OBJECTIVE: To report an exceptional case of male-to-male transmission of genetically based non-obstructive azoospermia (NOA) and varicocele through a naturally obtained pregnancy.
METHODS: A father and his son were both diagnosed with NOA after centrifugation and varicocele. The father has no other clinical concerns apart from infertility, detected after many attempts of having another child, but given his urological situation (bilateral varicocele and NOA) assisted reproductive techniques were discouraged. After genetic counseling, several genetic-chromosomal analyses were carried out in the son (karyotype, chromosome Y microdeletions, CFTR screening, NGS infertility panels, and finally array-CGH).
RESULTS: After a series of inconclusive tests, array-CGH detected a deletion of 224-283 kb (del9p24.3) involving part of the KANK1 and DMRT1 genes, inherited from the father. Haploinsufficiency of DMRT1 was therefore considered the determining factor in the development of azoospermia in the family by a loss of function mechanism.
CONCLUSIONS: The confirmation of father-to-son transmission of a deletion including DMRT1 represents an important point for clinicians dealing with male infertility, even when complete azoospermia is repetitively detected, and must be of hope for a relevant portion of men. Inclusion criteria for the access to assisted reproductive techniques may also be reconsidered and worthy of a greater number of clinical insights. Finally, since DMRT1 alterations have been associated with NOA and abnormal testicular development, but not specifically with varicocele, further studies are required to validate this issue, as varicocele may have played a crucial role in this case.

This study aimed to determine the factors associated with continuation of hormonal contraceptive methods among married women of Gilgit, Pakistan at least 6 months after their initiation.
Unmatched case-control study.
Community settings of Gilgit, Pakistan from 1 April 2021 to 30 July 2021.
The cases were married women of reproductive age who, at the time of interview, were using a hormonal method of contraception for at least 6 months continuously, and controls were married women of reproductive age who had used a hormonal method in the past and currently were using a non-hormonal method for at least 6 months.
OR for continuation of hormonal contraceptive.
The factors significantly associated with continuous use of hormonal contraceptive methods for our sample from Gilgit were the family planning centre\'s distance from home (adjusted OR (AOR) 6.33, 95% CI 3.74 to 10.71), satisfaction with current method used (AOR 3.64, 95% CI 2.06 to 6.44), visits to the family planning centre to avail services (AOR 1.86, 95% CI 1.07 to 3.45) and relatively older age of women (AOR 1.07, 95% CI 1.02 to 1.12). In addition, women with formal education (AOR 0.27, 95% CI 0.12 to 0.6) were less likely to use a modern contraceptive method.
Continuation of using a hormonal method was associated with easy access to family planning centres, satisfaction with the current method and frequent visits to the family planning centres. Continuation of using a hormonal method was also seen in women with low education status. The importance of the presence of family planning centres near residential areas cannot be emphasised more. This does not only provide easy access to family planning methods, but also reassure women of continuation of modern methods when they face any unpleasant effects while using these.

Early initiation of antenatal care (ANC) is vital for the early detection and treatment of adverse pregnancy outcomes. Despite the widespread convenience of free ANC services, most women in Ethiopia attend their initial antenatal clinic late and fail to come back for follow-up care, which results in both maternal and fetal complications. Despite the fact that assessing the determinants of early ANC booking based on the local context is advised, it is not well studied in the study area.
This study aimed to assess determinants of early ANC booking among pregnant women attending ANC at public health facilities in the Nole Kaba district, western Ethiopia.
Facility-based unmatched case-control study design was conducted from April to June 2020. Systematic random sampling was used to select a total of 297 participants. A validated, pretested and structured instrument was used to interview the participants. The data were cleaned and coded before being entered into Epi-Info V.7.2.2.6 and exported to SPSS V.25 for analysis. The logistic regression analyses were done to assess the determinants of early ANC booking. Adjusted odds ratio (AOR) with 95% CI was estimated to measure the strength of the association. The level of statistical significance was set at a p value <0.05.
A total of 297 pregnant women participated in the study (99 cases and 198 controls), with a 100% response rate. Place of residence (AOR=2.21, 95% CI 1.11, 2.72), level of education (AOR=3.42, 95% CI 1.01, 6.04), planned pregnancy (AOR=8.01, 95% CI 2.79, 23.03), history of abortion (AOR=5.96, 95% CI 2.07, 17.13), places of previous delivery (AOR=4.57, 95% CI 1.09, 19.12), presence of accompanied by husband during ANC visit (AOR=2.48, 95% CI 2.77, 7.98) and media exposure (AOR=6.95, 95 CI 2.68, 18.02) were found statistically significant.
Places of residence, educational level, pregnancy, having a history of abortion, accompanied by the husband during ANC visit, place of previous delivery and media exposure were significantly associated with early initiation of ANC. Therefore, health extension programmes on early ANC initiation should be strengthened by giving priority to less educated women and living in rural areas.

The pregnancy rescue case (PRC) is supposed to show that when forced between preventing a fetus from being killed and preventing someone from remaining unwillingly pregnant, we are morally required to do the former. If this is true, then Hendricks argues that the typical abortion is morally wrong. I pose four problems for PRC and how Hendricks uses it here. First, one might simply deny the intuition Hendricks takes PRC to pump for reasons having to do with the moral status of the fetus. Second, even if it is true that we should prevent the fetus from being killed in PRC, this might not tell us much about the moral permissibility of abortion in typical cases because there are important differences between PRC and the typical abortion. Third, I propose some modifications to PRC that would better isolate whether fetal personhood does any work to pump the target intuition. Fourth, I argue that PRC only succeeds if we presuppose that Thomson\'s defence is unsound, but presupposing this comes at too high a cost.

Current research aimed at understanding and preventing stillbirth focuses almost exclusively on the role of the placenta. The underlying origins of poor placental function leading to stillbirth, however, remain poorly understood. There is evidence demonstrating that the endometrial environment in which the embryo implants impacts not only the establishment of pregnancy but also the development of some pregnancy outcomes. Menstrual fluid has recently been applied to the study of menstrual disorders such as heavy menstrual bleeding or endometriosis, however, it has great potential in the study of adverse pregnancy outcomes. This study aims to identify differences in menstrual fluid and menstrual cycle characteristics of women who have experienced preterm stillbirth and other associated adverse pregnancy outcomes, compared with those who have not. The association between menstrual fluid composition and menstrual cycle characteristics will also be determined.
This is a case-control study of women who have experienced a late miscarriage, spontaneous preterm birth or preterm stillbirth or a pregnancy complicated by placental insufficiency (fetal growth restriction or pre-eclampsia), compared with those who have had a healthy term birth. Cases will be matched for maternal age, body mass index and gravidity. Participants will not currently be on hormonal therapy. Women will be provided with a menstrual cup and will collect their sample on day 2 of menstruation. Primary exposure measures include morphological and functional differences in decidualisation of the endometrium (cell types, immune cell subpopulations and protein composition secreted from the decidualised endometrium). Women will complete a menstrual history survey to capture menstrual cycle length, regularity, level of pain and heaviness of flow.
Ethics approval was obtained from Monash University Human Research Ethics Committee (27900) on 14/07/2021 and will be conducted in accordance with these conditions. Findings from this study will be disseminated through peer-reviewed publications and conference presentations.

This paper offers a qualified defence of physician non-compliance with antiabortion legislation in the wake of the Supreme Court\'s decision in Dobbs v. Jackson Women\'s Health Organization. The paper examines two ethically troubling trends of post-Dobbs legislation: narrow and vague maternal health exemption clauses and mandatory reporting of miscarriages in jurisdictions where patients may criminal prosecution for medically induced abortions. It then examines and defends a professional obligation on the part of physicians to comply with the law. This obligation, however, is defeasible. The paper then argues that physicians\' obligations to comply with the law is defeated when the law is illegitimate and following the law would constitute bad medical practice. Finally, it argues that the ethically troubling trends in post-Dobbs antiabortion legislation may meet these criteria.

The aim of this study was to assess the prevalence of pregnancy and associated factors among adolescent girls in Nguenyyiel Refugee Camp.
Cross-sectional study was employed to conduct this study.
A community-based cross-sectional study was done in Nguenyyiel Refugee Camp.
Four hundred and fourteen adolescent girls participated in this study. The systematic random sampling technique was used to select respondents. Data were collected using a well-structured and pretested questionnaire. Pregnancy test was done using the human chorionic gonadotropin test. Bivariate and multivariate logistic regression analysis was run to identify factors associated with adolescent pregnancy.
The prevalence of pregnancy among adolescent girls in the Nguenyyiel Refugee Camp was 21.7% (95% CI: 17.6% to 25.6%). Factors associated with adolescent pregnancy were age (17-19 years) (AOR): 2.79; 95% CI: 1.55 to 5.05; educational status: primary education (AOR: 7.69; 95% CI: 3.55 to 16.68) and no formal education (AOR: 3.42; 95% CI: 1.59 to 7.36); and household living arrangement: living with none of the biological parents (AOR: 2.14; 95% CI: 1.02 to 4.49) and living with either of the biological parent (AOR: 3.71; 95% CI: 1.76 to 7.81).
This study showed that there is a high prevalence of pregnancy among adolescent girls in the study setting. Age (17-19 years), educational status and household living arrangement (living with none of the biological parents and living with either of the biological parents) were among the factors significantly associated with adolescent pregnancy. Hence, health workers and other stakeholders in the camps should focus on strengthening adolescent sexual health education giving special attention to late adolescents, uneducated and living without biological family.

A woman in her 50s with Turner syndrome was referred to the endocrine clinic, having been unaware of her diagnosis until she received a shielding letter from the UK government during the COVID-19 pandemic. Despite a neonatal diagnosis of Turner syndrome on her general practitioner record and despite having undergone laparoscopic examination for absent puberty and primary amenorrhoea aged 18 years, she had not received any prior hormone treatment or cardiovascular screening.Though Turner syndrome is rare, recent data from the UK Biobank suggest that it may be underdiagnosed. Clinicians should be aware of the clinical features and associated complications of Turner syndrome to avoid delayed diagnosis and missed opportunities for treatment.In this report, we discuss the clinical features of this rare syndrome and current guidelines for screening and treatment. We stress the importance of peer-to-peer support and information sharing through patient-led groups, such as the Turner Syndrome Support Society.

BACKGROUND: Restorative reproductive medicine represents a comprehensive approach to subfertility (infertility and miscarriage) with investigations, diagnoses, and treatments combined with fertility charting to restore optimal reproductive function. Restorative reproductive medicine assumes that multiple factors need to be identified and treated (cycle optimization) for up to 12 cycles to achieve a successful pregnancy. Conception can occur during normal intercourse without intrauterine insemination or in vitro fertilization.
METHODS: A 35-year-old Croatian female presented for fertility treatment in May 2019 with a previous diagnosis of polycystic ovaries, infertility of 16 years duration, and 8 unsuccessful embryo transfers with in vitro fertilization and intracytoplasmic sperm injection. She was gravida 3 para 0, with 2 miscarriages after spontaneous conception at 5-6 weeks gestation in 2002 and 2004, followed by a miscarriage after in vitro fertilization at 12 weeks gestation in 2011. We initially found poor follicle function and suboptimal progesterone levels. Restorative reproductive medicine treatment resulted in conception after two cycles of treatment. This pregnancy ended in miscarriage at 7 weeks 4 days. Additional investigations found a balanced Robertsonian translocation (13, 14) and a uterine septum. We achieved repeat fertilization with restorative reproductive medicine after three cycles of treatment following resection of the uterine septum and ovulation induction with letrozole and human chorionic gonadotrophin. She had a full-term healthy pregnancy and live birth in 2021.
CONCLUSIONS: We propose that a full evaluation of underlying factors, and up to 12 cycles of cycle optimization, should be offered to subfertile patients before considering in vitro fertilization treatment.

We assessed maternal delays and unfavourable newborn outcomes among skilled deliveries in public hospitals of Hadiya Zone, Southern Ethiopia using \'the three maternal delays\' framework.
A case-control study was conducted.
Public hospitals in Hadiya Zone, southern Ethiopia.
Sample of 57 cases and 121 controls participated from 4 September 2019 to 30 October 2019. Consecutive dead newborns at discharge or admitted newborns for more 24 hours after delivery were selected as cases. Two consecutive controls were selected from none cases discharged within 24 hours of skilled delivery.
Total of 57 cases and 121 controls participated with 97.3% response rate. Forty-eight (84.2%), 46 (80.7%) and 51 (89.5%) of cases had first, second and third maternal delay, respectively. Eighty-six (71.1%), 18 (14.9%) and 69 (53.7%) of controls had first, second and third maternal delay, respectively. Cases with second maternal delay were 23.9 times more likely to have unfavourable newborn outcome when compared with controls. The first and third delays and wealth index were not significantly associated with newborn outcome in this study.
First, second and third maternal delays were higher in cases than controls. \'Delay in reaching health facility\' was determinant for unfavourable newborn outcome in this study. However, \'delay in decision-making to seek care\' and \'delay in receiving care\' were not significantly associated with new born outcome. Government should work to improve labouring mother transportation.