Extracellular vesicles are highly abundant in seminal fluids and have a known role enhancing sperm function. Clinical pregnancy rates after IVF treatment are improved after female exposure to seminal fluid. Seminal fluid extracellular vesicles (SF‐EVs) are candidate enhancers, however, whether SF‐EVs interact with cells from the endometrium and modulate the implantation processes is unknown. Here, we investigated whether SF‐EVs interact with endometrial stromal cells (ESCs) and enhance decidualisation, a requisite for implantation. SF‐EVs, isolated from human seminal fluid (n = 11) by ultracentrifugation, were characterised by nanoparticle tracking analysis and Western blotting, and purified using size exclusion chromatography. Non‐decidualised and decidualised primary ESCs (n = 5) were then treated with SF‐EVs. Binding of bio‐maleimide‐labelled SF‐EVs was detected by flow cytometry and fluorescence microscopy. Prolactin and IGFBP‐1 protein levels in culture media were also analysed after single and multiple SF‐EV exposure. SF‐EVs size ranged from 50 to 300 nm, and they expressed exosomal markers (ALIX, SYNTENIN‐1, CD9 and CD81). SF‐EVs bound to non‐decidualised and decidualised ESCs at similar levels. ESCs prolactin secretion was increased after single (p = 0.0044) and multiple (p = 0.0021) SF‐EV exposure. No differences were found in IGFBP‐1 protein levels. In conclusion, SF‐EVs enhance in vitro ESC decidualisation and increase secretion of prolactin, an essential hormone in implantation. This elucidates a novel role of SF‐EVs on endometrial receptivity. Abbreviations: ECACC: European Collection of Authenticated Cell Cultures; ESCs: endometrial stromal cells; EVs: extracellular vesicles; FCS: foetal calf serum; HRP: horse‐radish peroxidase; IFNγ: interferon‐gamma; IGF: insulin‐like growth factor; IGFBP‐1: insulin‐like growth factor binding protein 1; IVF: in vitro fertilisation; MVB: multivesicular bodies; NTA: nanoparticle tracking analysis; PRLR^−/−: homozygous prolactin receptor knockout; RT: room temperature; SF‐EVs: seminal fluid extracellular vesicles; STR: short tandem repeat; TGFβ: transforming growth factor β; uNK: uterine natural killer

We present findings from a longitudinal ethnographic study of infertile couples seeking treatment following initial GP referral to specialist fertility services. Repeated observations and interviews were undertaken with the same 14 heterosexual participants over an 18‐month period. Heterosexual, non‐donor couples comprise the majority of fertility clinic patients; however, research interest in this group has dwindled over time as IVF cycles have increased. In the United Kingdom, IVF is presented as a logical response to involuntary childlessness, and as an entirely predictable, and linear, course of action. The market is well‐developed and often patients' first experience of privatised health care in the NHS. Our couples were challenged by this, and while they felt expected to move on to IVF, some wished to explore other options. While IVF is ubiquitous, the discomfort and challenge around fertility treatments remain; experiences are prolonged and characterised by recursive narratives and expressions of disequilibrium, which are rarely acknowledged and reflected in ongoing clinic‐patient interactions. Our findings develop understanding of the process of ‘mazing’ (Image ‐ The Journal of Nursing Scholarship, 1989, 21, 220), the pursuit of parenthood, by showing that the routine and normative status of IVF, at least in the current health care context, is at odds with the lived experiences of individuals.

Information giving is a key aspect of the provision of high-quality patient-centred health care, resulting in patients who are well-informed, better adjusted to their circumstances and are compliant with their treatment. Fertility patients generally appear to be satisfied with the information they are given but a significant minority are not. Giving information to infertile patients is complicated by the nature of their condition, desire for a child and complexity of treatment options. Patients need detailed, well-timed information to support difficult decision-making, such as when to end treatment. The experiences of some individual patients and particular sub-groups in receiving and understanding information suggest that the quality of information or the way it is communicated could be improved. It is suggested that this may be achieved by reviewing the format and timing of the information provided, ensuring adequate staff training and facilitating flexibility in clinic organisation.