Male factors may be present in up to 50–70% of infertile couples and the prevalence of male infertility accounts for 20–30% of infertility cases. Understanding the mechanisms and causes behind male infertility remains a challenge, but new diagnostic tools such as DNA fragmentation might aid in cases where the routine semen analysis is insufficient. DNA fragmentation, which refers to damages or breaks of the genetic material of the spermatozoa, is considered one of the main causes of male infertility due to impaired functional capability of sperm. The aim of the present narrative review is to investigate and enlighten the potential correlation between DNA fragmentation and male infertility parameters such as the seminal profile and the reproductive outcomes. Comprehensive research in PubMed/Medline and Scopus databases was conducted and 28 studies were included in the present review. Fourteen studies provided data regarding the impact of DNA fragmentation and seminal parameters and showed a correlation of significantly lower sperm count, lower concentration, motility, and abnormal morphology with an increased DNA fragmentation index (DFI). Similarly, 15 studies provided data regarding the impact of DFI on reproductive outcomes. Two studies showed higher aneuploidy rates with higher DFI values, and seven studies showed significantly lower pregnancy rates and live birth rates with higher DFI values. Ultimately, the studies included in this review highlight, collectively, the importance of measuring sperm DFI in the assessment of male infertility. Further studies are needed to explore the effectiveness of interventions aiming to reduce DFI levels.

Background/Objectives: Adenomyosis is increasingly being identified in women of childbearing age as a cause of infertility and adverse pregnancy outcomes. As hysterectomies are not suitable for fertile women, conservative surgical management has become a promising solution. We aimed to synthesize current evidence on conservative uterus-sparing surgical techniques for adenomyosis, focusing on implications for infertility treatment and pregnancy outcomes. Methods: A search of PubMed, Google Scholar, and Europe PMC from 2022 to July 2025 was conducted using combinations of the words “adenomyosis,” “fertility,” “infertility,” “pregnancy outcomes,” “adenomyomectomy,” and “uterine-sparing surgery.” Sixteen high-relevance studies were chosen that included reproductive-aged women who had conservative surgery for adenomyosis. Results: Excisional techniques such as adenomyomectomy yield pregnancy rates of >50% and live birth rates of up to 70% in focal disease, with less success in diffuse disease. Non-excisional approaches—high-intensity focused ultrasound (HIFU), radiofrequency ablation (RFA), and uterine artery embolization (UAE)—yield equivalent pregnancy (40–53%) and live birth (35–74%) rates in selected patients, with fewer surgical complications. Adjunctive hormonal therapy, particularly GnRH agonists, appears to improve outcomes. Risks include placenta accreta spectrum disorders and uterine rupture (≤6%), especially in diffuse adenomyosis. The type of lesion, location, and junctional zone thickness are strong predictors of fertility outcomes. Conclusions: Conservative surgery can augment fertility in appropriately chosen women with adenomyosis, with removal being the preferred treatment for focal disease and non-removal techniques offering encouraging alternatives in mild or intracorporeal disease. The addition of adjunct hormonal therapy and standardized patient selection criteria will optimize results. The lack of European professional society guidelines underscores the need for harmonized protocols in order to standardize the diagnosis, surgery, and reporting of results.

Vitamin D is an essential nutrient, involved in various biological processes including calcium homeostasis, bone health, immune function, and brain development. Vitamin D from the mother crosses the placenta during pregnancy, directly impacting the neurodevelopment of the fetus. Vitamin D insufficiency is a substantial global health problem, influencing almost 47.9% of individuals, with especially high predominance rates among pregnant women. Background/Objectives: Preclinical studies suggest that maternal vitamin D deficiency results in significant alterations in the development of the offspring’s brain. Nonetheless, randomized clinical trials in humans have produced conflicting results on the beneficial effect of high-dose vitamin D supplementation during pregnancy on neurodevelopmental outcomes. This review aims to evaluate the association of maternal prenatal vitamin D levels and vitamin D supplementation during pregnancy with offspring neurodevelopment. Methods: This study thoroughly reviewed the literature and searched throughout PubMed, ScienceDirect, Cochrane Library, and Google Scholar, adhering to PRISMA guidelines. Studies assessing maternal vitamin D levels, supplementation, and offspring neurodevelopmental outcomes were included based on predefined eligibility criteria. Results: Among 9686 screened studies, only 20 met the inclusion criteria, representing 18,283 mother–child pairs. A small, non-significant trend suggested a positive association between higher maternal vitamin D levels and offspring cognitive, language, motor, and social-emotional development. The strongest associations were observed in cognitive performance and language acquisition, though inconsistencies emerged across studies. Cord blood vitamin D levels showed no consistent effects on neurodevelopment. Maternal vitamin D supplementation during pregnancy demonstrated no reliable benefits for offspring neurodevelopment, with results varying by study design and participant characteristics. Conclusions: Large-scale, multicenter randomized trials, with standardized neurodevelopmental assessments at multiple ages are needed to define the effects of vitamin D deficiency and supplementation during pregnancy on offspring neurodevelopmental outcomes. Future research should investigate the confounding factors contributing to inconsistencies, including supplementation protocols, genetic variations, and assessment methodologies. Clarifying these aspects will enhance the understanding of maternal vitamin D’s role in fetal neurodevelopment and aid in refining prenatal supplementation guidelines.

Crucial regulators of gamete metabolism and signaling, mitochondria synchronize energy generation with redox equilibrium and developmental proficiency. Once thought of as hazardous byproducts, reactive oxygen species (ROS) are now understood to be vital signaling molecules that provide a “redox window of competence” that is required for oocyte maturation, sperm capacitation, and early embryo development. This review presents the idea of mitochondrial metabolic checkpoints, which are phases that govern gamete quality and fertilization potential by interacting with cellular signaling, redox balance, and mitochondrial activity. Recent research shows that oocytes may sustain a nearly ROS-free metabolic state by blocking specific respiratory-chain components, highlighting the importance of mitochondrial remodeling in gamete competence. Evidence from in vitro and in vivo studies shows that ROS act as dynamic gatekeepers at critical points in oogenesis, spermatogenesis, fertilization, and early embryogenesis. However, assisted reproductive technologies (ARTs) may inadvertently disrupt this redox–metabolic equilibrium. Potential translational benefits can be obtained via targeted techniques that optimize mitochondrial function, such as modifying oxygen tension, employing mitochondria-directed antioxidants like MitoQ and SS-31, and supplementing with nutraceuticals like melatonin, CoQ10, and resveratrol. Understanding ROS-mediated checkpoints forms the basis for developing biomarkers of gamete competence and precision therapies to improve ART outcomes. By highlighting mitochondria as both metabolic sensors and redox regulators, this review links fundamental mitochondrial biology to clinical reproductive medicine.

Surgery is one of the most energy-intensive branches of healthcare. Although the COVID-19 pandemic has reduced surgical volumes, infection control protocols have increased the ecological footprint of surgery owing to the extensive use of personal protective equipment, sanitation, testing and isolation resources. The burden of environmental diseases requiring surgical care, the international commitment towards environmental sustainability and the global efforts to return to the pre-pandemic surgical workflow call for action towards climate-friendly surgery. The authors have searched the peer-reviewed and gray literature for clinical studies, reports and guidelines related to the ecological footprint of surgical care and the available solutions and frameworks to reduce it. Numerous studies concede that surgery is associated with a high rate of energy utilization and waste generation that is comparable to major non-medical sources of pollution. Recommendations and research questions outlining environmentally sustainable models of surgical practices span from sanitation and air quality improvement systems to the allocation of non-recyclable consumables and energy-efficient surgical planning. The latter are particularly relevant to infection control protocols for COVID-19. Paving the way towards climate-friendly surgery is a worthy endeavor with a major potential to improve surgical practice and outcomes in the long term.

Background and Objectives: This meta-analysis aimed to determine whether pre-implantation uterine artery (UtA) Doppler measurements are associated with clinical pregnancy in women undergoing assisted reproductive technologies (ART). Materials and Methods: A systematic search of MEDLINE, Scopus, and the Cochrane Library from inception until 25 March 2025 was conducted to identify relevant studies. Additional records were retrieved through grey literature searching and manual reference checks. Eligible publications were observational studies or clinical trials that evaluated UtA Doppler indices prior to embryo transfer in adult women undergoing ART. Studies were required to report on clinical pregnancy rates, while those enrolling participants under 18 years of age, lacking Doppler data, or providing no pregnancy endpoints were excluded. Three reviewers independently assessed study quality using the Newcastle–Ottawa Scale and the Quality in Prognosis Studies tool. Meta-analyses were performed using a random-effects model to calculate mean differences (MDs) with 95% confidence intervals (CIs). Heterogeneity was examined via Cochran’s Q and the I² statistic. Sensitivity analyses excluded studies at high risk of bias. Results: In total, 12 studies met the inclusion criteria, including a population of 3317 women. Women who achieved clinical pregnancy had a lower mean UtA pulsatility index (PI) (MD, −0.26; 95% CI, −0.46 to −0.06) and a higher peak systolic velocity (PSV) (MD, 8.59; 95% CI, 2.31 to 14.87) than those who did not conceive. Subgroup analyses showed that UtA PI measured during the menstrual cycle was lower in clinical pregnancy cases (MD, −0.38; 95% CI, −0.66 to −0.10). Measurements on the day of hCG administration or the day before showed a non-significant difference in UtA PI (MD, −0.43; 95% CI, −1.03 to 0.17), while assessments on the day of embryo transfer showed no significant difference between groups (MD, −0.02; 95% CI, −0.28 to 0.24). Conclusions: This meta-analysis suggests that lower UtA PI and higher PSV prior to embryo transfer are associated with higher clinical pregnancy rates in ART, particularly when measurements are taken during the menstrual cycle. Although these findings highlight a potential role for uterine hemodynamics in successful clinical pregnancy, UtA Doppler alone may not be a reliable predictor. Future studies should focus on earlier-cycle Doppler measurements and their integration into multifactorial models to improve prognostic accuracy.