Male infertility is an increasingly serious global health problem. As an organ with immune privilege, the testis possesses a unique immune microenvironment that shapes normal spermatogenesis. Distinct from the testicular microenvironment, the epididymis plays a critical role in both sperm maturation and immune regulation. This review aims to systematically describe the regulatory mechanisms of the testicular and epididymal immune microenvironment and, using various diseases as examples (varicocele, testicular torsion, prostatitis, orchitis, viral infections, environmental toxicant exposure, aging and obesity), to explore in depth how disruption of this balance leads to male infertility through immunological pathways. Targeted antioxidant and anti-inflammatory interventions on specific immune pathways currently represent major therapeutic directions. Although many precision interventions and other emerging therapies remain at the experimental stage, they provide broad prospects for the development of novel treatment paradigms.

Reproductive health-seeking behaviour is critical to maternal health and overall well-being, yet many reproductive disorders remain underdiagnosed and contribute substantially to morbidity in India. Health-seeking for reproductive health conditions is often limited by symptom normalization, stigma, lack of awareness, and restricted access to female healthcare providers. This systematic review and meta-analysis aimed to quantify the prevalence of health-seeking behaviour for reproductive morbidities among Indian women and to summarise key factors influencing care utilisation. The protocol was registered in PROSPERO (CRD42024562508), and the review followed PRISMA 2020 guidelines. PubMed, Scopus, and Google Scholar were searched from inception to January 29, 2026, for studies reporting reproductive health-seeking behaviour among women in India. Eligible studies addressed reproductive morbidities, including menstrual disorders, gynecological infections, pregnancy complications, menopause-related problems, infertility, structural abnormalities, including uterine prolapse, pelvic organ prolapse, vaginal prolapse, and chronic pelvic pain. Data were extracted, risk of bias was assessed, and quantitative findings were synthesized using a meta-analysis of proportions with the inverse-variance method. Heterogeneity was examined using Cochran's Q and the I2 statistic. The pooled prevalence of reproductive morbidities among women was 41.5% (95% CI: 31.2%-52.7%). Overall, 54.8% (95% CI: 46.0%-63.4%) sought treatment for at least one morbidity. Among care seekers, 31.4% used government facilities and 54.7% used private facilities. Allopathic medicine was the most common treatment modality (66%), followed by home remedies (27.9%), AYUSH therapies (12.7%), and over-the-counter medications (15.4%). While 47% perceived no need for treatment, the key barriers included symptom normalisation (60%), embarrassment (16.3%), lack of awareness (13.5%), financial constraints (12.3%), communication difficulties (27.3%), and distance to facilities (8.4%). This SRMA highlights substantial gaps in health-seeking among Indian women with reproductive morbidities, with only about half seeking formal treatment. Education and socioeconomic status remain key determinants of health-seeking, while limited awareness and poor knowledge of reproductive health services continue to impede timely treatment. PROSPERO CRD42024562508.

Background Declining fertility rates are a globally documented problem, affecting even regions that have historically high fertility rates. In the Asia Pacific (APAC) region, most countries and territories are seeing birth rates drop far below the replacement rate of 2.1 children per woman. Policymakers in these countries have switched from a historic focus on population control policies to investing in pronatalist policies that aim to boost the national fertility rate by tackling the socioeconomic drivers of falling fertility. In this paper, we examine policies affecting the often-overlooked medical aspect of this challenge: infertility. Objective To review challenges in fertility policy and propose solutions to improve equitable access to assisted reproductive technologies (ART) and associated services. Methods A review of literature was conducted on fertility policy challenges and developments in the APAC region, covering fertility recognition and awareness; egg freezing; and access to ART treatment, psychosocial care, and supplementary care. Experts from nine different countries and territories were invited to validate secondary research findings and provide their perspectives on policy implications. The experts participated in individual 60-minute interviews, then a half-day Policy Forum discussion was held at the Asia-Pacific Assisted Conception Congress 2024, held in Kuala Lumpur, Malaysia. Results Whilst several countries in the region have long recognised falling total fertility rates (TFR) as a cause for concern, many have been slow to recognise infertility as a disease, resulting in limited policy development to support patients experiencing infertility. Commonly this presents as lack of funding allocated towards fertility services, limited or no reimbursement of fertility treatment or egg freezing, and poor societal awareness of infertility and hence delays in seeking care. Various policy changes can be adopted to improve care for patients across the APAC region. Conclusion Our review identified multiple gaps in policy development for supporting individuals experiencing infertility. Looking to countries in which the TFR dropped below replacement level many years ago, the importance of timely policy intervention before negative demographic consequences occur is critical.

IntroductionFactors underlying reproductive decisions, including contraceptive method choice, are poorly understood, especially in humanitarian settings where sexual and reproductive health (SRH) needs may be highest due to heightened risk of sexual violence and disruptions of health services. The study examined the association between method-specific beliefs and future method choice among women in refugee settlements in Uganda.MethodsData were from a baseline of a one-year prospective study involving a cohort of 2,498 women aged 15–45 years living in Kiryadongo and Kyangwali refugee settlements. Analysis used cross-tabulation with chi-square test and conditional logistic regression analysis to examine associations between method-specific beliefs and intention to use injectables, implants, or pills among contraceptive non-users.ResultAmong contraceptive non-users (n = 1,486), 32% intended to use a method within the next 12 months or later. Injectable was the most preferred future method (39%), followed by implants (25%) and pills (17%). Concerns about interference with menstruation, unpleasant side effects, and safety for long-term use were common across all three methods (range 58% – 90%). The likelihood that a woman intended to use injectable, implant, or pill in future was positively associated with perceived ease to access (AOR = 1.95; 95% CI: 1.03–3.66), ease of use (AOR = 4.17; 95% CI: 2.22–7.86), safety for long use (AOR = 4.51; 95% CI: 1.61–12.64), and satisfaction with past use (AOR = 2.87; 95% CI: 1.51–5.46).ConclusionIntention to use contraception in future among non-users in refugee settlements is low, coupled with widespread negative beliefs about available methods. There is need to improve counseling to counter negative beliefs and to expand access to a range of modern contraceptive methods.

BackgroundWomen in Mexico are not considered a key population for acquiring HIV and are often not perceived at risk by themselves or their physicians. This limited risk perception can delay testing and contribute to advanced HIV disease. We aimed to determine the frequency of missed opportunities for HIV diagnosis (MOHD) in a tertiary center in Mexico City and compare characteristics between men and women.MethodsWe conducted a retrospective observational study using standardized questionnaires administered to adults newly enrolled in care at a tertiary HIV Clinic between 2013 and 2023. MOHD was defined as a healthcare encounter for HIV related symptoms in which diagnosis was not made within 30 days and or the patient attended at least two medical consultations before diagnosis. We described sociodemographic characteristics, the proportion of MOHD, and advanced HIV defined as baseline CD4 < 200 cells or an AIDS defining condition. Comparisons were made by sex, proportions were stratified by age group, and logistic regression identified factors associated with MOHD.ResultsOf 1,332 questionnaires, 619 individuals reported symptoms and sought medical care before diagnosis; 320 (51.6 percent) met MOHD criteria, including 39 women and 281 men. MOHD was more frequent in women than men (67.2 percent vs. 50.1 percent, p = 0.03). Advanced HIV was also more frequent among women with MOHD (51.3 percent vs. 33.8 percent, p = 0.02). Women had longer symptom duration, more medical consultations, and longer delays from first medical contact to diagnosis. Increasing age (OR 1.01, CI 1.00 to 1.1, p = 0.02) and being a woman (OR 2.3, CI 1.21 to 4.52, p = 0.01) were independently associated with MOHD.ConclusionsIn this cohort, missed opportunities for HIV diagnosis were common and occurred more frequently among women than men. Women experienced longer delays to diagnosis and higher rates of advanced disease. These findings highlight persistent gaps in timely HIV diagnosis among women.

Ashwagandha (Withania somnifera) is widely recognized in Ayurvedic medicine as a potent Rasayana and aphrodisiac herb, with preclinical studies demonstrating androgen-modulating, anxiolytic, and antioxidant properties that may enhance male reproductive physiology. The present study aimed to rigorously evaluate the efficacy and safety of a standardized Ashwagandha Root Extract (ARE) in improving sexual function in healthy adult men. A prospective, randomized, double-blind, placebo-controlled, parallel-group clinical trial was conducted over 8 weeks in 76 healthy males aged 30-50 years. Participants were randomized (1:1) to receive either 300 mg ARE twice daily or a matched placebo. Sexual functioning was evaluated using validated instruments, including the Sexual Desire Inventory-2 (SDI-2), number of Satisfying Sexual Events (SSEs), and the International Index of Erectile Function (IIEF). Semen parameters were analyzed using WHO-standardized procedures, and quality of life was assessed with the Short Form-12 Health Survey. Both intention-to-treat and safety analyses were performed with a significance threshold of α = 0.05. ARE supplementation resulted in statistically significant improvements across multiple domains of sexual function compared with placebo, including SDI-2 scores, SSEs, sexual desire, and overall IIEF outcomes (p ≤ 0.001). Semen analysis demonstrated a 36% increase in ejaculate volume, 38% improvement in total sperm count, and an 87% increase in total sperm motility after 8 weeks, with moderate to large effect sizes indicating clinically meaningful benefits. No adverse events or safety concerns were reported. These findings suggest that standardized ARE may serve as an effective and well-tolerated natural intervention to support male sexual health. https://ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid=NzY3ODE=&Enc=&userName=, identifier CTRI/2,022/11/047,501.

Prior studies show that people with larger bodies experience pervasive weight stigma, which is often directly perpetuated by healthcare providers. This pattern has also been observed in women receiving prenatal and postpartum care. Individuals seeking treatment for infertility commonly encounter concrete barriers, such as formalized BMI-based restrictions. These limitations may further compound the isolating and stigmatizing experiences already known to affect women with infertility. Qualitative study exploring the experiences and perceptions of patients with larger bodies and infertility. Women seeking fertility care within the past 2 years with a BMI ≥ 30 kg/m2 were eligible for participation. Demographic surveys and one-on-one semi-structured interviews were performed. Interviews were deidentified, transcribed, and analyzed inductively using a thematic analysis approach. Major themes and subthemes were identified by two coders with discrepancies being resolved with a third coder. A total of 33 subjects were included in the analysis. Mean age of participants was 36.9 years. Key themes identified included stigmatizing treatment, perceptions of substandard care, complex body relationships, and quality care as an achievable goal. Many participants reported receiving shaming and judgmental care throughout their healthcare encounters including fertility care, which for several directly influenced their decision to pursue treatment. Participants often reported receiving abbreviated, substandard diagnostic evaluations that in many cases missed critical diagnoses. Participants conveyed significant awareness of the impact of weight on fertility and complex weight cycling histories, and this knowledge paired with these experiences often went unaddressed by providers. Consistent with the experiences of patients with larger bodies broadly, patients with infertility similarly report receiving stigmatizing treatment and perceived substandard care from their fertility providers. This potential harm to patients is not inevitable; participants report receiving quality care where providers offer humanizing and individualized care. There is a clear need for personalized and patient-centered treatment for this population of patients, that while marginalized, account for an increasing percentage of fertility patients.

Preeclampsia (PE) remains a major cause of maternal and perinatal morbidity worldwide. Although abnormal placentation and shallow trophoblast invasion are well recognized, increasing evidence suggests that the origins of PE lie earlier, at the stage of implantation and decidualization. A deeper understanding of impaired implantation as the initiating event offers new opportunities for prediction, prevention, and therapy. This narrative review synthesizes mechanistic, epidemiological, and biomarker evidence accumulated over the past two years. Mechanistic studies reveal that defective decidualization and resistance to progesterone signaling impair stromal cell differentiation, angiogenic balance, and vascular remodeling. Immunological dysregulation, including maladaptive KIR–HLA interactions, CD40–CD40L pathway activation, and altered cytokine tolerance, further disrupts maternal–fetal communication. Clinical epidemiology strongly implicates implantation context: programmed frozen embryo transfer cycles lacking a corpus luteum consistently increase the risk of hypertensive disorders, highlighting the importance of peri-conception physiology. First-trimester biomarkers such as low PAPP-A, reduced PlGF, and abnormal uterine artery Doppler indices capture the early “fingerprint” of impaired implantation long before clinical disease. Emerging evidence also supports seminal plasma as a key modulator of immune priming and endometrial receptivity, with reduced exposure linked to higher PE risk. Together, these findings reframe PE not solely as a disorder of placental development in mid-gestation but as a disease with origins in implantation biology. By bringing together molecular, immunological, and clinical evidence, this review positions impaired implantation as a central trigger of PE. Recognition of implantation-era events as the upstream pathway provides a new framework for translational research, emphasizing peri-conception exposures, assisted reproduction practices, and biomarker discovery. Clinically, it highlights novel opportunities for early risk stratification and prevention strategies. This implantation-centered model may help shift the paradigm of PE from late-pregnancy diagnosis toward early-pregnancy prediction and intervention.

Public health guidance and human rights standards recommend states to decriminalize abortion, and further recommend that they legalise abortion care to ensure that abortion seekers can access quality and human rights consistent care. This paper explores abortion decriminalization and legalization globally, including by clearly distinguishing between them to discuss the content, implications, and consequences of each. Furthermore, it uses data from the GAPD to identify trends and patterns in how countries have approached these regulatory questions, outlining four models of legalization identified through the texts of national laws and policies.

Polycystic Ovary Syndrome is a common condition among women of reproductive age, yet many cases remain undiagnosed. While several studies have assessed awareness in Saudi Arabia, data from the Eastern Province are limited. To measure the prevalence of Polycystic Ovary Syndrome among women aged 18-45 in the Eastern Province, evaluate their knowledge of the condition, and examine demographic factors associated with prevalence and knowledge levels. A cross-sectional online survey was administered to 408 women recruited. The questionnaire collected data on sociodemographic characteristics, knowledge levels, and symptom-based indicators related to Polycystic Ovary Syndrome. Data were analyzed using descriptive statistics and multiple linear regression analysis. Symptom-based prevalence was 19.9 per cent, and 16.7 per cent reported a formal diagnosis. Awareness was high (83.1 percent), and 61.5 percent showed good knowledge. Demographic factors were not significantly associated with prevalence. Knowledge was significantly associated with age, medical or health-related background, and income (p > 0.05). Although awareness is relatively high, knowledge gaps remain, especially among women without health-related backgrounds. Tailored educational and early detection efforts are needed to improve understanding and support timely diagnosis and management.