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Introduction: Poweromin X Ten (PXT) is a polyherbal formulation, traditionally used to enhance male sexual function. However, the safety and benefits of PXT have not been scientifically evaluated. Therefore, the present study investigated the toxicity and aphrodisiac potential of PXT in male rats and explored its principal mechanisms of action. Methods: Male Wistar rats were orally administered PXT (50 or 100 mg/kg) for 28 days, and sexual activity parameters, including latency and frequency of mounting and intromissions, were studied. The reproductive toxicity and spermatogenic potential were also examined. Furthermore, dopamine and serotonin levels in brain regions associated with sexual activity were assessed. Network analysis was used to identify the key bioactive compounds and their core targets involved in their beneficial actions. Results: Treatment with PXT improved sexual activity in male rats, as evidenced by reduced mounting and intromission latency and a significant increase in mount frequency. Moreover, PXT exhibited spermatogenic potential and did not induce reproductive toxicity. Notably, treatment with 50 mg/kg PXT elevated dopamine levels in median preoptic area and hypothalamus. Pathway analysis indicated that PXT primarily modulated the PI3K-Akt, calcium, and MAPK signalling pathways to enhance male sexual function. Network analysis identified macelignan, ß-estradiol, testosterone, and paniculatine as key bioactive components of PXT, which likely act through core targets, such as androgen receptor (AR), Mitogen-activated protein kinase 3 (MAPK3), epidermal growth factor receptor (EGFR), estrogen receptor 1 (ESR1), and vascular endothelial growth factor (VEGF) to facilitate the improvement of male sexual function. Conclusion: Study results suggest that PXT is a safer alternative with aphrodisiac and spermatogenic potential. These effects are partly attributed to the enhanced dopamine levels in the brain. Furthermore, this study provides insights into the specific signalling pathways and bioactive compounds that underlie the improvements in male sexual function associated with PXT.

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Microplastics and phthalates are prevalent and emerging pollutants that pose a potential impact on human health. Previous studies suggest that both microplastics and phthalates can adversely affect the reproductive systems of humans and mammals. However, the combined impact of these pollutants on the female reproductive system remains unclear. Here we show the impacts of exposure to polystyrene microplastics (PS-MPs) and di-2-ethylhexyl phthalate (DEHP) on female Sprague-Dawley rats' reproductive systems. We find that co-exposure to PS-MPs and DEHP results in a marked increase in cystic and atretic follicles, oxidative stress, fibrosis, and dysregulation of serum sex hormone homeostasis in the ovaries of the rats. Proteomic analysis identified differentially expressed proteins that were predominantly enriched in signaling pathways related to fatty acid metabolism and tight junctions, regulated by transforming growth factor ß1 (TGF-ß1). We further confirm that co-exposure to DEHP and PS-MPs activates the TGF-ß1/Smad3 signaling pathway, and inhibiting this pathway alleviates oxidative stress, hormonal dysregulation, and ovarian fibrosis. These results indicate that exposure to the combination of microplastics and phthalates leads to a significant increase in atretic follicles and may increase the risk of polycystic ovary syndrome (PCOS). Our study provides new insights into the reproductive toxicity effects of microplastics and DEHP exposure on female mammals, highlighting the potential link between environmental pollutants and the occurrence of PCOS. These findings highlight the need for comprehensive assessments of the reproductive health risks posed by microplastic pollution to women and contribute to the scientific basis for evaluating such risks.

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Based on an adapted version of the conceptual framework used by the Guttmacher-Lancet Commission on Sexual and Reproductive Health and Rights (SRHR), this study sought to analyse to what extent seven global agencies, five of which belong to the UN family and the other two closely linked, incorporate women's autonomy and freedom of choice in accessing services into their SRHR policies, and how they operationalize these in their global SRHR programmes that target women and adolescent girls. Twenty-nine SRHR-related policy documents published in 2013-2020 and 17 independent evaluations of global SRHR programmes in the same period were analysed. They were found to fall short of considering women's individual autonomy and choice as the two core principles of SRHR. By ignoring autonomy and choice, global SRHR programmes missed the opportunity to incorporate activities that could enhance the emancipatory empowerment of women and girls to improve their sexual and reproductive wellbeing. The study identified concrete aspects on which global agencies, in view of their respective mandates, could have pronounced themselves more explicitly and might have been more effective in implementing SRHR programmes. In light of the international gender equality and women's empowerment discourse this suggests that donor countries could hold global agencies more accountable, bilaterally or jointly, for their SRHR performance, in particular their active endorsement and application of SRHR core principles.

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Objective: In the age of digital health, mankind has resources to write over the historical narrative of queer individuals' healthcare exclusions. The main purpose of this study was to explore the perspectives of both healthcare providers (HCPs) and queer individuals regarding the use of web-based tools and mobile health applications (mHealth apps) in the context of addressing queer individuals' sexual and reproductive health services and needs (SRHSN). Methods: An overall study was conducted as an exploratory sequential mixed method. This article provides findings from the performed qualitative cycle. The selection method was led by purposeful sampling, which targeted 33 HCPs delivering SRHSN within the defined study settings. Additionally, respondent-driven sampling was employed to select 22 queer individuals. Throughout the study, semi-structured one-on-one face-to-face interviews were used to collect data. Results: Four major themes and related sub-themes emerged from HCPs and queer individuals: (a) aid queer individuals with consultations and treatment improvements, (b) drawing parallels with technology in other sectors, (c) enhancing knowledge and education, and (d) positive perception of technological advancements. Conclusions: In accordance with our findings, HCPs and queer individuals were all positive and sees mHealth apps as a tool to address SRHSN for homosexual people.

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BACKGROUND: The increasing incidence of papillary thyroid carcinoma (PTC), particularly among women, has prompted an investigation into possible associated factors. The effect of oral contraceptive pill (OCP) usage is debatable, with varying and often conflicting results. It is not confirmed whether OCPs have a protective effect against thyroid cancer or an increased risk. OBJECTIVE: The objective of this study is to investigate the prevalence of OCP usage among females diagnosed with PTC at a tertiary hospital in Saudi Arabia. METHODS: The study included females aged 18 and above diagnosed with PTC. An OCP user was defined as a female exposed to OCPs for at least one month. Data collection involved chart reviews and phone interviews, and statistical analyses were conducted using Excel and SPSS. RESULTS: Among 58 female patients diagnosed with PTC, 29.3% (n=17) reported using OCPs, and 70.7% (n=41) were non-users. The ages of OCP users ranged from 26 to 56 years, with a median age of 44 years. The duration of OCP usage varied from 1 to 72 months, with a median duration of seven months. Additionally, for the non-users of OCPs, the age range was from 21 to 85 years, with a mean age of 46.4 years. The median ages for the total sample, OCP users, and non-users were 43.5, 44, and 43 years respectively. The timing of OCP usage among users varied from 1 to 35, with a mean timing of 13. CONCLUSION: The study found about one-third 29.3% (n=17) of patients diagnosed with PTC reported using OCPs. These results contribute to the ongoing debate within epidemiological studies regarding the association between PTC and various reproductive factors, including OCP use. Further research is needed to clarify this relationship and its implications on public health.

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PURPOSE: To examine the association between physical, sexual, or physiological harm in pregnancy and perinatal outcomes in a large, contemporary birth cohort. METHODS: This retrospective cohort study used California-linked vital statistics and hospital discharge data from 2016 to 2020. We included singleton, non-anomalous births with a gestational age of 23-42 weeks. Violence in pregnancy was identified using International Classification of Disease, Tenth Revision (ICD-10) codes. Chi-square tests and multivariable Poisson regression models were used to evaluate associations of violence in pregnancy with perinatal outcomes. RESULTS: A total of 1,728,478 pregnancies met inclusion criteria, of which 3,457 (0.2%) had reported violence in pregnancy. Compared to those without violence in pregnancy, individuals who experienced violence had an increased risk of non-severe hypertensive disorders (aRR = 1.36, 95% CI 1.22, 1.51), preeclampsia with severe features (aRR = 1.34; 95% CI 1.11, 1.61), chorioamnionitis (aRR = 1.68; 95% CI 1.48, 1.91), anemia (aRR = 1.59; 95% CI 1.50, 1.68), antepartum hemorrhage (aRR = 2.17; 95% CI 1.19, 3.95), and postpartum hemorrhage (aRR = 1.65; 95% CI 1.48, 1.85). Violence in pregnancy was also associated with increased risk of Apgar score < 7 at 5 min (aRR = 1.37; 95% CI 1.11, 1.71) and neonatal hypoglycemia (aRR = 1.26; 95% CI 1.07, 1.48). CONCLUSION: Violence experienced in pregnancy is associated with an increased risk of adverse perinatal outcomes. Understanding how universal screening and early recognition of violence in pregnancy may reduce disparities in maternal morbidity for this understudied population is critical.

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Squamate reptiles are central for studying phenotypic correlates of evolutionary transitions from oviparity to viviparity because these transitions are numerous, with many of them being recent. Several models of life-history theory predict that viviparity is associated with increased female size, and thus more female-biased sexual size dimorphism (SSD). Yet, the corresponding empirical evidence is overall weak and inconsistent. The lizard Zootoca vivipara, which occupies a major part of Northern Eurasia and includes four viviparous and two non-sister oviparous lineages, represents an excellent model for testing these predictions. We analysed how sex-specific body size and SSD is associated with parity mode, using body length data for nearly 14,000 adult individuals from 97 geographically distinct populations, which cover almost the entire species' range and represent all six lineages. Our analyses controlled for lineage identity, climatic seasonality (the strongest predictor of geographic body size variation in previous studies of this species) and several aspects of data heterogeneity. Parity mode, lineage and seasonality are significantly associated with female size and SSD; the first two predictors accounted for 14%-26% of the total variation each, while seasonality explained 5%-7%. Viviparous populations exhibited a larger female size than oviparous populations, with no concomitant differences in male size. The variation of male size was overall low and poorly explained by our predictors. Albeit fully expected from theory, the strong female bias of the body size differences between oviparous and viviparous populations found in Z. vivipara is not evident from available data on three other lizard systems of closely related lineages differing in parity mode. We confront this pattern with the data on female reproductive traits in the considered systems and the frequencies of evolutionary changes of parity mode in the corresponding lizard families and speculate why the life-history correlates of live-bearing in Z. vivipara are distinct. Comparing conspecific populations, our study provides the most direct evidence for the predicted effect of parity mode on adult body size but also demonstrates that the revealed pattern may not be general. This might explain why across squamates, viviparity is only weakly associated with larger size.

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The importance of universal access to health services including sexual and reproductive health and rights (SRHR) services by migrant populations and the fundamental role of healthcare workers in providing SRHR services, requires a balanced understanding of the experiences of both migrants and healthcare workers. This study explored the experiences of migrant women in accessing and utilising SRHR services and the experiences of healthcare workers in providing SRHR and HIV services in Ekurhuleni, South Africa. In-depth interviews were conducted with five internal migrants, eight international migrant women aged 18-49 years, and four healthcare workers. Migrant women were selected using snowball sampling while healthcare workers were purposively sampled. Migrant women face multifaceted challenges including but not limited to language barriers, discrimination based on migration status, cultural and religious hurdles when accessing and utilising SRHR and HIV services. Similarly, healthcare workers encounter challenges in providing SRHR and HIV services to migrant women which include language barriers and having migrants who seek services without referral documentation and legal migration documents. Training healthcare workers on cultural sensitivity and integration of migrant friendly services in the health policy may improve migrant women's experiences in accessing and utilising as well as healthcare workers' experiences in providing SRHR services.

L'importance de l'accès universel aux services de santé, y compris les services de santé et de droits sexuels et reproductifs (SDSR) pour les populations migrantes et le rôle fondamental des agents de santé dans la fourniture de services SDSR, nécessitent une compréhension équilibrée des expériences des migrants et des agents de santé. Cette étude a exploré les expériences des femmes migrantes en matière d'accès et d'utilisation des services SDSR et les expériences des agents de santé dans la fourniture de services SDSR et VIH à Ekurhuleni, Afrique du Sud. Des entretiens approfondis ont été menés avec cinq migrants internes, huit femmes migrantes internationales âgées de 18 à 49 ans et quatre agents de santé. Les femmes migrantes ont été sélectionnées à l'aide d'un échantillonnage boule de neige tandis que les travailleurs de la santé ont été échantillonnés à dessein. Les femmes migrantes sont confrontées à des défis multiformes, notamment les barrières linguistiques, la discrimination basée sur le statut migratoire, les obstacles culturels et religieux lors de l'accès et de l'utilisation des services SDSR et VIH. De même, les agents de santé rencontrent des difficultés pour fournir des services SDSR et VIH aux femmes migrantes, notamment des barrières linguistiques et le fait que les migrantes recherchent des services sans documents de référence ni documents de migration légaux. La formation des agents de santé à la sensibilité culturelle et à l'intégration de services adaptés aux migrants dans la politique de santé peut améliorer les expériences des femmes migrantes en matière d'accès et d'utilisation, ainsi que les expériences des agents de santé dans la fourniture de services SDSR.

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Reproductive development plays an essential role in the perpetuation of genetic material and environmental adaptation. In angiosperms, the Short Vegetative Phase (SVP) serves as a flowering repressor, influencing the development of floral organs. In this study, heterologous transformation of Arabidopsis thaliana with SVP-like genes (PtSVL1 and PtSVL2) derived from Pinus tabuliformis significantly impacted stamen formation and pollen fertility, without altering flowering time. Gene co-expression networks revealed that SVP-like and SOC1-like genes function as key coregulatory transcription factors during the initial stages of cone development in P. tabuliformis. Interestingly, the regulatory module of SOC1 regulated by SVP in angiosperms is absent in conifers and conifer SVP-like exercises its function in a form that is physically bound to SOC1-like. Furthermore, combining the yeast one-hybrid scanning with co-expression network analysis, revealed that SPLs and TPSs were the principal downstream target genes of PtSVL1. Notably, the PtSPL16 promoter is positively regulated by PtSVL1, and overexpression of PtSPL16 results in delayed flowering in Arabidopsis, suggesting that the PtSVL1-PtSPL16 module plays a crucial role in regulating reproductive development in conifers. Collectively, these findings enhance our understanding of the roles of SVP-like genes in conifers and the key regulatory networks centred on PtSVL1 during reproductive cone development.

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The declining African and Asian elephant populations emphasize the importance of a backup population. Successful reproduction in captivity plays a key role in maintaining such a genetically diverse ex situ population but is challenged by reproductive loss in the form of abortions and stillbirths. The elephants' biphasic prolactin pattern led us to predict a higher incidence of abortions during the time of reduced prolactin concentrations. Therefore, this study focuses on the identification of months during elephant gestation which are prone to loss of pregnancy. A metric was developed to identify the fetal age of aborted calves based on the fetal mass using a regression model. Data on idiopathic abortions in captive and wild elephants collected from zoos, tourist camps, semi-captive, and free-ranging populations since 1974 were analyzed, revealing a significantly higher prevalence of abortions during the 15th and 17th month of gestation. Additionally, the prevalence of stillbirths in the 22nd month of gestation between 2000 and 2023 was assessed. Although stillbirths showed a declining trend over time, the average prevalence between 2019 and 2023 was still 2.8%. Consequently, the 15th, 17th, and 22nd month of gestation were identified as stages prone to pregnancy loss. These findings underscore the necessity of researching risk factors and preventative measures for pregnancy loss in these 3 months, especially exploring a possible link with prolactin during the 15th and 17th month of gestation. The identification of stages prone to fetal loss is a key step towards enhancing elephant reproductive success and welfare.

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Mitochondrial donation to reduce the risk of primary mitochondrial disease transmission from mother to child is now permitted under Australian law as part of a clinical trial. The energy demands of pregnancy have the potential to worsen mitochondrial disease symptoms and severity in affected women. We conducted a systematic literature review on mitochondrial disease in pregnancy; five cohort studies and 19 case reports were included. For many women with mitochondrial disease, pregnancy does not have a negative effect on health status. However, serious adverse outcomes may occur. We provide suggested guidelines for preconception counselling and antenatal care.

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This study investigated how women undergoing IVF make sense of themselves in the context of their reproductive experiences. Interviews were conducted with fourteen women aged 27-42. Interpretative phenomenological analysis was used. Four main themes emerged: Motherhood beyond all, Us and them, Changes in self-perception, My agency. The results are discussed in the context of reproductive identity. It has shown that being a mother is an identity the participants strongly strive for. Participants feel connected to women with whom they share the experience of dealing with infertility and different from those without such an experience. The specificity of their reproductive experience leads to changes in self-perception that can be interpreted as either impairment or growth. On their reproductive journey, they show their agency by undertaking a series of activities (control of thoughts, feelings, and body). Practical implications of the obtained results are discussed.

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PURPOSE: To report an exceptional case of male-to-male transmission of genetically based non-obstructive azoospermia (NOA) and varicocele through a naturally obtained pregnancy. SUBJECTS AND METHODS: A father and his son were both diagnosed with NOA after centrifugation and varicocele. The father has no other clinical concerns apart from infertility, detected after many attempts of having another child, but given his urological situation (bilateral varicocele and NOA) assisted reproductive techniques were discouraged. After genetic counseling, several genetic-chromosomal analyses were carried out in the son (karyotype, chromosome Y microdeletions, CFTR screening, NGS infertility panels, and finally array-CGH). RESULTS: After a series of inconclusive tests, array-CGH detected a deletion of 224-283 kb (del9p24.3) involving part of the KANK1 and DMRT1 genes, inherited from the father. Haploinsufficiency of DMRT1 was therefore considered the determining factor in the development of azoospermia in the family by a loss of function mechanism. CONCLUSION: The confirmation of father-to-son transmission of a deletion including DMRT1 represents an important point for clinicians dealing with male infertility, even when complete azoospermia is repetitively detected, and must be of hope for a relevant portion of men. Inclusion criteria for the access to assisted reproductive techniques may also be reconsidered and worthy of a greater number of clinical insights. Finally, since DMRT1 alterations have been associated with NOA and abnormal testicular development, but not specifically with varicocele, further studies are required to validate this issue, as varicocele may have played a crucial role in this case.

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BACKGROUND: Although menstruation is a monthly biological phenomenon, it is shrouded in stigma and shame which directly impacts health, education, gender equality, decent work, and economic growth. However, there is scarce evidence on how personal agency, an individual's ability to access resources, may act as a protective factor to adequate menstrual health and hygiene practices. Therefore, we assess the association between attitudes toward menstruation and personal agency among very young adolescent girls. METHODS: We use cross-sectional data from the Global Early Adolescent Study in São Paulo, Brazil, among 10- to 14-year-old girls who have experienced menarche (n = 325) and completed a home-based self-administered questionnaire in 2021. "Attitudes toward menstruation" was created based on five indicators on a Likert scale, with a higher score indicating more positive attitudes. The main covariate was personal agency, comprised of three scales and modeled as three continuous variables: voice, decision-making power, and freedom of movement. Data were analyzed using multivariable linear regression. RESULTS: Attitudes toward menstruation mean score was 12.5 (range 5-19). Older adolescents (12-14 years-old) had higher mean scores (more positive) than younger adolescents (10-11 years-old) on attitudes toward menstruation, whereas no other sociodemographic or menstrual health indicator (knowledge or access to products) were associated with attitudes toward menstruation. In the multiple regression model, older age and higher freedom of movement remained positively associated with attitudes toward menstruation (ßadjust = 0.5; 95%CI 0.1 to 0.8). CONCLUSION: Positive attitudes toward menstruation are associated with higher freedom of movement among very young Brazilian adolescent girls. The promotion of personal agency should be recognized as key strategies to accelerate young girls' positive approaches to their own menstruation and, consequently, well-being.

Menstrual Health and Hygiene Attitudes are associated with Personal AgencyOur results show that positive attitudes toward menstruation among very young adolescent girls are associated with personal agency, measured through freedom of movement. This information can inform strategies to accelerate young girls' positive approaches to their own menstruation and, consequently, well-being.

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Introduction: The prevalence of male infertility has been increasing globally, necessitating the search for safe and nontoxic active compounds to alleviate reproductive dysfunction. Although the precise mechanism remains unknown, Cynomorium songaricum Rupr. (CS) extract has protective effects on the reproductive system. The effect of C. songaricum Rupr. flavonoids (CSF) on reproductive injury and testicular mesenchymal stem cell viability in male mice and TM3 cells was investigated. Methods: We explored the possible association between these effects and the testosterone (T) synthesis pathway. Mice were administered cyclophosphamide to induce reproductive damage, followed by CSF administration. Body mass and organ index were recorded. Pathological changes in T and the epididymis were observed using hematoxylin-eosin staining. ELISA measured the serum levels of T, luteinizing hormone (LH), gonadotropin-releasing hormone (GnRH), follicle-stimulating hormone (FSH), and estradiol (E2) in mice. Fructose and zinc ion levels in the seminal plasma were measured. TM3 cells were treated with Bisphenol A (BPA) and different concentrations of CSF, followed by proliferative evaluations using the CCK-8 assay and T and LH level assessments using ELISA. Furthermore, the expression of steroidogenic enzyme genes and proteins was investigated using western blotting and RT-PCR. Results: CSF exhibited a notable reduction in reproductive damage and improved pathological changes in testicular and epididymal tissues. CSF group demonstrated substantially higher levels of seminal plasma fructose and zinc ions; markedly elevated serum levels of T, LH, GnRH, and FSH; and lower levels of E2 than those of the model group. Intracellular T content and secretion of T and LH increase with CSF while effectively mitigating BPA-induced damage to TM3 cells. CSF group exhibited substantially higher gene and protein expression of steroidogenic enzymes than those of the model group, both in vivo and in vitro. CSF ameliorates reproductive impairment by enhancing the expression of pivotal enzymes involved in synthesizing T. Discussion: CSF ameliorates cyclophosphamide-induced reproductive impairment and bisphenol A-induced TM3 cell damage in mice by regulating sex hormone levels in the Hypothalamic-Pituitary-Gonadal Axis (HPG axis) and upregulating the expression of steroidogenic enzymes. Therefore, CS is a potential treatment for male reproductive impairment.

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The declining fertility rate and increasing marriage age among girls pose challenges for policymakers, leading to issues such as population decline, higher social and economic costs, and reduced labor productivity. Using machine learning (ML) techniques to predict the desire to have children can offer a promising solution to address these challenges. Therefore, this study aimed to predict the childbearing tendency in women on the verge of marriage using ML techniques. Data from 252 participants (203 expressing a "desire to have children" and 49 indicating "reluctance to have children") in Abadan, and Khorramshahr cities (Khuzestan Province, Iran) was analyzed. Seven ML algorithms, including multilayer perceptron (MLP), support vector machine (SVM), logistic regression (LR), random forest (RF), J48 decision tree, Naive Bayes (NB), and K-nearest neighbors (KNN), were employed. The performance of these algorithms was assessed using metrics derived from the confusion matrix. The RF algorithm showed superior performance, with the highest sensitivity (99.5%), specificity (95.6%), and receiver operating characteristic curve (90.1%) values. Meanwhile, MLP emerged as the top-performing algorithm, showcasing the best overall performance in accuracy (77.75%) and precision (81.8%) compared to other algorithms. Factors such as age of marriage, place of residence, and strength of the family center with the birth of a child were the most effective predictors of a woman's desire to have children. Conversely, the number of daughters, the wife's ethnicity, and the spouse's ownership of assets such as cars and houses were among the least important factors in predicting this desire. ML algorithms exhibit excellent predictive capabilities for childbearing tendencies in women on the verge of marriage, highlighting their remarkable effectiveness. This capacity to offer accurate prognoses holds significant promise for advancing research in this field.

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Objective: In many Transcaucasian and Middle Eastern populations, research in women's sexual and reproductive health remains limited, especially in Armenia despite recent political and cultural changes. This study explores the current state of family planning in Armenia while both highlighting the recent progress and identifying current barriers to reproductive health. Study Design: We conducted a mixed-methods study using both a quantitative survey and qualitative interviews with women and key informants in the field of women's sexual and reproductive health. Results: Armenian women are familiar with many types of contraception. The use of modern methods has increased but remains low. Sexual education for women is uncommon and often sought through independent online searches or books. We found no significant access barriers, however, a prevailing distrust in hormonal contraceptive methods left many women to rely on condoms and withdrawal. Although the majority of surveyed women (72%) believed having access to safe abortions was an important right, only 42% would consider having an abortion in the case of an unintended pregnancy. Interviewees highlighted the lack of sexual education, discrepancies in sexual and reproductive services between rural provinces and the urban capital city of Yerevan, as well as the need for information and the government's responsibility in this field. Conclusions: The lack of comprehensive sexual education in Armenia fuels misinformation regarding family planning options. One option we recommend is a government-funded sexual education program which begins as culturally sensitive, sex-positive education in schools and continues with counseling and support for women within the health care system.

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Background: Bone fractures represent a significant health issue and impose a considerable burden on healthcare systems globally. However, data pertaining to bone fractures, especially among reproductive-age women in Malaysia, are very limited. Micronutrients like calcium, magnesium and phosphorus play vital roles in bone health, influencing bone mineral density and fracture risk. The objective of this study was to determine the prevalence of bone fractures among reproductive-age women and the association with dietary micronutrient intakes. Methods: In this cross-sectional study, a total of 1,730 participants of reproductive-age women from the Malaysia Prospective Urban and Rural Epidemiological (PURE) study were recruited. The participants' dietary intakes were assessed using a validated semi-quantitative food frequency questionnaire (FFQ). Selected micronutrients in the participants' diets were calculated using the Malaysian food composition and the US Department of Agriculture food composition databases. The association between micronutrient intakes, comorbidities and physical activity levels with bone fractures were evaluated to identify predictors of bone fractures among reproductive-age women. Results: The prevalence of bone fractures among Malaysian reproductive-age women was low (3.7%). The multiple logistic regression analysis showed that none of the micronutrients was associated with bone fractures. However, factors of diabetes and passive smoking in this study showed 2.6- and 4.0-times-higher odds of having bone fractures, respectively (AOR 2.580; 95% CI: 1.173-5.672) and (AOR 4.012; 95% CI: 2.265-7.107). Conclusions: It was found that the majority of women in this study were taking lower micronutrient intakes of calcium, magnesium, and vitamin K than the Malaysia recommended nutrient intakes (RNI). Although this study showed that a low micronutrient intake is not significantly associated with bone fractures, it is recommended that future studies focus on controlled trials or prospective data analyses to establish causal relationships and the optimal micronutrient requirements for maintaining strong and healthy bones in women of reproductive age.

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Managing a thin endometrium is a common challenge in assisted reproductive treatments. The thickness of the endometrium is crucial for embryo implantation, with younger patients generally having higher success rates even with a thinner lining. A frozen embryo transfer cycle often allows for a more thorough assessment of the endometrium compared to a fresh transfer. We present a case of a 36-year-old woman who presented to our fertility center with primary infertility for six years. Despite having regular menstrual cycles, her endometrial thickness consistently measured between 5 and 6.0 mm on ultrasonography. She underwent ovarian stimulation using an antagonist protocol, resulting in the retrieval of oocytes and the freezing of three embryos. However, three frozen embryo transfer cycles were cancelled due to inadequate endometrial thickness (ranging from 4.3 to 5.2 mm). In the fourth cycle, she was treated with gonadotropins with the goal of achieving two to three follicles and improved endometrial thickness. Triggering was performed on day 15, followed by the transfer of one frozen embryo at an endometrial thickness of 5.7 mm. Her beta-human chorionic gonadotropin (hCG) level was positive, with an initial value of 136.9 mIU/mL, and she subsequently delivered a healthy baby. This case highlights the challenges of managing a thin endometrium in assisted reproductive techniques. Through persistent efforts and tailored treatment protocols, a successful live birth was achieved despite recurrent thin endometrium. This case underscores the importance of individualized treatment strategies in overcoming endometrial challenges in infertility treatments.

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Subfertility, a condition marked by a reduced capacity to conceive naturally, affects a significant proportion of couples globally. Nutrition is a fundamental aspect of reproductive health, with various nutrients essential in maintaining optimal reproductive function. This comprehensive review explores the intricate relationship between nutritional deficiencies and subfertility. It examines key micronutrients such as vitamins D, E, C, and B12, as well as minerals such as zinc, iron, selenium, and magnesium, and their impacts on fertility. The review also considers macronutrients and the importance of a balanced diet in supporting reproductive health. Drawing on an extensive body of clinical evidence and studies, this review highlights how deficiencies in these nutrients can lead to hormonal imbalances, impaired gametogenesis, and suboptimal pregnancy outcomes. It discusses the efficacy of nutritional interventions, including dietary supplements and lifestyle modifications, in improving fertility. Furthermore, it addresses the emerging research on personalized nutrition and its potential to enhance reproductive outcomes. The review underscores the necessity for healthcare providers to assess and address the nutritional status of patients with subfertility. It provides practical recommendations for developing nutritional plans, counseling patients, and integrating nutritional interventions into fertility treatments. By offering a comprehensive synthesis of current evidence, this review aims to inform clinical practice and promote further research into the role of nutrition in enhancing fertility.