Background: Ovarian tissue cryopreservation (OTC) is the only fertility preservation option for premenarcheal girls before gonadotoxic treatment, but is still considered to be experimental in pediatric patients. This study investigated storage behaviors across different age groups to refine counseling approaches for pediatric patients. Methods: This retrospective study analyzed data from children (0–14 years), adolescents (15–19 years), and adults (≥ 20 years) who underwent OTC between 2000–2021 at the University Hospital Bonn's cryobank. Comparison to adults (age ≥ 20 years) was conducted. Results: Of 2,475 patients, 6% were children and 12% adolescents. Sarcoma was most common in children, lymphoma in adolescents. Adults had longer active storage than children (5.5 vs. 4.7 years, p = 0.011), but for active storage ≥ 10 years, children and adolescents stored longer than adults (13.1 and 12.6 vs. 11.8 years, p ≤ 0.01). The proportion of adolescents increased, while that of children decreased in long-term storage. Median ovarian cortex surface before cryopreservation was 3.5 cm² in children and 4.5 cm² in adolescents. Leukemia and sarcoma had the highest mortality rates in children (25% and 13.5%). Overall, pregnancy and birth rates following ovarian tissue transplantation (OTT) were 34.5% and 24.1%, respectively. Among adolescents, pregnancy rates were 33.3% after OTT and 27.3% without OTT, while all children without OTT achieved pregnancy (100%). Conclusions: Children and adolescents represent a small subset of OTC patients, with indications linked to common pediatric malignancies. For active storage ≥ 10 years, they store longer than adults, likely due to delayed reproduction or awaiting in vitro growth / in vitro maturation in hematological cases. Overall, adults store longer, but adolescent storage has risen over time possibly due to higher child mortality and previously limited OTC use in younger patients. Mean ovarian cortex surface data may guide pediatric tissue harvest recommendations, with unilateral oophorectomy advised. Fertility preservation counseling and cost coverage should be standard for pediatric patients undergoing gonadotoxic treatment. A tailored approach to OTC indications is essential, especially in high-mortality cancers like leukemia or sarcoma. Favorable pregnancy rates observed, even without OTT, suggest possible OTC overutilization, highlighting the need for individualized strategies and careful clinical decision-making to balance risks and preserve reproductive potential.

Cesarean section (CS) is the most widely performed and one of the most painful surgeries. This study investigated postoperative pain after CS using patient-related outcomes (PROs) to identify risk factors for severe pain. The secondary outcome was to evaluate the influence of surgery indication (primary CS (PCS) vs. urgent CS (UCS)). This multi-center, prospective cohort study included data submitted to the pain registry “quality improvement in postoperative pain treatment” (QUIPS) between 2010 and 2020. In total, 11,932 patients were evaluated. Median of maximal pain was 7.0 (numeric rating scale (NRS) 0 to 10); 53.9% suffered from severe pain (NRS ≥ 7), this being related to impairment of mood, ambulation, deep breathing and sleep, as well as more vertigo, nausea and tiredness (p < 0.001). Distraction, relaxation, mobilization, having conversations, patient-controlled analgesia (PCA) and pain monitoring were shown to be protective for severe pain (p < 0.001). Maximal pain in PCS and UCS was similar, but UCS obtained more analgesics (p < 0.001), and experienced more impairment of ambulation (p < 0.001) and deep breathing (p < 0.05). Severe pain has a major effect on daily-life activities and recovery after CS, and depends on modifiable factors. More effort is needed to improve the quality of care after CS.

Background: The relationship between the immune system and embryo implantation is intricate and not yet fully understood. Although a genetically normal (euploid) embryo is essential, successful implantation also relies on carefully regulated immune responses that promote tolerance and prevent rejection. The main objective of this study was to examine the paternal levels of the immunoregulatory factors HLA‐G, transforming growth factor (TGF)‐ß and interleukin (IL)‐6 and to investigate possible correlations with other semen parameters, age and pregnancy outcome of the female partner. Methods: Seminal plasma samples from 225 men were collected from 2022 to 2025, divided into four groups (live birth, biochemical pregnancy, abortion, no pregnancy) and determined for immunological profiling using commercial HLA‐G, TGF‐ß and IL‐6 enzyme‐linked immunosorbent assay (ELISA) kits. Results: SHLA‐G levels were significantly lower in the live birth group compared to biochemical pregnancies ( p < 0.001) non‐pregnancies ( p < 0.001) and in abortions compared to non‐pregnancies ( p = 0.004). TGF‐β levels were reduced in all pregnancy‐related groups versus non‐pregnancies ( p < 0.001). IL‐6 levels were lower in biochemical pregnancies compared to non‐pregnancies ( p = 0.017). Absolute HLA‐G levels were lower in live births ( p < 0.001) and were reduced in abortions ( p = 0.004) compared to non‐pregnancies. Absolute TGF‐ß values were significantly lower in the live birth group ( p < 0.001) compared to non‐pregnancies. Absolute TGF‐β and IL‐6 levels were also decreased in biochemical pregnancies compared to non‐pregnancies ( p < 0.001 and p = 0.03, respectively). Conclusion: Our findings show that seminal plasma levels of HLA‐G, TGF‐β and IL‐6 differ significantly among pregnancy outcome groups in ART cycles, underlining a potential role of these immunological factors in influencing reproductive success. These results highlight the importance of seminal immunological profiling as a possible predictive tool for ART outcomes and warrant further investigation in larger cohorts.

Introduction: This study aims to systematically describe eye malformations and correlate these with extraocular findings. Based on these findings, we propose a protocol for ultrasound evaluation of the fetal eye.Material and Methods: In this multicentric retrospective cohort study, 264 fetuses with ocular malformations from two tertiary referral centers for prenatal medicine were analyzed. Anophthalmia, microphthalmia, exophthalmos, hyper‐ or hypotelorism, cataract, aphakia, cyclopia, and retinal detachment were assessed, and their association with extraocular findings and genetic changes was investigated.Results: The majority of the cases (99.2%) were non‐isolated and presented further extraocular findings. Most commonly, the brain and central nervous system (65.9%), the limbs and the heart (46.6% each) and the cranial anatomy (41.2%) were affected. Significant associations were found between exophthalmos and anomalies of the fetal skeletal system (OR = 4.8, 95% CI 1.6–14) and cranial malformations (OR = 3.3, 95% CI 1.5–7.4). Hypotelorism showed an increased risk of cardiac anomalies (OR = 1.8, 95% CI 1.1–3.5) and brain malformations (OR = 2.16, 95% CI 1.2–4.1), with holoprosencephaly being the most common one. Fetuses with microphthalmia were more likely to have anomalies in the renal system (OR = 2.3, 95% CI 1.2–4.3). In 51.4% of the cases, a genetic aberration could be found, among them most frequently trisomy 13.Conclusions: There is a significant association between specific fetal eye anomalies and certain extraocular anomalies, as well as genetic changes. Systematic evaluation of the eye using the proposed protocol is simple to learn and highly reproducible and could help to concentrate diagnosis on a certain group of malformations. Data from this study could help to develop targeted diagnostic molecular tools.

Purpose: Rudimentary horn pregnancies are rare and carry significant maternal and fetal risks. This study aims to systematically review published cases of rudimentary horn pregnancies describing data about time of diagnosis, time of rupture, and live birth rate (LBR), with exploratory comparisons between communicating (CHP) and non-communicating horn pregnancies (NCHP). Methods: A PRISMA-guided systematic search of PubMed, MEDLINE, and Cochrane (October 1, 2025) was performed with terms “unicornuate uterus pregnancy” OR “rudimentary horn pregnancy.” Case reports, series, and reviews with defined clinical data were included; abstracts and unclear reports were excluded. Three independent reviewers extracted data using a standardized protocol. Descriptive statistics (means, medians, standard deviations, and ranges) and exploratory group comparisons (Fisher's exact test, Mann–Whitney U and Student's t test with p < 0.05 denoting significance) were performed. Results: From 132 articles, 190 cases were included: 27 CHP (14.2%) and 163 NCHP (85.8%). Time of diagnosis was earlier in NCHP (15.9 ± 8.9 weeks) than CHP (22.1 ± 10.0 weeks, p = 0.01). Rupture occurred in 68 cases (35.8%), similarly in CHP (48.1%) and NCHP (33.7%, p = 0.19). Time of rupture was earlier in NCHP (18.7 ± 6.6 weeks) than CHP (23.0 ± 9.2 weeks, p = 0.02). Four cases attempted to continue pregnancy; all resulted in premature rupture. Reported live births were infrequent (11.6%) and more common in published CHP (25.9%) vs. NCHP cases (9.2%; p = 0.02). Conclusions: This descriptive synthesis indicates uterine horn communication may be associated with later diagnosis/rupture and reported live births were significantly more frequent in published CHP vs. NCHP cases. However, all comparisons are exploratory and must be interpreted with extreme caution, as data limitations preclude causal inference. Exhaustive imaging and diagnosis are essential to characterize horn type. Surgical termination is advised, but if expectant management is chosen, close monitoring and multidisciplinary care, including weekly ultrasounds, are advisable to mitigate complications.

STUDY QUESTION: Does geographic proximity to a centralised cryobank reflect age-dependent differences in ovarian tissue cryopreservation (OTC) utilisation? SUMMARY ANSWER: Paediatric patients resided significantly closer to the cryobank than adolescents and adult women, suggesting age-dependent geographic differences in the utilisation of fertility preservation services. WHAT IS KNOWN ALREADY: OTC is an established fertility preservation option, and previous studies have primarily focused on return rates of cryopreserved ovarian tissue and subsequent pregnancy and live birth outcomes. However, less is known about utilisation patterns of fertility preservation, particularly for OTC in paediatric oncology, where utilisation may be influenced by factors such as clinician-initiated counselling and local referral pathways. STUDY DESIGN, SIZE, DURATION: This retrospective nationwide multicentre cohort study included 2,426 patients referred from 124 centres who underwent OTC at a central cryobank between 2000 and 2021. PARTICIPANTS/MATERIALS, SETTING, METHODS: Patients were stratified into children (<15 years, n = 149), adolescents (15–19 years, n = 296), and adults (≥20 years, n = 1,981). Residential addresses were geocoded, and distances to the cryobank were calculated. Regional distribution was categorised by population size. Statistical analyses included Chi-square and non-parametric tests with Bonferroni correction. MAIN RESULTS AND THE ROLE OF CHANCE: Median distance to the cryobank increased with age (children: 136 km; adolescents: 183 km; adults: 222 km), with children living significantly closer than adolescents (p = 0.03) and adults (p = 0.001). Overall, 44.8% of patients resided in large cities, with significant age-group differences (p < 0.001). Paediatric cases were concentrated in urban areas, whereas adults were more geographically dispersed. Among adults, distance varied by indication (p = 0.021), but not in younger groups. This pattern persisted despite the nationwide referral network. LIMITATIONS, REASONS FOR CAUTION: The retrospective design precludes causal inference. Distances were calculated as straight-line measures instead of real travel time, and socioeconomic factors were not available. Furthermore, only patients who successfully underwent OTC were available for analysis. Consequently, the study cannot assess true access to fertility preservation, referral rates, counselling rates, or the number of eligible patients who did not proceed to treatment. Although patients were referred from centres across Germany, cryopreservation was centralized in Bonn. Regional referral relationships and the structure of the referral network may therefore have influenced the observed geographic distribution, particularly in paediatric patients, and may limit generalisability to the entire German population. WIDER IMPLICATIONS OF THE FINDINGS: The findings demonstrate age-dependent geographic utilisation patterns among patients who underwent OTC. These patterns may reflect differences in referral pathways, counselling practices, and utilisation of fertility preservation services. However, because only patients who successfully underwent OTC were included, the study cannot directly assess referral rates, unmet need, or access barriers. Expanding structured referral pathways and reimbursement policies may improve equitable utilisation of fertility preservation services. FUNDING: Intramural funding from the University Hospital Bonn. This publication was supported by the Open Access Publication Fund of the University of Bonn. No external grant funding was received from any funding agency in the public, commercial, or not-for-profit sectors. DISCLOSURES: The authors declare that they have no competing interests. TRIAL REGISTRATION NUMBER: N/A