Managing type 1 diabetes during pregnancy presents significant challenges due to physiological and hormonal changes. These factors contribute to major changes in insulin sensitivity, complicating efforts to achieve and sustain optimal blood glucose levels. Poorly controlled glucose levels during pregnancy can result in diabetic embryopathy and elevate the risks of maternal complications such as hypertensive disorders and diabetic ketoacidosis. Fetal complications may include preterm birth, fetal demise, and admission to neonatal intensive care units. It is essential to recognize that there is no universal approach to managing glycemic control in pregnant women with T1DM and care should be individualized. Effective management requires a multidisciplinary approach involving regular monitoring, adjustments in insulin therapy, dietary modifications, and consistent prenatal care. Continuous glucose monitoring has emerged as a valuable tool for real-time glucose monitoring, facilitating tighter glycemic control. Education and support for self-management are important in addressing these challenges. Future developments in technology and personalized approaches to care show promising potential for advancing diabetes management during pregnancy. This provides a comprehensive overview of current literature on the challenges with the management of T1DM during pregnancy, focusing on its impact on maternal and neonatal outcomes and highlighting effective strategies for achieving optimal glycemic control.

Rheumatoid arthritis (RA) is a systemic autoimmune disease that more commonly affects women, including many women during the childbearing years. This can make management challenging for practitioners involved in the care of these patients. This review article will discuss the available data and expert recommendations pertaining to women with RA who are pregnant or planning pregnancy. Herein, we will consider pregnancy complications associated with RA, the benefits of maintaining low disease activity prior to conception and throughout pregnancy, flare management during pregnancy, ensuring pregnancy-compatible medications to treat RA, and the reduced rates of fertility in patients with RA. While research in this area has greatly expanded over the past decade, it continues to be an area where more research is needed to best support women with RA as they navigate pregnancy.

Reproductive counseling is crucial for women's health, especially for those with inflammatory bowel disease (IBD), which often affects younger patients during their childbearing years. Patients with IBD need special considerations when planning for pregnancy. Preconception counseling is important as it helps patients make informed decisions about pregnancy and allows for optimal management of IBD before, during, and after pregnancy. In this review, we aim to provide guidance for managing and treating patients with IBD throughout the preconception, pregnancy, and postpartum period.

Celiac disease is a systemic autoimmune disorder triggered by dietary gluten ingestion. The classic clinical presentation is characterized by diarrhea with malabsorption and weight loss; however, the spectrum of possible initial symptoms is broad. Affected individuals may be asymptomatic or may suffer from extraintestinal manifestations that can include metabolic bone disorders, thyroid dysfunction, neurologic manifestations, amenorrhea, or impaired fertility. Several studies have demonstrated an association between celiac disease and infertility and worsened pregnancy outcomes. Numerous possible mechanisms through which celiac disease could be associated with women's fertility have been proposed in the literature.

Antiphospholipid syndrome (APS) is a disease characterized by the presence of antiphospholipid (aPL) antibodies, thrombosis, and obstetric complications. While patients with APS can have successful pregnancies, many important considerations exist. APS can also cooccur with other systemic autoimmune diseases which can affect pregnancy, particularly systemic lupus erythematosus. This article reviews specific considerations for pregnancy and reproductive health in patients with APS. Similar to other autoimmune diseases, stable or quiescent disease and planning with a rheumatologist and obstetrician prior to conception are vital components of a successful pregnancy. Pregnancy management for patients with aPL antibodies or diagnosis of APS with aspirin and/or anticoagulation depending on disease profile is discussed, as well as the effects of physiologic changes during pregnancy in maternal and fetal outcomes for this population. Given the reproductive span lasts beyond conception through delivery, we include discussions on safe contraception options, the use of assistive reproductive technology, pregnancy termination, menopause, and male fertility. While APS is a relatively rare condition, the effects this disease can have on maternal and fetal outcomes even with available therapies demonstrates the need for more high-quality, evidence-based research.

Smartphone-based fertility awareness methods with home-based urinary hormonal testing are gaining popularity for fertility tracking. In our university-affiliated family practice, we integrated a previously developed ovulation tracking application into a protocol for monitoring urinary sex hormones and cervical secretions. Serum progesterone was used to confirm the luteal phase, with levels ≥ 15.9 nmol/L ensuring confirmation. Data from 110 women seen for infertility treatment ( = 95) or family planning advice ( = 15) and using our ovulation prediction protocol showed that most opted for a combination of cervical mucus and luteinizing hormone testing ( = 86). Among those using it for family planning, the median usage among women spanned 56 cycles, and 13 cycles per woman required progesterone testing for confirmation. Thirteen patients are still using the method without unintended pregnancies. No unintended pregnancies occurred. Confidence in tests based on serum progesterone was high (93%). For infertility, the method helped in the identification of anovulation, evaluating treatment response, and in diagnosing subfertility causes. This proof-of-concept retrospective descriptive case series suggests the potential for smartphone-based monitoring in fertility management, urging further studies for application enhancements and prospective validation.

Although in vitro fertilization (IVF) has become an extremely effective treatment option for infertility, there is significant underutilization of IVF by patients who could benefit from such treatment. In order for patients to choose to consider IVF treatment when appropriate, it is critical for them to be provided with an accurate, understandable IVF prognosis. Machine learning (ML) can meet the challenge of personalized prognostication based on data available prior to treatment. The development, validation, and deployment of ML prognostic models and related patient counseling report delivery require specialized human and platform expertise. This review article takes a pragmatic approach to review relevant reports of IVF prognostic models and draws from extensive experience meeting patients' and providers' needs with the development of data and model pipelines to implement validated ML models at scale, at the point-of-care. Requirements of using ML-based IVF prognostics at point-of-care will be considered alongside clinical ML implementation factors critical for success. Finally, we discuss health, social, and economic objectives that may be achieved by leveraging combined human expertise and ML prognostics to expand fertility care access and advance health and social good.

Identified barriers to care for common, chronic conditions that impact millions of females suggest that patient education is critical to improving the care experience, expediting a diagnosis, and elevating outcomes. This article aims to understand the efficacy of digital patient education interventions on patient outcomes, specifically those addressing common causes of chronic abnormal uterine bleeding, premenstrual dysphoric disorder, and endometriosis. We queried MEDLINE, PubMed, Cochrane Library, and Google Scholar for articles published in English between January 1, 2014, and May 1, 2024, on digital patient education and urogenital diseases. The search identified 260 articles, 247 of which were retrieved for title and abstract review, 27 of which were retrieved for full-text review, and 25 of which were excluded. Two studies were included in this review. Both studies were individual-/community-level interventions involving digitally delivered patient education. Participants had received a diagnosis and were engaged in accessing care when enrolled, and each study was conducted at a single site. Both interventions produced positive results. Despite the potential of digital health education to improve patient outcomes, limited research in this field underscores the need for further studies to validate interventions and address gaps in knowledge.

The menstrual cycle (MC) serves as a vital indicator of overall health and metabolic function, regulated by the hypothalamic-pituitary axis and involving a complex interplay of hormones. Understanding these hormonal dynamics is crucial for deciphering an individual's physiological status and performance potential, particularly in athletes. Studies regarding the MC's impact on athletic performance and training often lack inclusivity, standardized methodologies, and inconsistent biological definitions, hindering comprehensive conclusions. Moreover, societal inequalities contribute to the underrepresentation of female athletes in research, exacerbating the lack of understanding regarding female physiology in sports medicine. Leveraging wearable technology presents a promising avenue for both tracking MCs and optimizing athletic training/recovery. Wearables offer real-time monitoring of biometrics that often correlate with hormonal fluctuations, and lifestyle trends (diet, sleep, stress) aiding in personalized training schedules and performance optimization. Integrating data collected by MC dynamics and wearable technology into athletic training has the potential to decrease the generally perceived negative impacts MC has on athletic performance. Addressing gaps in research methodologies and promoting awareness among athletes, coaches, and healthcare professionals are essential steps toward maximizing the potential of MC-informed training strategies.

Ovulation is critical for both conception and overall health, but many people who may ovulate are not tracking ovulation or any other part of their menstrual cycle. Failure to track ovulation, especially in those trying to conceive, can lead to fertility challenges due to absent ovulation, mistiming intercourse, or an undetected luteal phase defect. Ovulatory disorders and mistiming intercourse are both primary causes of infertility, and tracking ovulation is shown to decrease the average time to conception. While there are many tracking methods and apps available, the majority are predictive apps or ovulation predictor kits and do not test or track both successful ovulation and the health of the luteal phase, leading to missing information that could contribute to diagnosis or successful conception. Here, we review why ovulation tracking and a healthy luteal phase are important for those trying to conceive. We present currently available ovulation tracking methods that detect both ovulation and the luteal phase, including cervical mucus, urinary hormone testing, and basal body temperature, and discuss the use, advantages, and disadvantages of each. Finally, we consider the role of digital applications and tracking technologies in ovulation tracking.

The rise in smartphone utilization and technology uptake has popularized digital health interventions as a means of supporting healthy pregnancies and optimizing maternal and child health. Digital health interventions include several modalities, such as telemedicine, remote patient monitoring, smartphone applications, web-based interventions, wearables, and health information technology. However, the impact of these interventions on improving maternal and infant health outcomes by race and socioeconomic status to achieve birth equity is unknown. This review summarizes current literature on the impact of digital health interventions on the outcomes of communities of color and lower socioeconomic status in the United States. We demonstrate there is emerging evidence of the impact of digital health interventions on maternal health outcomes, particularly for telemedicine, but evidence specifically focused on assessing outcomes by race and ethnicity and for other modalities, like mHealth apps or wearables, is limited. Digital health interventions may play a part in birth equity initiatives, but should not be considered a standalone solution, and instead should be integrated into other existing efforts to achieve birth equity, like diversifying the clinician workforce, expanding access to high-quality prenatal and postpartum care, or delivering respectful maternity care.

Ovulation is a vital sign, as significant as body temperature, heart rate, respiratory rate, and blood pressure, in assessing overall health and identifying potential health issues. Ovulation is a key event of the menstrual cycle that provides insights into the hormonal and reproductive health aspects. Affected by the orchestra of hormones, namely thyroid, prolactin, and androgens, disruptions in ovulation can indicate endocrinological conditions and lead to gynecological problems, such as heavy menstrual bleeding, irregular periods, amenorrhea, dysmenorrhea, and difficulties in getting pregnant. Monitoring ovulation and detecting disruptions can aid in the early detection of health issues, extending beyond reproductive health concerns. It can help identify underlying causes of symptoms like excessive fatigue and abnormal hair growth. The integration of digital health technologies, such as mobile apps using machine learning algorithms, wearables tracking temperature, heart rate, breath rate, and sleep patterns, and devices measuring reproductive hormones in urine or saliva samples, offers a wealth of opportunities in family planning, early health issue diagnosis, treatment adjustment, and tracking menstrual cycles during assisted reproductive techniques. These advancements provide a comprehensive approach to health monitoring, addressing both reproductive and overall health concerns.

Between 2010 and 2016, elective oocyte cryopreservation (OC) increased in use by 880% in the United States; however, there have been increasing reports of regret among patients after elective OC. There is a growing need for individualized counseling on the timing and number of oocytes to cryopreserve for patients to make informed choices and set realistic expectations, but currently available tools seem to be insufficient. The purpose of this review is to describe the OC calculators currently available online, identify sources of regret, and illustrate the need for unified counseling tools for improved patient care and education. OC calculators were identified via Google search. Only calculators that cite scientific literature were included in the review. Calculators for in vitro fertilization or embryo transfer were excluded. Thirteen OC calculators were found; however, only six cited literature supporting the calculator's design. When entering the same hypothetical patient parameters for age and number of oocytes cryopreserved, the calculators provided drastically different probabilities of live births. The lack of cohesive online educational materials creates confusion and stress for patients considering OC, leading to unrealistic expectations and increased feelings of regret thereafter. Physicians need tools to provide comprehensive guidance to patients seeking to cryopreserve oocytes.

In recent years, the expanding roles of anti-Müllerian hormone (AMH) in various aspects of reproductive health have attracted significant attention. Initially recognized for its classical role in male sexual differentiation, AMH is produced postnatally by the Sertoli cells in the male testes and by the granulosa cells in the female ovaries. Traditionally, it was believed to primarily influence gonadal development and function. However, research over the last decade has unveiled novel actions of AMH beyond the gonads, specifically all along the hypothalamic-pituitary-gonadal axis. This review will focus on the emerging roles of AMH within the hypothalamus and discusses its potential implications in reproductive physiology. Additionally, recent preclinical and clinical studies have suggested that elevated levels of AMH may disrupt the hypothalamic network regulating reproduction, which could contribute to the central pathophysiology of polycystic ovary syndrome. These findings underscore the intricate interplay between AMH and the neuroendocrine system, offering new avenues for understanding the mechanisms underlying fertility and reproductive disorders.

The 2023 international evidence-based guideline update for the assessment and management of polycystic ovary syndrome (PCOS) recommends using the Rotterdam criteria for the diagnosis of PCOS. The updated guideline has evidence-based recommendation for the diagnosis, and it now also includes serum anti-Müllerian hormone (AMH) measurement as an alternative tool for gynecological ultrasound to diagnose polycystic ovary morphology (PCOM). The aim of this new recommendation was to facilitate PCOS diagnostic workup in primary care and other disciplines, as currently most diagnosing is done in gynecology and infertility clinics. Here, we review factors affecting AMH levels as well as the utility of AMH in PCOS diagnosis. We identified relevant studies that report different cut-offs for AMH to diagnose PCOM as part of PCOS diagnosis. There are, however, some limitations when using AMH that should be acknowledged. These include physiological aspects like age, ethnicity, and obesity and iatrogenic causes like hormonal medication and ovarian surgery. Also reference ranges are different depending on AMH assay used. As a summary, we conclude that AMH is a usable tool in PCOM diagnostics, but it does not have a single cut-off. Therefore, further studies are needed to establish age and assay-based reference ranges.

Anti-Müllerian hormone (AMH) is a member of the transforming growth factor β (TGFβ) superfamily, whose actions are restricted to the endocrine-reproductive system. Initially known for its role in male sex differentiation, AMH plays a role in the ovary, acting as a gatekeeper in folliculogenesis by regulating the rate of recruitment and growth of follicles. In the ovary, AMH is predominantly expressed by granulosa cells of preantral and antral follicles (i.e., post primordial follicle recruitment and prior to follicle-stimulating hormone (FSH) selection). AMH signals through a BMP-like signaling pathway in a manner distinct from other TGFβ family members. In this review, the latest insights in AMH processing, signaling, its regulation of spatial and temporal expression pattern, and functioning in folliculogenesis are summarized. In addition, effects of AMH variants on ovarian function are reviewed.

Anti-Müllerian hormone (AMH) is an important component within androgen receptor (AR)-regulated pathways governing the hyperandrogenic origin of polycystic ovary syndrome (PCOS). In women with PCOS, granulosa cell AMH overexpression in developing ovarian follicles contributes to elevated circulating AMH levels beginning at birth and continuing in adolescent daughters of PCOS women. A 6 to 7% incidence among PCOS women of gene variants coding for AMH or its receptor, AMHR2, suggests genetic contributions to AMH-related pathogenesis. Discrete gestational AMH administration to pregnant mice induces hypergonadotropic hyperandrogenic, PCOS-like female offspring with high circulating AMH levels that persist over three generations, suggesting epigenetic contributions to PCOS through developmental programming. Moreover, adult-onset, selective hyperactivation of hypothalamic neurons expressing gonadotropin-releasing hormone (GnRH) induces hypergonadotropic hyperandrogenism and PCOS-like traits in female mice. Both gestational and adult AMH inductions of PCOS-like traits are prevented by GnRH antagonist coadministration, implicating luteinizing hormone-dependent ovarian theca cell testosterone (T) action, mediated through the AR in AMH-induced pathogenesis. Interestingly, gestational or peripubertal exogenous T or dihydrotestosterone induction of PCOS-like traits in female mice, rats, sheep, and monkeys fails to elicit ovarian AMH hypersecretion; thus, AMH excess per se may lead to a distinct pathogenic contribution to hyperandrogenic PCOS origins.

Anti-Müllerian hormone (AMH) is secreted by Sertoli cells and is responsible for the regression of Müllerian ducts in the male fetus as part of the sexual differentiation process. Serum AMH concentrations are at their lowest levels in the first days after birth but increase after the first week, likely reflecting active Sertoli cell proliferation. AMH rises rapidly in concentration in boys during the first month, reaching a peak level at ∼6 months of age, and it remains high during childhood, then they will slowly decline during puberty, falling to low levels in adulthood. Serum AMH measurement is used by pediatric endocrinologist as a specific marker of immature Sertoli cell number and function during childhood. After puberty, AMH is released especially by the apical pole of the Sertoli cells toward the lumen of the seminiferous tubules, resulting in higher levels in the seminal plasma than in the serum. Recently, AMH has received increasing attention in research on male fertility-related disorders. This article reviews and summarizes the potential contribution of serum AMH measurement in different male fertility-related disorders.

In recent years, the prevalence of infertility has increased, and appears to affect approximately one in six couples. Some of them must perform assisted reproductive techniques (ART) in order to achieve pregnancy. As a result, growing interest has arisen about predictive factors of pregnancy and live birth with and without ART. Anti-Mullerian hormone (AMH) is a glycoprotein discovered in the 1950s in male embryonic sexual differentiation. Later, in 1984, its role in folliculogenesis was reported: secreted by granulosa cells, this hormone is involved in the regulation of the recruitment of primordial follicles and in follicular growth. AMH assays were developed for women in 1990s, and the serum AMH level has rapidly become a crucial element in managing women's fertility. Based mainly on its ability to be a quantitative but indirect marker of ovarian reserve, the serum AMH assay is widely used in reproductive medicine and ART. This review summarizes current knowledge of the AMH assessment in the field of reproductive medicine. We focus on the role of AMH level to predict spontaneous pregnancy occurrence, ART outcomes, and fertility preservation outcomes.