STUDY QUESTION: Can patient age and ovarian reserve tests predict the number of cryopreserved oocytes in patients undergoing one or more ovarian stimulation cycles for elective oocyte cryopreservation (EOC)? SUMMARY ANSWER: A predictive model incorporating patient age, antral follicle count (AFC), anti-Müllerian hormone (AMH), and FSH levels achieved the greatest predictive accuracy. WHAT IS KNOWN ALREADY: As a consequence of societal evolution, women are increasingly delaying starting a family. However, the natural decline in ovarian reserve and oocyte quality as age advances can increase the risk of age-related fertility decline (ARFD) and involuntary childlessness. EOC is a fertility preservation procedure designed to mitigate against the risk of ARFD. Multiple studies have evaluated the optimum number of cryopreserved oocytes to achieve one or more live births, with many women requiring more than one cycle. Previous studies have modelled oocyte yield in response to ovarian stimulation in single-cycle sub-fertile populations, which limits translatability to a population who are presumed fertile and electively cryopreserving their oocytes. Predictive models incorporating data from multiple cycles in an elective population could aid clinician–patient counselling in women undergoing EOC. STUDY DESIGN, SIZE, DURATION: This retrospective cohort study was conducted using data from patients (N = 579) who underwent one or more ovarian stimulation cycles for EOC at the Centre for Reproductive and Genetic Health (CRGH) between 2016 and 2023 inclusive. Baseline characteristics at each cycle, including age, BMI, AFC, AMH, and FSH levels, were recorded. PARTICIPANTS/MATERIALS, SETTINGS, METHODS: Cryopreservation of ≥10 oocytes following an ovarian stimulation cycle was classified as a good response, while ≥5 oocytes indicated an adequate response. The following parameter combinations were subsequently evaluated in negative binomial regression models with generalized estimation equation: (i) age, AFC, AMH, and FSH; (ii) age, AFC, and AMH; (iii) age, AMH, and FSH; (iv) age and AMH; and (v) age and AFC. Receiver operating characteristic curves, with corresponding AUC, sensitivity, and specificity values, were generated for all models. R version 4.4 was used for all statistical analyses. MAIN RESULTS AND THE ROLE OF CHANCE: Model 1 achieved the highest AUC for predicting a good response, AUC: 0.7922 (95% CI: 0.7628–0.8217), with a corresponding sensitivity of 0.7631 (95% CI: 0.7190–0.8095), and a specificity of 0.694 (95% CI: 0.6580–0.7297). Model 2 achieved the second highest AUC of 0.7919 (95% CI: 0.7625–0.8213), followed by Model 3, AUC 0.7770 (95% CI: 0.7463–0.8078). Model 5 achieved an AUC of 0.7749 (95% CI: 0.7441–0.8056), and Model 4 achieved the lowest AUC of 0.7727 (95% CI: 0.7417–0.8038). Similarly, Model 1 achieved the highest AUC for predicting an adequate response, AUC: 0.7917 (95% CI: 0.7586–0.8249), with a corresponding sensitivity of 0.7255 (95% CI: 0.6940–0.7571), and a specificity of 0.7481 (95% CI: 0.6890–0.8036). Model 2 achieved the second highest AUC of 0.7837 (95% CI: 0.7504–0.8169), followed by Model 5, AUC 0.7729 (95% CI: 0.7391–0.8068). Model 3 achieved an AUC of 0.7723 (95% CI: 0.7376–0.8069), and Model 4 similarly achieved the lowest AUC of 0.7607 (95% CI: 0.7257–0.7958). LIMITATIONS, REASONS FOR CAUTION: This analysis, based on data from a single fertility centre, does not incorporate patient ethnicity or previous oocyte yield as model variables. Consequently, while we evaluate the impact of age and baseline ovarian reserve on predictive accuracy, model performance may vary across different patient cohorts. WIDER IMPLICATIONS OF THE FINDINGS: Predictive models incorporating patient age and baseline ovarian reserve tests across multiple cycles may aid clinician–patient discussions for women undergoing EOC. Model accuracy could be enhanced by the incorporation of ethnicity and prior EOC outcomes as model variables in large multicentre studies. STUDY FUNDING/COMPETING INTEREST(S): No external funding was used for this study. None of the authors have any competing interests, nor have they received or are due to receive any payment for writing this article. TRIAL REGISTRATION NUMBER: This cohort study did not require registration. Following consultation with the Medical Advisory Committee at CRGH, ethical approval was not deemed necessary.

This review determines the association between ovarian reserve markers, anti-Müllerian hormone (AMH) and antral follicle count (AFC), with risk of miscarriage in women undergoing assisted reproductive technology. A systematic search of PubMed, Embase, Cochrane Library and Google Scholar from inception to September 2023 identified 16 retrospective studies, including 43,147 patients. A meta-analysis using a random effects model demonstrated that low AMH concentration is associated with a significantly increased risk of miscarriage compared with medium and high AMH concentration (OR 1.48, 95% CI 1.20 to 1.83, P = 0.0002). When stratified by age, the risk remained significant in women aged younger than 35 years (OR 1.34, 95% CI 1.17 to 1.54, P < 0.0001); however, results were not significant among women aged 35 years or younger (OR 1.29, 95% CI 0.95 to 1.76, P = 0.10). Similarly, low AFC was associated with an increased risk of miscarriage across all ages (OR 1.80, 95% CI 1.33 to 2.45, P = 0.0002). After age adjustment, the association was significant in women aged younger than 35 years (OR 1.61, 95% CI 1.20 to 2.16, P = 0.002), but not among women aged 35 years or older (OR 1.41, 95% CI 0.90 to 2.22, P = 0.14). Therefore, a reduced ovarian reserve is associated with an increased risk of miscarriage, although results are only significant among women aged younger than 35 years.

Background/Objectives: To determine whether long-term oncological follow-up is required following fertility-sparing surgery (FSS) for mucinous borderline ovarian tumours (MBOTs). Methods: A retrospective cohort study set in the tertiary gynaecology oncology centre at Imperial College Healthcare NHS Trust. Patients included were those under follow-up post-surgery for an MBOT in the ovarian clinic from 2007 to 2025. Rate of recurrence was compared amongst patients who underwent ovarian cystectomy, unilateral salpingo-oophorectomy (USO) or bilateral salpingo-oophorectomy (BSO) +/− hysterectomy. Results: From 74 patients diagnosed with MBOT, 36.5% (27/74) underwent BSO +/− hysterectomy and 63.5% (47/74) had FSS. Of the patients who underwent FSS, 59.6% (28/47) had an initial USO and 40.4% (19/47) underwent ovarian cystectomy. Subsequently, 63.2% (12/19) of patients who initially had ovarian cystectomy proceeded with completion USO, leading to a total of 40 USOs performed. There were no recurrences following BSO +/− hysterectomy, primary USO or completion USO after a median follow-up of 49.0, 65.5 and 48.0 months, respectively. Of the patients who underwent ovarian cystectomy, 15.8% (3/19) were found to have residual MBOT (n = 1) two months post-cystectomy or MBOT recurrence (n = 2) at 10- and 66-months post-cystectomy, all diagnosed at USO. There is a significant association between ovarian cystectomy and disease recurrence (Fisher’s exact test p = 0.015). Conclusions: Patients of reproductive age who undergo USO for a MBOT can be offered a reduced follow-up schedule as the risk of recurrence is very low. In contrast, patients who are managed by ovarian cystectomy have a higher risk of recurrence and require long-term surveillance monitoring.

Introduction: Across many countries, paternal age at childbirth is rising, increasing exposure to age-related fertility decline. This study evaluated fertility-related knowledge, attitudes, and perceptions among young men. Methods: An anonymous cross-sectional survey was distributed via social media between 13/02/2025 and 29/09/2025. UK adult males completed 54 close-ended questions covering participant characteristics, fertility knowledge, reproductive aspirations, and personal/socioeconomic influences. Results: A total of 408 men participated in the survey, of whom 214 (52.5%) completed all components, with a median age of 34 years (interquartile range 31–38). Most were married (61.5%; N = 176), had degree-level education or higher (78.4%; N = 226), and were in full-time employment (85.4%; N = 246). Over half had no children (55.6%; N = 160). Most wished to have their first child between 30–35 years (64.5%; N = 71), and last between 36–40 years (64.3%; N = 119). More than half of the participants recognised that paternal age affects fertility (58.6%; N = 133). However, few were aware of the contribution of male-factor infertility (16.9%; N = 38), or the age at which semen quality declines (17.7%; N = 40). The majority understood that modifiable lifestyle factors influence semen quality (88.9%; N = 200), and either agreed or strongly agreed that smoking (99.1%; N = 211), recreational drug use (95.3%; N = 203), and radiation/chemical exposure (98.1%; N = 209) impacted male fertility. Many men (43.2%; N = 92) had never sought fertility information; among those who did, online medical websites were most common (32.9%; N = 70), while social media was rarely used (1.4%; N = 3). Key considerations influencing reproductive plans included biological parenthood (76.5%; N = 160), partner suitability (94.7%; N = 196), financial security (95.2%; N = 197), and suitable housing (72.4%; N = 150). Conclusion: Young men demonstrated limited awareness of age-related fertility decline despite recognising lifestyle effects. Routine healthcare offers an opportunity for counselling to improve awareness, alongside consideration of socioeconomic factors. Findings are limited by a small, highly educated sample and possible self-selection bias. Trial registration number: Imperial College Research Ethics Committee number: 700608.

Objective This study aims to determine whether long-term follow-up is required following fertility sparing surgery (FSS) for mucinous borderline ovarian tumours (MBOT). Design Retrospective cohort study. Setting Tertiary gynaecology oncology centre at Queen Charlotte’s and Chelsea Hospital, Imperial College Healthcare NHS Trust (United Kingdom). Population or sample Patients under follow-up post-surgery for MBOT in the ovarian clinic from 2007-2025. Methods Rate of recurrence was compared amongst patients who underwent primary debulking, unilateral salpingo-oophorectomy (USO) or ovarian cystectomy for MBOT. Main outcome measures Duration of follow-up, rate of disease recurrence and the requirement for further surgery. Results Out of 75 patients diagnosed with MBOT, 27 underwent primary debulking surgery and 48 had FSS. Of the patients who underwent FSS, 28 had USO and 20 underwent ovarian cystectomy. Subsequently, 13 of the 20 patients (65%) who initially had ovarian cystectomy proceeded with completion USO. There were no recurrences following primary debulking, primary USO or completion USO after a median follow up of 49, 65.5 and 39 months, respectively. Four of the 20 patients (20%) who underwent ovarian cystectomy were found to have: residual MBOT (n=1) two months post-cystectomy, MBOT recurrence (n=2) at 10 and 66 months post-cystectomy, or mucinous carcinoma (n=1) five months post-cystectomy, all diagnosed at USO. Conclusions Patients of reproductive age who undergo USO for a MBOT do not require long-term follow-up as the overall risk of recurrence is very low. In contrast, patients who are managed by ovarian cystectomy have a higher risk of recurrence and should be offered long-term surveillance monitoring. Keywords Fertility sparing surgery; Mucinous borderline ovarian tumours; Recurrence of BOT.