Haematopoietic stem cell transplantation (HSCT) exposes patients to long-term complications like gonadal dysfunction and infertility. The European Society for Blood and Marrow Transplantation advised in 2015 that fertility preservation should be considered for children and adolescents requiring HSCT. This systematic review and meta-analysis is part of the FertiTOX project, which aims to close the data gap regarding the gonadotoxicity of anticancer therapies to provide more accurate advice regarding fertility preservation. This review were conducted in November 2023, covering articles since 2000. In total, 56 studies were included in the meta-analysis, comprising 1853 female malignant, 241 female benign, 1871 male malignant, and 226 male benign cases. The analysis, using a random-effects model, estimated the prevalence and its 95% confidence interval, revealing that overall infertility exceeded 30% in all groups. Female malignant cases had a prevalence of 65% (95% CI: 0.58–0.71), while in females with benign disease, it was 61% (CI: 0.48–0.73). Males with malignant disease had a prevalence of 41% (CI: 0.32–0.51), and those with benign disease had 31% (CI: 0.19–0.46). The > 30% overall prevalence indicates a clinical need for fertility preservation counseling in both genders undergoing HSCT. Further prospective studies are necessary to address HSCT’s individual impact on gonadal function. This systematic review is registered with the International Prospective Register of Systematic Reviews (PROSPERO) under CRD42023486928.

Background: The incidence of colorectal cancer (CRC) is increasing in the population under 50 years of age, with more than 10% of cases occurring in young adults. Fertility preservation counseling has therefore received increased attention in this younger patient population. The treatment of CRC is often based on multimodal therapies, including surgery, radiotherapy, chemotherapy, and, more recently, immunotherapy, which makes it difficult to estimate the expected effect of treatment on fertility. We, therefore, systematically analyzed the published literature on the gonadotoxic effects of CRC treatments to better advise patients on the risk of infertility and the need for fertility preservation measures. This systematic review and meta-analysis are part of the FertiTOX project, which aims to reduce the data gap regarding the gonadotoxicity of oncological therapies. Objectives: The aim of this review and meta-analysis is to evaluate the potential impact of CRC therapies on gonadal function to allow more accurate counseling regarding the risk of clinically relevant gonadotoxicity and the need for fertility preservation measures before oncological treatment. Materials and Methods: A systematic literature search was conducted in Medline, Embase, the Cochrane database of systematic reviews, and CENTRAL in March 2024. A total of 22 out of 4420 studies were included in the review. Outcomes were defined as clinically relevant gonadotoxicity, indicated by elevated follicle-stimulating hormone (FSH) and/or undetectable anti-Müllerian hormone (AMH) levels and/or the need for hormone replacement therapy in women and azoo-/oligozoospermia and/or low inhibin B levels in men. Studies with fewer than nine patients were excluded from the meta-analysis. Results: The qualitative analysis included 22 studies with 1634 subjects (775 women, 859 men). Treatment consisted of active surveillance after surgery (37.7%), chemotherapy (12.7%), radiation (0.2%), or radiochemotherapy (53.9%). In 0.5%, the therapy was not clearly described. The meta-analysis included ten studies and showed an overall prevalence of clinically relevant gonadotoxicity of 23% (95% CI: 13–37%). In women, the prevalence was 27% (95% CI: 11–54%), and in men, 18% (95% CI: 13–26%). A subanalysis by type of CRC was only possible for rectal cancer, with a prevalence of relevant gonadotoxicity of 39% (95% CI: 20–64%). In patients undergoing chemotherapy exclusively, the prevalence was 4% (95% CI: 2–10%). In those receiving only radiotherapy, the prevalence was 23% (95% CI: 10–44%); in contrast, it reached 68% (95% CI: 40–87%) in patients who received radiochemotherapy. Conclusions: This first meta-analysis of the clinically relevant gonadotoxicity of CRC therapies provides a basis for counseling on the risk of infertility and the need for fertility preservation measures. Despite the low prevalence of gonadotoxicity in cases receiving chemotherapy alone, fertility preservation is still recommended due to the uncertainty of subsequent therapy and the lack of large longitudinal data on individual treatment effects. Further prospective studies are needed to investigate the impact of CRC treatment on gonadal function and estimate the effect of new treatment modalities, such as immunotherapies.

Background: Uterine contractility, also known as uterine peristalsis (UP), is a critical determinant of fertility, affecting sperm transport and embryo implantation. Increased uterine peristaltic activity has been associated with reduced pregnancy rates. However, data are heterogeneous and uterine contractility has not been widely translated into clinical practice. Cine-MRI, although limited by cost and heterogeneity in data reporting, has emerged as a promising tool to assess uterine dynamics and increase our knowledge of UP in physiological and pathological conditions. Objective: This systematic review and meta-analysis aimed to describe patterns of UP in physiological and pathological uterine conditions, including endometriosis and fibroids, using cine-MRI. Methods: A systematic literature search of the Medline, Embase, Cochrane and CENTRAL databases and Google Scholar was conducted up to May 2024, including studies evaluating UP by cine-MRI. Clinical studies evaluating uterine contractility were included, excluding those affected by therapeutic interventions or unrelated pathologies. This meta-analysis pooled data from studies comparing uterine contractility in patients with endometriosis. Results: In the 13 included studies (365 women), uterine contractility varied significantly according to menstrual cycle phases and pathological conditions. This meta-analysis showed that women with endometriosis had higher uterine contractility in the luteal phase (0.74; 95% CI: 0.27–1.21) but not in the periovulatory phase (SMD 0.8; 95% CI: −3.78–5.37). Conclusions: Cine-MRI is a promising diagnostic tool for the analysis of UP. Endometriosis is associated with impaired UP, which may be a cause of the decreased implantation rate and infertility in endometriosis. However, further research is needed to consolidate the effect of UP on implantation and fertility and to develop standardised and cost-effective tools to assess uterine contractility and tailor infertility treatment.

Background: Testicular cancer is the most common solid tumour among young men in the reproductive phase. After completing cancer treatment, up to 77% of cancer survivors report an interest in paternity after completing cancer treatment. To preserve fertility, most guidelines recommend that physicians should counsel their patients about sperm cryopreservation before initiating gonadotoxic therapy. However, few studies have assessed fertility parameters after testicular cancer therapies over the last 20 years.Objectives: To close the gap of data regarding gonadotoxicity of testicular cancer therapies to enable more accurate counselling regarding fertility preservation.Materials and methods: A systematic literature search was conducted in Medline, Embase and Cochrane until December 2022. The systematic review included studies of men who had undergone all types of unilateral testicular cancer treatment, whereas the meta‐analysis excluded studies with unspecified treatments, less than 10 patients for outcome evaluation or rare tumours. Infertility (i.e. azoospermia, failure to achieve paternity or the usage of cryosperm) was defined as outcome.Results: The qualitative analysis included 30 studies with a total of 13,718 men after unilateral testicular cancer. Treatment comprised active surveillance after unilateral orchidectomy (32.7%), radiotherapy (23.1%), standard‐ or low‐dose chemotherapy (33.7%) and high‐dose chemotherapy (1.4%). Post‐treatment spermiograms were analysed in 17 studies. The quantitative synthesis included 23 studies, revealing an overall pooled prevalence of infertility (95% CI) of 14% (9%–21%). Azoospermia occurred in 8% (6%–12%). For good‐prognosis patients who received standard therapy, the overall prevalence of infertility was only 4% (2%–10%).Conclusion: So far, this very first meta‐analysis of overall infertility prevalence provides the best approximation of fertility prognosis for men who have undergone testicular cancer therapy. Despite the low prevalence of infertility, it is still recommended to undergo sperm cryopreservation because of the uncertainty of the subsequent therapy and the lack of large longitudinal data on individual treatment effects.

Background: Ultra‐high‐field magnetic resonance imaging (MRI) at a field strength of 7 Tesla (T) has marked a significant milestone in diagnostic imaging since it was approved for clinical use in 2017. Despite the potential to improve image analysis by advances in signal‐to‐noise ratio, and improved spatial resolution and metabolic imaging, the clinical implementation of 7‐T MRI remains limited. Factors that contribute to this limited availability are the high price, the operating costs, the need for specifically educated personnel, and lack of evidence of clinical benefit.Methods: The aim of this scoping review was to evaluate the evidence of the clinical advantages of 7‐T MRI versus MRI at lower field strengths, complementary imaging modalities, and diagnostic standard approaches for neurological and musculoskeletal disorders. We searched MEDLINE, CENTRAL, Embase and Web of Science for this review.Results: We identified 1966 studies, of which 83 were included in our review. Most studies (73 studies, 88%) examined neurological indications, nine studies (11%) examined musculoskeletal indications, and one study reported on peripheral arterial occlusive disease. Of the neuroimaging indications, cerebrovascular diseases were the most frequently investigated (14 studies), followed by multiple sclerosis (13 studies) and epilepsy (11 studies).Conclusion: The available comparative evidence varied greatly across indications, with the best‐documented evidence being for imaging of epilepsy. Risk of bias overall was high, with limitations in blinding information, study design reporting, and patient recruitment details. The identified evidence gaps underscore the need for comparative research to determine appropriate indications and to understand whether the potential diagnostic advantage of 7‐T MRI translates to a tangible clinical benefit for patients. Future studies should include clinically relevant patient outcomes that go beyond radiological metrics.

Background: In recent decades, there has been a notable rise in the prevalence of caesarean sections, which has been accompanied by a concomitant increase in the incidence of long-term complications, including the occurrence of isthmocele. This anatomical alteration has been associated with symptoms such as abnormal uterine bleeding (AUB), chronic pelvic pain, and secondary infertility. On the other hand, chronic endometritis (CE), characterised by the infiltration of plasma cells into the endometrium, is also associated with infertility and repeated implantation failures. Given the coincidence of symptoms between these two conditions, the question arises as to whether there is an association between isthmocele and CE. Objective: This systematic review and meta-analysis aim to examine the association between isthmocele and CE and to assess its potential clinical implications. Methods: A systematic literature search was conducted in Medline, Embase, and Cochrane CENTRAL up to February 2025. The inclusion criteria were studies involving histopathological findings in isthmocele. The results of the meta-analysis incorporated observational studies and trials to evaluate the prevalence of CE in women with isthmocele, as well as the odds ratios (OR) for CE in isthmocele compared to women without isthmocele, and for CE in isthmocele with AUB compared to women without AUB. Results: A total of seven studies were included in the systematic review, comprising 976 women in the systematic review and 876 women in the meta-analysis. The pooled prevalence of CE in women with an isthmocele was 40% (95% CI: 24–58%). Here, the risk of CE was threefold higher in the presence of an isthmocele as compared to its absence (OR = 3.01; 95% CI: 1.02–9.03). Furthermore, the risk of CE was further increased in women with AUB and isthmocele compared to those without AUB (OR = 6.33, 95% CI: 1.94–20.67). Conclusions: CE and isthmocele are both under-diagnosed and poorly understood conditions. The high prevalence of CE in isthmocele indicates a substantial clinical burden. Specifically, women with AUB and isthmocele exhibit a six-fold higher risk of developing CE. These results underscore the importance of recognising isthmocele as a significant risk factor for CE, particularly in women presenting with isthmocele-associated AUB. Further research is warranted to elucidate the underlying mechanisms and to develop targeted interventions for the prevention and management of CE in this population.