sharbaf ORCID , Mahbobeh Shirazi , Sara Saeedi , Athar Abdolrazagh Nejad , Sahar Garfami , Nafise Saedi , Jafar Golshahi ORCID , Zeynab Amiriarya , Narjes Tavakolikia , Behrokh Sahebdel ORCID

 Approximately 10 to 15% of couples are impacted by infertility. Recently, the pivotal role that lifestyle factors play in the development of infertility has generated a considerable amount of interest. Lifestyle factors are the modifiable habits and ways of life that can greatly influence overall health and well-being, including fertility. Many lifestyle factors such as the age at which to start a family, nutrition, weight, exercise, psychological stress, environmental and occupational exposures, and others can have substantial effects on fertility; lifestyle factors such as cigarette smoking, illicit drug use, and alcohol and caffeine consumption can negatively influence fertility while others such as preventative care may be beneficial. The present literature review encompasses multiple lifestyle factors and places infertility in context for the couple by focusing on both males and females; it aims to identify the roles that lifestyle factors play in determining reproductive status. The growing interest and amount of research in this field have made it evident that lifestyle factors have a significant impact on fertility.

 It has been estimated that 7.4% of women and their husbands in the United States are infertile [1] and that the number of infertile people in the world may be as high as 15%, particularly in industrialized nations [2]. Decreasing the number of people affected by infertility has become a top priority for many health organizations, including Healthy People 2020 [3]. Lifestyle factors can be modified to enhance overall well-being and they are ultimately under one’s own control. They play a key role in determining reproductive health and can positively or negatively influence fertility.

 The goal of this review is to demonstrate the potential effects of multiple lifestyles on reproductive health for both men and women. The review focuses primarily on modifiable lifestyles including the age when starting a family, nutrition, weight management, exercise, psychological stress, cigarette smoking, recreational drugs use, medications, alcohol use, caffeine consumption, environmental and occupation exposure, preventative care, clothing choices, hot water, and lubricants. While many aspects of life are not modifiable, lifestyles may be changed.

 The age of a man or woman is a factor among others that can affect fertility. Due to pursuit of education and other factors, many couples are choosing to delay child-bearing. Fertility peaks and then decreases over time in both men and women, thus the reproductive timeline may be one aspect to consider when determining the ideal time to start a family. As men age, testosterone levels begin to decrease and hypogonadism results. However, if testosterone is used to treat hypogonadism, it can suppress spermatogenesis [4]. Semen parameters also begin a steady decline as early as age 35 [5]; semen volume and motility both decrease and morphology may become increasingly abnormal [4,6]. After the age of 40, men can have significantly more DNA damage in their sperm, as well as decline in both motility (40%) and viability (below 50%) (n = 504, p < 0.001) [7]. There may also be an increase in time to pregnancy with an increase in male age [8]. Hassan and Killick reported that when men were over the age of 45, their partner’s relative risk of an increase in time to pregnancy over one year increased to 4.6, and over two years increased to 12.5 (n = 1832, CI = 24.5-38.1) [9]. The authors also noted that the older population tended to consume more alcohol, have intercourse less often, had longer contraceptive usage, and smoked less cigarettes which could have been confounding factors. Another study found that there are also exponentially fewer infants born to fathers ≥35 to 39 years of age and older compared to younger age groups even when controlling for female age (n = 122,061) [10].

 The reproductive timeline for women is complex. A woman is born with all the oocytes she will ever have, and only 400–500 are actually ovulated [6]. As the number of oocytes decline, a woman’s menstrual cycle shortens, infertility increases, and menstrual irregularity begins 6–7 years before menopause. Increasing age increases a woman’s time to pregnancy. When under the age of 30, a woman’s chances of conceiving may be as high 71%; when over 36, it may only be 41% [8]. The chances of becoming pregnant and being able to maintain a pregnancy are also affected. Matorras et al. reported that in a population of women, the number of infants born begins to exponentially decrease after the age bracket of 35–39 (n = 89,287) [10]. The odds of becoming pregnant and maintaining a pregnancy are believed to be connected to numerous factors, including euploidy. Euploidy has been found to be inversely correlated with female age (P < .01; n = 544) [11]. Another study reported that the rate of aneuploidy for women over 35 was 45.7% versus 34.8% for women under 35 (n = 352, p = .018) [12]. In comparison, Munné et al. reported the rates of euploidy decrease 50% for women under 35, decrease 40% for women between the ages of 35 and 40, and decrease 33.3% for women over 40 [13]. In addition, chromosomal abnormalities and aneuploidy may increase the risk of spontaneous abortion and implantation loss with increasing age [4,6]. Overall, women’s fertility is significantly lower in the 30s and 40s [6].

 Aspects of a male’s diet may have an impact on his fertility. Consuming a diet rich in carbohydrates, fiber, folate, and lycopene [14] as well as consuming fruit (OR 2.3) and vegetables (OR 1.9) [15] correlates with improved semen quality. Consuming lower amounts of both proteins and fats were more beneficial for fertility [14]. Another potential benefit could be antioxidants, which play a pivotal role in the body by scavenging reactive oxygen species (ROS). Reactive oxygen species or ROS are a collection of free radicals and non-radical derivatives of oxygen such as superoxide anion (O2• -), hydrogen peroxide (H2O2), hydroxyl radical (OH•). This category also includes free radicals derived from nitrogen called reactive nitrogen species such as: nitric oxide (NO•), nitric dioxide (NO2•), peroxynitrite (ONOO-). Collectively they are termed as reactive oxygen species. 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 [16]. Antioxidants are molecules such as albumin, ceruloplasmin, and ferritin; and an array of small molecules, including ascorbic acid, α-tocopherol, β-carotene, reduced glutathione, uric acid, and bilirubin or enzymes superoxide dismutase, catalase, and glutathione peroxidase. Antioxidants help remove the excess ROS in the seminal ejaculate and assist in the conversion of ROS to compounds that are less detrimental to cells. If there is more ROS than the local antioxidants can remove, it results in oxidative stress. Oxidative stress can result in sperm protein, lipid and DNA damage and sperm dysfunction [16]. However, there have been some disputes when it comes to research outcomes. Mendiola et al. demonstrated that vitamin C, but neither vitamin E nor selenium, had significant effects on semen quality (n = 61, p < 0.05) [14]. A high amount of antioxidants has been demonstrated to increase semen quality, compared to low or moderate amounts [17]. Another study reported that vitamin E and selenium decreased levels of malondialdehyde (MDA), a marker for damage done by reactive oxygen species, more so than did vitamin B [18]. Suleimen reported that Vitamin E decreased MDA levels, increased spermatozoa motility, and led to 21% couples conceiving over a 2.5 year period versus no conceptions in men who took a placebo (n = 52) [19]. An article reviewing previous studies on antioxidants concluded almost every study conducted pertaining to DNA damage and oxidative stress revealed that antioxidants caused significant improvement, particularly in asthenospermic patients [20]. A Cochrane review including 34 studies, determined that men who use oral antioxidants had a significant increase in live birth rate (OR 4.85; CI 1.92-12.24; P = 0.0008; n = 214) when compared to control [21]. Antioxidants were also associated with a significant increase in pregnancy rate when compared to control (OR 4.18; CI 2.65-6.59; P < 0.00001; n = 964) [21].