In vitro maturation of oocytes: what is already known?

Assisted reproductive technologies (ARTs) involve the laboratory manipulation of gametes and embryos to help couples with fertility problems become pregnant. One of these procedures controlled ovarian stimulation uses pharmacological agents to induce ovarian and follicular maturation in vivo. Despite the effectiveness in achieving pregnancy and live births, some patients may have complications due to over-response to gonadotropins and develop ovarian hyperstimulation syndrome (OHSS). In vitro maturation of oocytes (IVM) has emerged as a technique to reduce the risk of OHSS, particularly in women with polycystic ovary syndrome (PCOS), and for fertility preservation in women undergoing oncological treatment. Although there are some limitations, primarily due to oocyte quality, recent advances have improved pregnancy success rates and neonatal and infant outcomes. Different terms have been coined to describe variations of IVM, and the technique has evolved with the introduction of hormones to optimize results. This review we provide a comprehensive overview of IVM and its reproductive outcomes during ARTs.

Neurodevelopmental or behavioural disorders in children conceived after assisted reproductive technologies: A nationwide cohort study.

OBJECTIVE: To study differences in risk for drug-treated neurodevelopmental or behavioural disorders in children conceived through assisted reproductive technologies in comparison with children conceived without assisted reproductive technologies and to examine if different treatments alter these risks. DESIGN: Nationwide registry-based cohort study. SUBJECTS: Liveborn children born in Denmark between 1994 and 2012 after assisted reproductive technologies in comparison to children conceived without assisted reproductive technologies aged 0-7. EXPOSURE: Conception following assisted reproductive technologies treatment, including in vitro fertilisation, intra-cytoplasmic sperm injection, intrauterine insemination and 'others' comprising frozen embryo transfer, and frozen embryo transfer in both in vitro fertilisation and intra-cytoplasmic sperm injection and testicular sperm aspiration. MAIN OUTCOME MEASURES: Prescription of neurodevelopmental or behavioural disorders medication in offspring: Antipsychotics, anxiolytics, antidepressants, antiepileptics, attention deficit hyperactivity disorder medication and hypnotics/sedatives obtained from nationwide registers. Unadjusted and adjusted odds ratios with 95% confidence intervals were calculated. The association was examined in different sensitivity analyses, including sibling and mediator analyses. RESULTS: In total, 57,964 (4.7%) children conceived after assisted reproductive technologies and 1,183,070 (95.3%) children not conceived using assisted reproductive technologies were included. The adjusted analysis showed higher odds of prescribing neurodevelopmental or behavioural medication to assisted reproductive technology-conceived children (OR 1.15; 95% Cl 1.09-1.20) compared to other children. Prescription of antipsychotics in assisted reproductive technology-conceived children was the most common association in intrauterine insemination treatments, hypnotics/sedatives with both including in vitro fertilisation and intra-cytoplasmic sperm injection and antiepileptics with 'other' treatments. Birth weight partially mediated the association between assisted reproductive technologies and diminished the odds of neurodevelopmental or behavioural medication use in children conceived using assisted reproductive technologies. Sibling analysis showed no increased risk for the first-born child conceived without assisted reproductive technology vs. the second-born child conceived with assisted reproductive technology and vice-versa. CONCLUSION: Based on the minor observed effects, a potentially higher increased attentiveness of assisted reproductive technology parents, the demonstrated mediation effect of birth weight and preterm birth on the observed association, and the no effect of the within-mother analysis, we find little evidence for increased risk of neurodevelopmental or behavioural disorders in children conceived using assisted reproductive technologies.

Reflecting sex, social class and race inequalities in reproduction? Study of the gender representations conveyed by 38 fertility centre websites in 8 European countries.

BACKGROUND: Fertility centre websites are a key sources of information on medically assisted reproduction (MAR) for both infertile people and the general public. As part of a global fertility market, they are also a window to attract potential future patients. They give formal and practical information but in the way the information is displayed, they also convey social representations, and in particular, gender representation in its intersectional dimension. The objective is to analyse the sex, class and race representations regarding reproduction and parenthood that are embedded in the content of fertility centre websites in eight European countries. METHODS: The 5 most visible fertility centres that appeared in the first places on Internet search were selected for each country under study, except for one country which has only three fertility centres. In total, 38 fertility centre websites were considered for a thematic analysis using an iterative approach and a comprehensive perspective. RESULTS: Each centre details its services and techniques according to the legal provisions in force in its country. However, on all the websites studied, the fertility centres demonstrate a strong gendered representation. The logos generally depict women or parts of their bodies, as do the photos, which mainly show white women with light eyes. The description of the causes of infertility and the techniques offered by the centres also highlights gender differences. Sperm donation, where MAR is reserved for heterosexual couples, is included among the techniques for women with the comment that it will enable them to fulfil their dream of becoming mothers. CONCLUSIONS: MAR, and through it the project of having a child and procreative work, is presented as a matter for white, cisgender and heterosexual women, thus fueling stratified reproduction and limiting reproductive justice. The research team formulated guidelines for fertility centres to encourage them to adopt a more inclusive approach in terms of sex, social class and race, so that the diversity of infertile people feel involved and welcome in these centres, to avoid misperceptions about infertility in the general population and to reinforce autonomy and justice in reproductive matters.

Fertility centre websites are a key sources of information on medically assisted reproduction (MAR) for both people undergoing MAR and the general public. As part of a global fertility market, they may also be a window to attract potential future patients. In this context, they convey formal and practical information but also, through their content, narratives and visuals, social representations. The objective is here to analyse the gender representations of reproduction and parenthood that the 38 European fertility centres under study convey through the texts and images they display on their websites. Each centre details its services and techniques according to the social and legal provisions in force in its country. However, on all the websites studied, the fertility centres demonstrate a strong gendered representation, including in terms of social class and race. MAR, and through it the project of having a child and procreative work, is presented as a matter for white, cisgender and heterosexual women, thus fueling stratified reproduction and limiting reproductive justice.

In vitro gametogenesis (IVG): reflections from a workshop.

Key ideas from a workshop convened by the National Academies of Sciences, Engineering, and Medicine to discuss developments in IVG (National Academies of Sciences, Engineering, and Medicine 2023) chaired by Dr Eli Y. Adashi (former Dean of Medicine and Biological Sciences at Brown University). The authors are solely responsible for the content of this paper, which does not necessarily represent the views of the National Academies of Sciences, Engineering, and Medicine.

The misappropriation of knowledge: unravelling the narratives of efficiency and donor fear in the medicalisation of reproduction for lesbian and bisexual women.

The intersection between the feminist movement and the LGBTQIA + movement regarding assisted reproductive techniques has fostered greater openness towards the reproductive possibilities of lesbian and bisexual motherhood in Spain. Until February 2023, lesbian couples were obliged to marry in order to jointly register their children. Access to assisted reproductive technologies in Spain requires medicalised processes and the mandatory anonymity of sperm donors. In this context, we explore how lesbian mothers narrate their journeys towards parenthood through an analysis of interviews. As reproductive rights are individualised through the use of medical interventions, we apply the notion of reproductive justice as a lens to question how women's bodies are medicalised through a cultural and socio-legal system that imposes mandatory anonymous sperm donation over other possible forms of kinship construction.

Follicle-stimulating hormone sweetness: How carbohydrate structures impact on the biological function of the hormone.

Follicle-stimulating hormone (FSH), or follitropin, exists in multiple molecular forms due largely to its protein-carbohydrate composition and the complexity of the glycans attached to the protein core. The heterogeneity of gonadotropins exists in two forms, macroheterogeneity, which results from the absence of one or two oligosaccharide chains in the ß-subunit, and microheterogeneity which results from variation in the structures and complexity of the glycans attached to the hormone. In the clinical arena, FSH compounds are widely used by fertility specialists to promote ovarian follicle growth and maturation to a preovulatory follicle containing a fertilization-competent oocyte. Several genetically engineered recombinant human FSH preparations have been added to the arsenal of follitropin preparations in several countries for the treatment of infertility, particularly in women attending assisted reproduction clinics. Although the primary structure of these recombinant proteins is identical to that of naturally occurring FSH, the cell context and variations in the production and purification processes may impact the glycosidic profile of the recombinant FSH macro- and micro-heterogeneity, which may potentially influence the pharmacokinetics and pharmacodynamics of the compound. This review concentrates on the structure-function correlates of follitropin, with emphasis on the physiological and biological importance of the carbohydrates attached to its protein core, including its pharmacokinetics and biological activity. Emphasis is placed on pituitary FSH, and the available data on the various recombinant FSH preparations employed in therapeutics are also discussed, considering that this gonadotropin represents the cornerstone for the treatment of infertility in modern assisted reproduction.

Methodological approaches in 16S sequencing of female reproductive tract in fertility patients: a review.

BACKGROUND: The female genital tract microbiome has become a particular area of interest in improving assisted reproductive technology (ART) outcomes with the emergence of next-generation sequencing (NGS) technology. However, NGS assessment of microbiomes currently lacks uniformity and poses significant challenges for accurate and precise bacterial population representation. OBJECTIVE: As multiple NGS platforms and assays have been developed in recent years for microbiome investigation-including the advent of long-read sequencing technologies-this work aimed to identify current trends and practices undertaken in female genital tract microbiome investigations. RESULTS: Areas like sample collection and transport, DNA extraction, 16S amplification vs. metagenomics, NGS library preparation, and bioinformatic analysis demonstrated a detrimental lack of uniformity. The lack of uniformity present is a significant limitation characterised by gap discrepancies in generation and interpretation of results. Minimal consistency was observed in primer design, DNA extraction techniques, sample transport, and bioinformatic analyses. CONCLUSION: With third-generation sequencing technology highlighted as a promising tool in microbiota-based research via full-length 16S rRNA sequencing, there is a desperate need for future studies to investigate and optimise methodological approaches of the genital tract microbiome to ensure better uniformity of methods and results interpretation to improve clinical impact.

Non Invasive Preimplantation Testing for Aneuploidies in Assisted Reproduction: A SWOT Analysis.

The implementation of non-invasive PGT-A offers a new strategy to genetically assess the preimplantation embryo and to enhance IVF results. The extraction of DNA from the embryo culture medium has been sufficiently demonstrated, and the ability to obtain chromosomal information as a result is particularly interesting. As morphological criteria have proven to have a weak correlation with embryo ploidy status, this technique emerges as a promising alternative for embryo selection. It also appears reasonable that avoiding biopsy may enhance further embryo development. However, there are growing concerns regarding several aspects of this technique, such as the origin of this cell free DNA, the degree of representativeness of the whole embryo, the need for extended culture or the absence of standardized protocols. Despite the published data on good prognosis couples are promising, niPGT-A is yet to be considered a substitute for trophectoderm biopsy. The current SWOT analysis aims to summarize both resolved and unresolved issues, as well as limiting aspects of niPGT-A.

Impact of blastocyst grading and blastocyst biopsy dates on the clinical outcomes of patients undergoing preimplantation genetic testing.

Background: Preimplantation genetic testing (PGT) allows for the evaluation of embryo genetic information prior to implantation, enabling the selection of normal embryos for transfer and ultimately leading to better pregnancy outcomes. In this study, we explored factors that influence clinical outcomes of patients undergoing PGT. The effects of blastocyst grading and biopsy dates on clinical outcomes were also analyzed. Methods: The clinical data and pregnancy outcomes of 428 PGT cycles performed in the Reproductive Medicine Department of the Northern Theater General Hospital between January 2017 and December 2022 were retrospectively analyzed. Multifactorial logistic regression analysis and nomograms were used to determine factors influencing pregnancy outcomes. The impact of D5 blastocysts (290 cycles) and D6 blastocysts (138 cycles) with different quality levels on clinical outcomes was also compared. Results: Multifactorial logistic regression analysis showed that age, BMI, endometrial thickness, and embryo quality of women affected PGT clinical outcomes. Women aged <40 years or with a body mass index (BMI) >18.5 and endometrial thickness>1.0 cm had a significantly higher pregnancy success rate. Compared to that of D6 blastocyst biopsy, D5 blastocyst biopsy was associated with a higher pregnancy success rate but a similar live birth rate. No significant differences were observed in the pregnancy and live birth rates of D5 and D6 high-quality blastocysts. Conclusion: To achieve better pregnancy outcomes after PGT, considering blastocyst grading and biopsy dates when transferring embryos is essential for improving pregnancy outcomes. Furthermore, patients should adjust their BMI, endometrial receptivity, and endometrial thickness and pattern.

Relationship status among lesbian and heterosexual couples 8-10 years after undergoing assisted reproductive treatment in Sweden.

Background: Infertility along with fertility treatments has been reported to have a devastating effect on the well-being of the individuals involved as well as their relationship. So far, the studies exploring the impact on the relationship have mainly focused on heterosexual couples facing infertility and undergoing treatment. There is, therefore, a lack of data on the potential role of sexual orientation, gamete origin, as well as treatment success on the risk of separation after fertility treatment. The purpose of this study was, thus, to explore whether sexual orientation, donation treatment, and fertility success affected the relationship well-being and to explore various separation-related aspects. Methods: We have performed a prospective cohort study of heterosexual and homosexual couples undergoing fertility treatment with autologous and donated gametes in Sweden and followed them for up to 10 years after receiving fertility treatment. In the current follow-up study, 660 individuals have been included. Results: Almost 39% of lesbian couples participating reported having separated as opposed to 11-17% of heterosexual couples undergoing treatment with own or donated gametes. Neither background factors nor treatment success protected against separation. By using the relationship satisfaction ENRICH tool, we were able to demonstrate that dissatisfaction of one of the lesbian spouses or heterosexual spouses undergoing oocyte donation increased significantly the risk of separation 8-10 years after treatment commencement. Conclusion: The findings can be used by fertility clinics to provide relationship tools to the treated couples in order to help them nurture their relationship and decrease the risk of separation in the long run.

Extensive Peritoneal and Pelvic Granulomatous Inflammation Due to Syphilis Infection Manifesting as Primary Infertility: A Case Report.

Infertility affects millions of couples worldwide and can result from various factors, including sexually transmitted infections. Although syphilis is known to contribute to a small number of infertility cases through chronic pelvic inflammatory disease, which ultimately impairs fertility, detailed descriptions of such cases are limited. In this report, we present a case of primary infertility caused by extensive peritoneal granulomatous inflammation, adhesions, and tubal obstruction resulting from syphilis.

On the role of artificial intelligence in analysing oocytes during in vitro fertilisation procedures.

Nowadays, the most adopted technique to address infertility problems is in vitro fertilisation (IVF). However, its success rate is limited, and the associated procedures, known as assisted reproduction technology (ART), suffer from a lack of objectivity at the laboratory level and in clinical practice. This paper deals with applications of Artificial Intelligence (AI) techniques to IVF procedures. Artificial intelligence is considered a promising tool for ascertaining the quality of embryos, a critical step in IVF. Since the oocyte quality influences the final embryo quality, we present a systematic review of the literature on AI-based techniques used to assess oocyte quality; we analyse its results and discuss several promising research directions. In particular, we highlight how AI-based techniques can support the IVF process and examine their current applications as presented in the literature. Then, we discuss the challenges research must face in fully deploying AI-based solutions in current medical practice. Among them, the availability of high-quality data sets as well as standardised imaging protocols and data formats, the use of physics-informed simulation and machine learning techniques, the study of informative, descriptive yet observable features, and, above all, studies of the quality of oocytes and embryos, specifically about their live birth potential. An improved understanding of determinants for oocyte quality can improve success rates while reducing costs, risks for long-term embryo cultures, and bioethical concerns.

Serum progesterone measurement on the day of fresh embryo transfer and its correlation with pregnancy success rates: A prospective analysis.

Studies regarding serum Progesterone (P4) concentration and Clinical Pregnancy Rates (CPR) in fresh Embryo Transfer (ET) after Controlled Ovarian Stimulation Cycles (COS) remain inconclusive. To find a P4 cutoff point on fresh ET day associated with higher CPR, and to identify predictive factors of CPR and P4, the authors conducted a prospective cohort of 106 patients who underwent COS at a public IVF center. The luteal phase was supported with vaginal micronized progesterone (200 mg, 8/8h), beginning on oocyte retrieval day. The primary outcome was CPR beyond the 8th week of pregnancy. A ROC curve was constructed to identify the best cutoff point correlated with higher CPR. Multivariate analysis evaluated predictive variables of CPR and P4 concentration. P4 levels showed no significant differences between pregnant and non-pregnant patients (67.12 ± 31.1 ng/mL vs. 64.17 ± 61.76, p = 0.7465). The cutoff point correlated with higher CPR was P4 ≥ 28.9 ng/mL (AUC 0.5654). Women's age (OR = 0.878; 95 % CI 0.774-0.995) and top-quality embryo transfer (OR = 2.89; 95 % CI 1.148-7.316) were associated with CPR. Women's age ≥ 40 years (OR = 0.0956; 95 % CI 0.0156-0.5851), poor response to COS (OR = 0.0964; 95 % CI 0.0155-0.5966), and follicles ≥ 10 mm (OR = 1.465; 95 % CI 1.013-2.117) were associated with the cutoff point. As the ROC curve was unsatisfactory, P4 ≥ 28.9 ng/mL should not be used to infer gestational success. In fresh ET, P4 concentration may merely reflect a woman's age and individual response to COS rather than being a reliable CPR predictor.

Challenges for the legislation enabling egg donation in Switzerland.

Switzerland is one of the most restrictive countries in Europe when it comes to the regulation of egg donation in medically assisted reproduction (MAR). Indeed, even after the introduction of modifications to the law regulating reproductive medicine allowing embryo culture, embryo freezing, and preimplantation genetic testing, egg donation has remained completely forbidden. The absolute ban on egg donation is heavily discussed in academia, society, and politics. After many failed attempts, this prohibition is now on its way to be lifted, after agreement was reached in the legislative institutions. The forthcoming legalisation of egg donation raises, however, several questions on how some aspects of this practice will be regulated. In this contribution, we briefly review the reasons why a ban on egg donation has been present for so long in Switzerland, to then analyse two issues raised by the commitment to lift this ban. First, we reflect on the question of whether the new legislation should introduce chronological age limits for access to heterologous MAR. Second, we consider how the practice of egg sharing could be regulated once egg donation is legal.

Ethical and Psychological Considerations for Posthumous-Assisted Reproduction for Adolescents and Young Adults With Poor Cancer Prognosis in the Context of Grief.

Objective: Families or loved ones of adolescents and young adults (AYA) with a poor cancer prognosis who preserved fertility and did not survive treatment may choose to pursue posthumous assisted reproduction (PAR; i.e., use of preserved reproductive material for future family-building attempts). Decisions about PAR may be occurring in the context of grief and bereavement, which is associated with ethical and psychological considerations because grief can complicate a person's capacity for informed decision-making. Methods: Through the use of a five-step ethical decision-making model, the American Psychological Association's Ethical Principles of Psychologists and Code of Conduct, and a blended case example, the ethical and psychological considerations for families of AYA with poor prognosis who pursue PAR is discussed with an ethical analysis. Results: Ethical and psychological considerations included assessing the potential for harm to involved parties, navigating PAR decision-making with responsibility and honesty, examining the accessibility of PAR, and considering informed consent/assent and autonomy. Conclusions: Clinical recommendations for supporting families and loved ones exploring PAR in the context of grief were discussed, with considerations for improving clinicians' comfort and competence with PAR, incorporating grief into informed consent conversations, standardizing conversations about PAR, and promoting an interdisciplinary approach to PAR-related decisions.

Sperm DNA Fragmentation: Unraveling Its Imperative Impact on Male Infertility Based on Recent Evidence.

Male factors may be present in up to 50-70% of infertile couples and the prevalence of male infertility accounts for 20-30% of infertility cases. Understanding the mechanisms and causes behind male infertility remains a challenge, but new diagnostic tools such as DNA fragmentation might aid in cases where the routine semen analysis is insufficient. DNA fragmentation, which refers to damages or breaks of the genetic material of the spermatozoa, is considered one of the main causes of male infertility due to impaired functional capability of sperm. The aim of the present narrative review is to investigate and enlighten the potential correlation between DNA fragmentation and male infertility parameters such as the seminal profile and the reproductive outcomes. Comprehensive research in PubMed/Medline and Scopus databases was conducted and 28 studies were included in the present review. Fourteen studies provided data regarding the impact of DNA fragmentation and seminal parameters and showed a correlation of significantly lower sperm count, lower concentration, motility, and abnormal morphology with an increased DNA fragmentation index (DFI). Similarly, 15 studies provided data regarding the impact of DFI on reproductive outcomes. Two studies showed higher aneuploidy rates with higher DFI values, and seven studies showed significantly lower pregnancy rates and live birth rates with higher DFI values. Ultimately, the studies included in this review highlight, collectively, the importance of measuring sperm DFI in the assessment of male infertility. Further studies are needed to explore the effectiveness of interventions aiming to reduce DFI levels.

Maternal Characteristics in Natural and Medically Assisted Reproduction Dizygotic Twin Pregnancies.

Previous studies have shown that mothers of naturally conceived dizygotic (DZ) twins tend to be taller, older, and smoke more than mothers of naturally conceived monozygotic (MZ) twin and mothers of singletons. Here, we investigate whether mothers of naturally conceived DZ twins differ from mothers who conceived their DZ twins after medically assisted reproduction (MAR) in eight maternal traits related to fertility based on observational survey data. We include data from 33,648 mothers from the Netherlands Twin Register (NTR) and 1660 mothers of twins from the Norwegian Mother, Father and Child Cohort Study (MoBA). We contrast mothers of naturally conceived DZ twins with mothers of MAR DZ twins. Next, we further segment the MAR group into mothers who underwent hormonal induction of ovulation but not in vitro fertilization (IVF) and those who IVF twins, comparing them both to each other and against the mothers of naturally conceived DZ twins. Mothers of naturally conceived DZ twins smoke more often, differ in body composition, have a higher maternal age and have more offspring before the twins than mothers of MZ twins. Compared to MAR DZ twin mothers, mothers of naturally conceived DZ twins have fewer miscarriages, lower maternal age and increased height, more offspring and are more often smokers. BMI before the twin pregnancy is similar in both natural and MAR DZ twin mothers. Mothers who received hormonal induction of ovulation (OI) have a lower maternal age, fewer miscarriages, and a higher number of offspring before their twin pregnancy than twin mothers who received IVF and/or intracytoplasmic sperm injection (ICSI) treatments. Our study shows that twin mothers are a heterogenous group and the differences between twin mothers should be taken into account in epidemiological and genetic research that includes twins.

Pregnancy outcomes after assisted reproductive technology among women with endometriosis in Ukraine: results a multicenter study.

OBJECTIVE: Aim: To evaluate the association between adverse pregnancy outcome, assisted reproductive technology (ART) and a previous diagnosis of endometriosis in Ukraine. PATIENTS AND METHODS: Materials and Methods: We conducted a multicentre retrospective cohort study was based on infertility surveillance data among women reproductive age from January 1st, 2017 to December 31st, 2021 in Ukraine. The patients from 10 Ukrainian regions who achieved singleton pregnancy by ART were included in this study. Linked hospital, pregnancy/birth and mortality data were used. Logistic regression analysis was performed to calculate odds ratios (OR) and 95 % confidence interval (CI) for the rates of adverse pregnancy outcomes. RESULTS: Results: During study period within the cohort of 11,271 singleton births, 94 women with endometriosis diagnosed before birth delivered 102 infants. Compared with women without endometriosis, women with endometriosis had higher risks of preterm birth [adjusted odds ratio 1.33, 95% confidence interval (CI), 1.23-1.44]. Women with endometriosis had higher risks of antepartal bleeding/placental complications, pre-eclampsia and Caesarean section. There was no association between endometriosis and risk of SGA-birth or stillbirth. CONCLUSION: Conclusions: Endometriosis and ART use are both independently associated with increased risk of preterm birth, antepartum haemorrhage, placenta praevia and planned birth. These findings are clinically relevant to obstetricians for distinguishing high- and low-risk pregnancies. Pregnant women with endometriosis require increased antenatal surveillance.

Genetics of female and male infertility.

Infertility is defined as the inability to conceive within one year of unprotected intercourse, and the causes are equally distributed between both sexes. Genetics play a crucial role in couple infertility and respective diagnostic testing should follow available guidelines. Appropriate tiered genetic analyses require comprehensive physical examination of both partners in an infertile couple. A wide range of chromosomal and monogenic variants can be the underlying genetic cause of infertility in both women and men. Accurate clinical phenotyping, together with identification of the genetic origin, helps to recommend the proper treatment and to counsel couples on the success rates and potential risks for offspring.

EuMAR stakeholder engagement: an analysis of medically assisted reproduction (MAR) data collection practices in EU countries†.

STUDY QUESTION: What are the current national medically assisted reproduction (MAR) data collection systems across EU Member States, and how can these countries contribute to a unique, cycle-by-cycle registry for the European Monitoring of Medically Assisted Reproduction (EuMAR) project? SUMMARY ANSWER: The study identified significant variation in MAR data collection practices across Member States, with differences in data types, collection methods, and reporting requirements; the EuMAR project emerges as an opportunity to enhance data standardization and improve MAR data collection in the EU. WHAT IS KNOWN ALREADY: There is a need for new approaches in MAR data collection that include long-term and cross border follow-up. The EuMAR project intends to establish a unified, cycle-by-cycle registry of data on MAR treatments in EU countries, from which accurate cumulative outcomes can be calculated. STUDY DESIGN, SIZE, DURATION: This cross-sectional study involved a survey and interviews with stakeholders from 26 EU Member States conducted in 2023 over a period of seven months. PARTICIPANTS/MATERIALS, SETTING, METHODS: Representatives from national competent authorities and professional associations involved in MAR data collection in EU countries were invited to complete the survey and interviewed to assess current data flows, information requirements, and their interest in the EuMAR project. MAIN RESULTS AND THE ROLE OF CHANCE: Half of the participating countries reported having a national MAR registry with cycle-by-cycle data (n = 13), while 31% reported having a national registry with aggregated data (n = 8) and 19% reported having no national registry (n = 5). Of the countries with a national cycle-by-cycle registry, eight countries collect identifiable data, five countries collect pseudonymized data, and one country collects fully anonymized data. Informed consent is required in 10 countries. The main advantages that participants expected from a European registry like EuMAR were the possibility of obtaining national statistics in the absence of a national registry and improving the calculation of cumulative outcomes. LIMITATIONS, REASONS FOR CAUTION: The results of the study are based on self-reported data, which may be subject to bias, however, the validity of the collected information was verified with different means, including follow-up calls for clarifications and sharing final transcript reports. The feasibility of the proposed data flow models will be tested in a pilot study. WIDER IMPLICATIONS OF THE FINDINGS: Despite the heterogeneity of data collection practices across EU countries, the results show that stakeholders have high expectations of the benefits that the EuMAR registry can bring, namely the improvement of data consistency, cross-border comparability, and cumulative live birth rates, leading to better information for patients, health care providers and policy makers. STUDY FUNDING/COMPETING INTEREST(S): The EuMAR project was co-founded by ESHRE and the European Commission (101079865-EuMAR-EU4H-2021-PJ2). No competing interests were declared. TRIAL REGISTRATION NUMBER: N/A.