Welcome to another edition of Countdown to 2026, and thank you for visiting the Contemporary OB/GYN website throughout 2025. Below, take a look at the top fertility stories published this year, and catch up on anything you may have missed.

1. Elective egg freezing on the rise, but few patients return to use preserved oocytes

An analysis of US data from the Society for Assisted Reproductive Technology Clinic Outcome Reporting System reported a near 4-fold increase in elective oocyte cryopreservation cycles from 4153 in 2014 to 16,436 in 2021, while utilization of frozen oocytes remained low. Among women who froze oocytes between 2014 and 2016, 5.7% returned to use them within 5 to 7 years, with the highest return rates observed in those aged 38 to 40 years (7.9%) and 41 to 42 years (8.0%).

Of patients who returned for oocyte warming, 78.5% obtained at least 1 usable embryo and the cumulative live birth rate was 28.9%, decreasing with increasing age at cryopreservation. When all women who underwent elective oocyte cryopreservation were included, regardless of utilization, the overall live birth rate was 1.6%, and the findings indicate low short-term utilization with outcomes comparable to age-related success rates of in vitro fertilization (IVF) among those who returned.

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2. Study finds weight loss before IVF may boost pregnancy rates

A systematic review and meta-analysis of 12 randomized clinical trials including 1921 women with obesity evaluated the association between pre–in vitro fertilization weight loss and reproductive outcomes. The analysis found a moderate-certainty association between weight loss interventions and greater overall pregnancy rates (RR, 1.21) and greater rates of unassisted conception–related pregnancy (RR, 1.47), while evidence was uncertain for improved pregnancy rates from IVF alone.

No significant association was observed between weight loss and pregnancy loss (RR, 1.05), and the effect on live birth rates was unclear because of very low certainty of evidence (RR, 1.15). The findings suggest that weight loss before IVF is associated with increased likelihood of pregnancy, particularly without assisted conception, although limitations included small sample sizes, heterogeneity, and high risk of bias in several studies.

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3. Record low US fertility rate reported in 2024

Recent US data from the Centers for Disease Control and Prevention showed that the total fertility rate fell below 1.6 births per woman in 2024, reaching a record low, while the general fertility rate declined from 54.5 to 53.8 births per 1000 women aged 15 to 44 years. Birth rates decreased among adolescents and women aged 20 to 34 years, remained stable among those aged 35 to 39 years, and increased slightly among women aged 40 to 44 years.

The cesarean delivery rate rose from 22.8% to 22.9%, with increases observed in women aged 30 to 39 years and stable or slightly decreased rates in younger age groups. Medicaid was the primary payer for 40.2% of births in 2024, reflecting a decline from 2023 across all age groups, and long-term trends indicated a 22% reduction in fertility rates since 2007 and declining public insurance coverage for deliveries.

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4. PCOS linked to delayed childbirth and higher infertility rates

A cohort study using data from the Australian Longitudinal Study of Women’s Health evaluated reproductive outcomes in women with and without polycystic ovary syndrome (PCOS). Among 6512 participants, 9.9% reported a PCOS diagnosis, and these women had greater rates of infertility (51% vs 21%), increased use of ovulation induction (4.9% vs 2.2%), and slightly greater nulliparity (23% vs 19%) compared with women without PCOS.

Women with PCOS had a later average age at first childbirth (29.5 vs 28.8 years) and longer interconception intervals, with adjusted odds ratios of 1.34 for advanced maternal age at first birth and 1.26 for all-cause infertility. The findings indicate that PCOS is associated with reduced parity and delayed childbearing, supporting recommendations for early diagnosis and reproductive life planning.

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5. First baby born via fully automated ICSI system

The first live birth using a fully automated, digitally controlled intracytoplasmic sperm injection (ICSI) system was reported in Reproductive Biomedicine Online on April 10, 2025. The system, developed to automate all 23 steps of ICSI with artificial intelligence or remote operator control, successfully fertilized 4 of 5 eggs in a 40-year-old patient using donor oocytes, leading to the delivery of a healthy male infant.

Procedure metrics included an average of 9 minutes 56 seconds per egg, with the system performing 115 steps and a 49.6% digital intervention rate. Components included an inverted microscope, lasers, piezo actuator, motorized stages, and AI software for sperm selection and oocyte alignment. Compared with manual ICSI, the automated system required longer procedure times but demonstrated high fertilization efficiency and the potential to improve precision, egg survival, and injection timing, representing a significant advancement toward automation in assisted reproductive technologies.

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