Purpose: Human papillomavirus (HPV), the most common sexually transmitted infection, has been proposed as a potential factor in male infertility. This study aimed to assess the prevalence of HPV in semen samples from men undergoing in vitro fertilization (IVF) in Sweden and evaluate its association with semen parameters and embryological outcomes. Methods: This prospective cohort study was conducted at Sahlgrenska University Hospital, Gothenburg, Sweden, between January 2023 and February 2024. Men (n = 246) undergoing IVF provided fresh semen samples for HPV DNA testing using real-time PCR. Semen analysis followed WHO guidelines, and fertilization and embryo quality assessments were conducted according to the Istanbul Consensus. Machine learning (ML) models were employed to predict fertilization and blastocyst formation outcomes. Results: HPV was detected in 8.9% of semen samples. No significant differences in semen parameters were found between HPV-positive and HPV-negative men. However, in the non-male infertility subgroup, HPV-positive men had significantly higher total motility (median 65 vs. 60%, p = 0.021) and progressive motility (median 65 vs. 55%, p = 0.016). Similarly, in the unexplained infertility subgroup, progressive motility was higher in HPV-positive men (median 60 vs. 50%, p = 0.033). No significant differences were found in fertilization or blastocyst formation rates, and ML analysis confirmed that HPV presence did not influence predictive model accuracy. Conclusion: HPV is detectable in the semen of a notable number of men undergoing IVF, but its presence does not significantly impact fertilization or embryo development. These findings suggest that routine HPV screening in semen may not be necessary for predicting IVF outcomes. Trial registration: The study was registered on ClinicalTrials.gov (ID: NCT06161727).

Introduction Endometriosis is a chronic, inflammatory and oestrogen-dependent disease frequently causing infertility. Assisted reproductive technologies (ART) are often required to achieve pregnancy, especially in women with advanced endometriosis. To date, there is no randomised controlled trial (RCT) exploring reproductive outcomes after first-line surgery followed by ART versus first-line ART in women with stage III-IV endometriosis. The aim in this study is to investigate if endometriosis surgery prior to ART in women with endometriosis stage III-IV and infertility results in improved reproductive outcomes compared with first-line ART. Methods and analysis A national multicentre prospective open label RCT including 350 subjects with stage III-IV endometriosis and infertility. Women aged 18–38 will be randomised 1:1 to endometriosis surgery prior to ART or first-line ART. Follow-up until 3 years from the first treatment. The primary outcome is the cumulative live birth rate 3 years after inclusion. Secondary outcomes are cumulative pregnancy rate, reproductive outcomes per in vitro fertilisation cycle, miscarriage rate, time to pregnancy and live birth, plasma progesterone levels on the day of frozen embryo transfer in hormone replacement cycles, obstetrical outcomes and complications, infections after oocyte retrieval, intraoperative and postoperative complications, pain, quality of life and cost-effectiveness. Ethics and dissemination The study protocol, patient information and informed consent are approved by Swedish Ethical Review Authority (dnr: 2024–04293-01, approved 7 October 2024, amendment, dnr: 2025–03699-02, approved 17 June 2025). An interim analysis is scheduled to ensure the safety of the interventions. The results of Endo-SOFT (Endometriosis: Surgery Or Fertility Treatment) will be published in scientific journals and are expected to influence clinical guidelines. Trial registration number ClinicalTrials.gov, NCT07240363.

Introduction: Ovarian tissue cryopreservation (OTC) has emerged as an important fertility preservation option for women and girls at risk of treatment-induced ovarian failure. However, long-term data on clinical utilization and reproductive outcomes remain limited. This study provides a 30-year regional overview of OTC practice in Western Sweden. Material and Methods: This retrospective observational cohort study included 60 patients who underwent OTC between 1995 and 2025 within a publicly funded regional fertility preservation program. Data on patient characteristics, indications, surgical approach, cryopreservation techniques, and reproductive outcomes were collected from medical records, tissue bank data, and fertility preservation registries. Results: Malignant diagnoses accounted for 51 cases (85%) of indications, most commonly hematologic malignancies and breast cancer, while 9 patients (15%) had benign conditions requiring gonadotoxic therapy. During follow-up, only one patient (1.7%) underwent ovarian tissue transplantation (OTT), resulting in recovery of endocrine function and a spontaneous twin pregnancy. Overall, 15 women (25%) achieved at least one pregnancy. Of these, 8 (13.3%) occurred spontaneously without prior transplantation, 4 (6.7%) were achieved through oocyte donation, 1 (1.7%) occurred after OTT, and 1 patient (1.7%) had both spontaneous and donor-egg pregnancies. Most women (45/60, 75%) had no documented pregnancy or fertility treatment during follow-up. Conclusions: Over three decades, OTC has been successfully implemented as part of a regional fertility preservation program. However, the low rate of tissue utilization and the predominance of spontaneous pregnancies highlight the gap between tissue preservation and clinical use. These findings underscore the need for improved patient selection, structured long-term follow-up, and individualized risk assessment to optimize the clinical impact of OTC.