30-Second Takeaway
- WHO releases global infertility guideline stressing access, rational testing, and person-centered care.
- Large non-selection PGT-A study finds mosaic reporting adds negligible predictive value for live birth.
- Endometriosis surgery remains key for pain, not an evidence-based replacement for IVF in infertility care.
- LNG-IUD vs norethindrone in adenomyosis: lower PID and anemia risk but higher BV risk with LNG-IUD.
- Emerging risk tools (GDM models, twin thyroid ranges, MLH1 methylation, ctDNA) refine stratification and follow-up.
Week ending December 20, 2025
Infertility, reproductive endocrinology, and gyn oncology: concise updates with near-term practice implications
WHO infertility guideline centers on rational testing, prevention, and person-centered management
The WHO guideline issues 40 recommendations and 6 good practice statements for infertility prevention, diagnosis, and treatment globally. It emphasizes careful test selection, active listening to individuals and couples, shared treatment decisions, follow-up, and documenting outcomes. Prevention guidance targets fertility education plus risk reduction for STIs, lifestyle factors, and tobacco use. Diagnostic recommendations address ovulatory dysfunction, tubal disease, and uterine cavity abnormalities in females, and when to perform semen testing in males. Recommendations were GRADE-based, weighing benefits, harms, values, costs, feasibility, acceptability, and equity to inform national policy and clinical care.
Non-selection study shows limited clinical value of PGT-A mosaic reporting for live birth
In 9,828 single-embryo transfers, 84.7% were euploid, 8.8% had segmental intermediate copy-number (ICN), and 5.6% had whole-chromosome ICN. Live-birth rates were modestly lower with ICN than euploid embryos, mainly among the small subset with high-level ICN. Adding ICN status to models including clinical and embryologic variables did not meaningfully improve live-birth prediction (AUC 0.552 vs 0.555). Miscarriage, obstetric, and neonatal outcomes were similar between ICN and euploid groups. The authors conclude that reporting putative mosaicism offers no clinical benefit and should not influence routine embryo selection.
Viewpoint rebuts claims that endometriosis surgery can replace IVF for infertility
The article affirms laparoscopic surgery as effective for severe endometriosis pain and quality-of-life improvement. It critiques “restorative reproductive medicine,” which promotes surgery and lifestyle changes as root-cause infertility cures that obviate ART. The authors find no evidence supporting endometriosis surgery as a replacement for IVF or primary infertility therapy. They advocate nuanced, shared decision-making based on symptoms, disease burden, reproductive goals, and patient values. Clinicians are urged to separate evidence-based indications for surgery from ideological agendas that seek to restrict IVF.
References
Numbered in order of appearance. Click any reference to view details.
Additional Reads
Optional additional studies from this edition.