Frontiers in reproductive health最新文献

{"title":"Legal protections for <i>in vitro</i> embryos in Paraguay and comparative contexts.","authors":"Evelina Gisela Lezcano, Carlos Gustavo González Morel, Eva Nara Pereira, Danilo Fernández Ríos","doi":"10.3389/frph.2025.1633574","DOIUrl":"10.3389/frph.2025.1633574","url":null,"abstract":"<p><p>The legal protection of <i>in vitro</i> embryos in Paraguay remains unresolved because no specific legislation regulates assisted reproductive technologies. This study analysed Paraguay's constitutional framework, Civil Code, judicial rulings, and international treaties through doctrinal legal analysis, complemented by a comparative review of international regulations and jurisprudence. Findings show that the Paraguayan doctrine and courts consider conception to occur at fertilisation, while the Inter-American Court of Human Rights associates conception with implantation. This difference generates tension between domestic law and international treaty obligations. A comparative analysis with the United Kingdom, Spain, Argentina, and Italy revealed diverse regulatory models and highlighted significant gaps in Paraguayan law concerning embryo storage, research, donation, consent, and dispute resolution. This work provides a comprehensive review of the challenges that Paraguay faces in developing a regulatory framework that balances respect for constitutional principles, alignment with international obligations, and nuanced ethical considerations of human embryos and reproductive rights.</p>","PeriodicalId":73103,"journal":{"name":"Frontiers in reproductive health","volume":"7 ","pages":"1633574"},"PeriodicalIF":2.9,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12451943/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145132941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sexual and reproductive health service use of unmarried adolescents in Morogoro, Tanzania: insights from a cross-sectional household survey.","authors":"Baraka M Morris, Suleiman Chombo, Connie M Ulrich, Deodatus C V Kakoko","doi":"10.3389/frph.2025.1623714","DOIUrl":"10.3389/frph.2025.1623714","url":null,"abstract":"<p><strong>Background: </strong>Adolescents in Tanzania represent a dynamic group that significantly influences public health trends, particularly in sexual and reproductive health. Despite the availability of adolescent-friendly sexual and reproductive health services (SRHS), their utilization remains low, especially among unmarried adolescents. This potentially exposes them to risky sexual behaviors, unwanted pregnancies, unsafe abortions, and sexually transmitted infections (STIs), including HIV. This paper examines the use of SRHS by unmarried adolescents in Tanzania and the factors associated with it.</p><p><strong>Methods: </strong>A cross-sectional household survey was conducted over eight months among 312 unmarried adolescents (15-19 years) from Morogoro Municipal and Mvomero District, Tanzania. Data collection utilized the World Health Organization (WHO)-approved Cleland questionnaire, and analysis was performed using STATA 18. To identify factors associated with service utilization, bivariate Chi-square tests and multivariable modified Poisson regression analyses were performed, with significance set at <i>p</i> < 0.05.</p><p><strong>Results: </strong>Among 312 unmarried adolescents, 18% had ever used SRH services. Use was significantly higher among those who had worked for pay (aRR = 1.98, <i>p</i> = 0.025) and those with sexual relationship experience (aRR = 2.27, <i>p</i> = 0.007).</p><p><strong>Conclusion: </strong>This paper found persistently low uptake of SRHS among unmarried adolescents in Tanzania, despite strong national policy commitments to improve access. This highlights the gap between policy and the everyday realities of adolescents, shaped by work and relationships. Effective solutions require youth-centered interventions grounded in social spaces, peer networks, and digital platforms to improve service utilization.</p>","PeriodicalId":73103,"journal":{"name":"Frontiers in reproductive health","volume":"7 ","pages":"1623714"},"PeriodicalIF":2.9,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12447904/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145114987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perceptions and moral distress in surplus embryo disposition among Japanese IVF patients: a qualitative study.","authors":"Shizuka Katsuzaki, Yoshiyuki Takimoto, Chikako Morioka, Masahiro Nakayama, Tatsuya Harada, Yoko Urata, Tomonori Ishikawa, Masatoshi Takagi","doi":"10.3389/frph.2025.1646340","DOIUrl":"10.3389/frph.2025.1646340","url":null,"abstract":"<p><strong>Background: </strong>The growing use of <i>in vitro</i> fertilization (IVF) in Japan has led to an increase in surplus frozen embryos and the associated ethical dilemmas. Cultural values, institutional practices, and limited legal guidance contribute to patient distress and uncertainty. However, little is known about how Japanese patients perceive surplus embryos, and how these views relate to their emotional experiences and support preferences.</p><p><strong>Methods: </strong>This qualitative study included semi-structured interviews with 46 female patients who had undergone IVF recruited from three Japanese fertility clinics with varying policies for embryo disposition. The interviews were conducted online between May 2024 and March 2025. Data were analyzed using thematic analysis guided by Boyatzis's inductive coding method.</p><p><strong>Results: </strong>Participants conceptualized embryos in three main ways: as \"life,\" as genetically connected \"blood ties,\" or as \"cells or eggs.\" These perceptions-now more diverse than in earlier reports-influence emotional responses and dispositional decisions. Viewing embryos as life forms is often associated with guilt and sorrow, particularly in the absence of clear information or acceptable options, and could be understood as a form of moral distress from the patient's perspective. Practical considerations, such as storage fees and future family planning, also shaped both perceptions and emotional burden. Gendered responses were observed: women with female-factor infertility tended to internalize blame, while male-factor diagnoses allowed for emotional distancing. Institutional factors, including storage fees, a lack of legal frameworks, and stigma, shape moral distress and decision-making. While embryo donation for research is often preferred, donation to other patients is strongly opposed, reflecting cultural concerns about kinship and genetic identity. Support preferences range from symbolic closures to informal peer dialogues.</p><p><strong>Conclusion: </strong>Patient perceptions of surplus embryos are shaped by cultural values, gendered expectations, and institutional factors, and practical constraints. These findings highlight the need for culturally responsive, ethically grounded, and flexible care models that acknowledge moral distress as experienced by patients and the growing diversity in how embryos are conceptualized.</p>","PeriodicalId":73103,"journal":{"name":"Frontiers in reproductive health","volume":"7 ","pages":"1646340"},"PeriodicalIF":2.9,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12443776/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145114978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Polycystic ovary syndrome and organochlorine pesticides: exploring potential links and mechanisms.","authors":"Shanshan Yin, Wanjia Yang, Feiyun Lin, Mei Jia, Ying Feng, Yanhong Chen, Xiaoxia Bai, Yihan Dong, Shuduan Mao, Kashif Hayat, Xuejing Jin","doi":"10.3389/frph.2025.1563414","DOIUrl":"10.3389/frph.2025.1563414","url":null,"abstract":"<p><p>Polycystic ovary syndrome (PCOS) is a prevalent endocrine disorder among women, characterized by metabolic abnormalities and infertility. Despite its high prevalence, the etiology and pathogenesis of PCOS remain poorly understood. Emerging evidence suggests that persistent organic pollutants (POPs), known for their detrimental effects on the endocrine and reproductive systems, may play a role in the development and progression of PCOS. Among POPs, organochlorine pesticides (OCPs) are particularly widespread and pose significant health risks. This review examines the potential of OCPs as an environmental factor in the development and progression of PCOS. It highlights the mechanisms through which OCPs may disrupt the hypothalamic-pituitary-ovarian (HPO) axis and impair hormonal regulation, contributing to the onset and exacerbation of PCOS. Evidence links OCPs to insulin resistance, obesity, and type 2 diabetes mellitus. These disruptions may occur via pathways involving hypothyroidism or altered adrenal androgen secretion. While current evidence supports a plausible connection between OCP exposure and PCOS, significant gaps and inconsistencies in the data warrant further investigation. Elucidating the precise mechanisms underlying these associations is crucial for developing targeted prevention and intervention strategies.</p>","PeriodicalId":73103,"journal":{"name":"Frontiers in reproductive health","volume":"7 ","pages":"1563414"},"PeriodicalIF":2.9,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12436413/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145082069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Influence of mental health conditions and symptoms on contraceptive use among adolescent girls and young women: a scoping review.","authors":"Muziwandile Qiniso Luthuli, Busisiwe Nkala-Dlamini, Nomfundo Nzuza-Moroe","doi":"10.3389/frph.2025.1620736","DOIUrl":"10.3389/frph.2025.1620736","url":null,"abstract":"<p><strong>Background: </strong>Adolescent girls and young women (AGYW) across the globe face a high risk of mental health challenges and unintended pregnancies, which are often complex and intertwined within their psychosocial environments. While earlier studies have examined contraceptive use, the influence of mental health conditions and symptoms on a broader range of contraceptive options among AGYW has not been thoroughly investigated.</p><p><strong>Objectives: </strong>This scoping review aims to map and synthesize peer-reviewed literature to understand how mental health conditions and symptoms influence contraceptive use among AGYW globally.</p><p><strong>Methods: </strong>This review followed Arksey and O'Malley's framework. Databases searched included PubMed, MEDLINE, PsycINFO, CINAHL, Psychology and Behavioral Sciences Collection, Web of Science, and African Journals Online. We included studies on AGYW aged 10-25 years that addressed how mental health conditions and symptoms influence contraceptive use.</p><p><strong>Results: </strong>Of the 9,817 records identified, only 17 studies met inclusion criteria. Depression (65%; <i>n</i> = 11) was the most frequently studied mental health factor, followed by stress (29%; <i>n</i> = 5), proxies for mental distress (24%; <i>n</i> = 4, including antidepressants and psychotropic drug use), and anxiety (18%; <i>n</i> = 3). Hormonal contraceptives (HCs) (100%; <i>n</i> = 17) were the most studied methods. Among the included studies, 71% (<i>n</i> = 12) found that mental health conditions and symptoms, such as depression, anxiety, psychological distress, stress, antidepressants, and psychotropic drug use, were associated with lower odds of HC use. Conversely, 29% (<i>n</i> = 5) found these factors to be associated with higher odds of HC use, particularly oral and non-oral methods. Stress and depression were associated with lower odds of consistent contraceptive use, while anxiety demonstrated mixed effects. Two studies reported no association between mental health factors and contraceptive use. Eleven studies focused on adolescents and six on young adults, showing a bidirectional influence between mental health and contraceptive use, with inconsistent findings across age groups.</p><p><strong>Conclusions: </strong>Mental health factors affect contraceptive use in different ways. Depression and stress reduce the odds of consistent HC use, especially among non-oral contraceptive users, while anxiety shows mixed outcomes. Findings underscore the complex influence of mental health factors on contraceptive behavior among AGYW and highlight the need for age-specific policies and interventions tailored to this high-priority population.</p>","PeriodicalId":73103,"journal":{"name":"Frontiers in reproductive health","volume":"7 ","pages":"1620736"},"PeriodicalIF":2.9,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12436440/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145081793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation strategies to support pre-exposure prophylaxis for HIV prevention care for cisgender women in federally-funded family planning clinics in Atlanta, Georgia.","authors":"K M Anderson, L V Bonadonna, E J Cortes, D L Er, C K Ellison, P Williams, S S Sullivan, M W Brooks, A N Sheth, J M Sales","doi":"10.3389/frph.2025.1529067","DOIUrl":"10.3389/frph.2025.1529067","url":null,"abstract":"<p><strong>Introduction: </strong>Title X-funded family planning clinics stand to play a significant role in Ending the HIV Epidemic (EHE), as a unique access point for cisgender women in the U.S. who account for approximately 1 in 5 new HIV infections. Biomedical HIV prevention, known as PrEP, is effective for cisgender women, yet uptake remains low and rates of new infections among women have remained steady while other key populations have experienced declines. Further, significant racial disparities persist in PrEP uptake and HIV acquisition, with Black women accounting for almost 60% of new cases. Low risk perception, lack of knowledge, and insufficient access to biomedical HIV prevention in sexual health service settings contribute to this. Despite receiving federal funds to provide free and low-cost family planning and preventative sexual health services, Title X clinics do not routinely provide PrEP as part of their services; this excludes the millions of U.S. women who engage in sexual behaviors aligned with HIV risk from access to effective prevention when utilizing Title X clinics for care.</p><p><strong>Methods: </strong>In the course of developing a systems-level bundle of tailored implementation strategies to support PrEP care delivery in Title X-funded family planning clinics, we conducted a series of baseline focus groups with staff and providers at Title X family planning clinics located in 4 EHE priority jurisdictions that comprise metro Atlanta. The analysis of these focus groups aimed to elucidate important considerations and needs to inform implementation strategy development and strengthen PrEP care delivery in these safety-net clinics.</p><p><strong>Results: </strong>This article describes the findings from these focus groups and recommendations and next steps for scaling PrEP in Title X family planning clinics in the Southern U.S. to improve PrEP reach among cisgender women.</p>","PeriodicalId":73103,"journal":{"name":"Frontiers in reproductive health","volume":"7 ","pages":"1529067"},"PeriodicalIF":2.9,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12436405/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145082576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring client satisfaction and determinants of family planning services at public health facilities in Debre Tabor town, Northwest Ethiopia: a mixed-method study.","authors":"Tseganesh Asefa, Winta Tesfaye, Gedamnesh Bitew, Hiwot Tezera Endale","doi":"10.3389/frph.2025.1558606","DOIUrl":"10.3389/frph.2025.1558606","url":null,"abstract":"<p><strong>Introduction: </strong>Client satisfaction is a crucial indicator of family planning service utilization, and understanding these insights is essential for designing responsive, client-centered interventions to address barriers to contraceptive use. This study aimed to explore client satisfaction and determinants of family planning services in public health facilities in Debre Tabor town, northwest Ethiopia.</p><p><strong>Methods: </strong>A convergent parallel mixed-methods design, incorporating both quantitative (facility-based cross-sectional) and qualitative (phenomenological) study approaches, was conducted at public health facilities in Debre Tabor town from April 15 to May 29, 2024. Data were collected using an interviewer-administered questionnaire following a multi-stage stratified random sampling technique. Simultaneously, qualitative data were collected from purposefully selected individuals using an in-depth interview guide. The study used EpiData version 4.6 for data input and SPSS version 25 for logistic regression analysis, using a <i>p</i>-value < 0.05 as the cutoff point. After an in-depth interview, the record and field notes were transcribed, translated, and analyzed using a thematic analysis technique.</p><p><strong>Result: </strong>Out of 379 participants, 62.5% of clients were satisfied with the family planning services. Factors significantly associated with clients' satisfaction were urban residents (AOR = 1.68, <i>p</i> = 0.022), government employees (AOR = 0.40, <i>p</i> = 0.020), shorter waiting times (AOR = 2.93, <i>p</i> = 0.039), method counseling (AOR = 2.32, <i>p</i> = 0.005), and receiving the preferred method (AOR = 2.59, <i>p</i> = 0.024). From the in-depth interview of 15 participants, two themes emerged: \"limited provider-client counseling interaction,\" with subthemes of \"cultural sensitivity gaps,\" \"misconceptions,\" and \"fear of ineffectiveness,\" and \"pathways to satisfaction,\" with subthemes of \"dignified care\" and \"accessibility.\"</p><p><strong>Conclusion and recommendations: </strong>The study found moderate client satisfaction with family planning services in public health facilities, with significant disparities in residence, occupation, waiting time, method counseling, and preferred methods. Clients reported a lack of cultural sensitivity, misconceptions, and a lack of involvement in decision-making. To improve satisfaction, health facilities should strengthen client-centered counseling, address cultural misconceptions, and provide flexible service hours and training for providers.</p>","PeriodicalId":73103,"journal":{"name":"Frontiers in reproductive health","volume":"7 ","pages":"1558606"},"PeriodicalIF":2.9,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12426020/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145066475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial: Accelerating to 2030 - doubling down on HIV prevention to end HIV/AIDS as a public health threat.","authors":"Robyn Eakle, Jason Reed, Nittaya Phanuphak, Kenneth Ngure, Kimberly E Green","doi":"10.3389/frph.2025.1670024","DOIUrl":"10.3389/frph.2025.1670024","url":null,"abstract":"","PeriodicalId":73103,"journal":{"name":"Frontiers in reproductive health","volume":"7 ","pages":"1670024"},"PeriodicalIF":2.9,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12426115/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145066480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between abortion restrictiveness and suicidality among birthing people in the United States 2010 to 2020.","authors":"I S Platt, K Zivin, Z Xiaosong, A Tilea, E Miller, A Widner, A Courant, S V Hall, A Schroeder, V K Dalton","doi":"10.3389/frph.2025.1553493","DOIUrl":"10.3389/frph.2025.1553493","url":null,"abstract":"<p><strong>Introduction: </strong>Prior research found that suicidality increased among commercially insured birthing people between 2006 and 2017. The 2022 <i>Dobbs v. Jackson Women's Health Organization</i> decision overturned <i>Roe v. Wade</i> and made obtaining an abortion more difficult across the United States, which may have negative mental health effects among commercially insured birthing people.</p><p><strong>Methods: </strong>We conducted a cross-sectional analysis using mixed-effects logistic regression models to quantify the relationship between state-level abortion restrictions and a diagnosis of suicidality or self-harm in the 12 months before or after delivery among individuals with employer-sponsored health insurance in the United States who delivered between 2010 and 2020.</p><p><strong>Results: </strong>Of the 610,177 deliveries in our final analytic cohort, birthing people residing in states with high abortion restrictiveness were younger (12.8% of birthing people were ages 15-24 compared to 7.8% in low restriction states) and more likely to be Black (10.4% compared to 6.1%). Birthing people living in states with high abortion restrictiveness were more likely to experience suicidality than birthing people living in states with low abortion restrictiveness [odds ratio (OR): 1.5; 95% CI: 1.2, 1.8; <i>p</i> = 0.0012]. When controlling for age, state abortion restrictiveness was not significantly associated with suicidality [adjusted odds ratio (adjOR): 1.2; 95% CI: 1.0, 1.4; <i>p</i> = 0.0603], and birthing people ages 15-24 were substantially more likely than birthing people ages 35-44 to experience suicidality (adjOR: 7.3; 95% CI: 6.5, 8.2; <i>p</i> < 0.001).</p><p><strong>Conclusion: </strong>In the years prior to the <i>Dobbs</i> decision, commercially insured birthing people in states with high abortion restrictiveness experienced a growing mental health crisis, when compared to those in low restriction states. These differences are associated with differences in demographic characteristics, such as age and race. As researchers continue to monitor health outcomes related to the recent enactment of the most severe category of restriction (e.g., bans), these findings remain crucial to recognize and account for in further studies.</p>","PeriodicalId":73103,"journal":{"name":"Frontiers in reproductive health","volume":"7 ","pages":"1553493"},"PeriodicalIF":2.9,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12426194/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145066528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Policy solutions to improve access to fertility treatment and optimise patient care: consensus from an expert forum.","authors":"G David Adamson, Hannah Armstrong, Ying Cheong, Elaine Damato, Human Fatemi, Rui Ferriani, Georg Griesinger, William Leigh Ledger, Michele Pistollato, Antonio Pellicer, Angelina Petrova, Luk Rombauts, Tim Wilsdon, Søren Ziebe","doi":"10.3389/frph.2025.1605480","DOIUrl":"10.3389/frph.2025.1605480","url":null,"abstract":"<p><strong>Background: </strong>Infertility is an underrecognized disease which affects over 17% of the reproductive age population worldwide. However, availability of, and access to, assisted reproductive technology (ART) is variable across countries. There are significant challenges relating to awareness, financial and other barriers to care, cultural considerations, and the level of support provided to people undergoing care. Previous studies have explored these challenges, but less attention has been given to the policy implications. As the need for fertility care rises, we investigate the evidence that policy changes can be implemented to improve access to ART treatment.</p><p><strong>Methods: </strong>A review of literature was conducted on fertility policy challenges and developments, covering fertility recognition and awareness; cultural and religious considerations; and access to ART treatment, psycho-social care, and supplementary care. Nine medical and academic experts were invited to validate secondary research findings and provide their perspectives on policy implications. The experts covered different specialties and geographic expertise. Experts participated in individual 60-minute interviews, then a half-day Policy Forum discussion was held virtually in May 2023.</p><p><strong>Results: </strong>Lack of recognition of infertility as a disease, low financial coverage of fertility services, limited psychosocial support, and cultural considerations are substantial barriers to fertility services access. Some countries have limited reimbursement of services or offer only private care, significantly limiting treatment access. Others restrict reimbursement based on age, gender and family status, which creates access inequities. Policy action is needed to mitigate these challenges and to ensure timely and equitable access to fertility care. Decision-makers need to collectively recognize infertility as a disease, rather than just a social issue. Equity of access to infertility services should be ensured by expanding the availability of public funding, along with review and rationalisation of criteria for treatment reimbursement. To improve engagement in treatment and support through the fertility journey, access to psychosocial care should be expanded and included as a core service.</p><p><strong>Conclusion: </strong>Major obstacles to accessing ART treatment have been identified across regions globally, highlighting the urgent need for national policy action to enhance care quality by reviewing current legislation, improving patient and physician education, refining reimbursement procedures, and expanding psychosocial support services.</p>","PeriodicalId":73103,"journal":{"name":"Frontiers in reproductive health","volume":"7 ","pages":"1605480"},"PeriodicalIF":2.9,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12426281/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145066531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}