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Elizabeth Ball Department of Obstetrics and Gynaecology, The Royal London Hospital, Barts Health NHS Trust, London, UK
Women’s Health Research Unit, Queen Mary University of London, London, UK

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Babu Karavadra Department of Gynecology, Norfolk & Norwich University Hospital, Norwich, UK

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Bethany Jade Kremer-Yeatman Poole Hospital NHS Foundation Trust, UK

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Connor Mustard Barts and the London Pragmatic Clinical Trials Unit, Queen Mary University of London, London, UK

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Kim May Lee Barts and the London Pragmatic Clinical Trials Unit, Queen Mary University of London, London, UK

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Sharandeep Bhogal Women’s Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK

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Julie Dodds Women’s Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK

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Andrew W Horne MRC Centre for Reproductive Health, University of Edinburgh, UK

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John Allotey Institute of Metabolism and Systems Research and Institute of Applied Health Research, University of Birmingham, Birmingham, UK

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Carol Rivas UCL Social Research Institute, University College London, London, UK

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laparoscopy (pre- and post-operative pain scores are not different), but it is not known which subgroup of women will respond and which will not. A recent meta-analysis ( Leonardi et al. 2020 ) entitled ‘When to Do Surgery and When Not to Do Surgery for

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Jason Mak Acute Gynaecology, Early Pregnancy and Advanced Endosurgery Unit, Nepean Hospital, Sydney Medical School Nepean, University of Sydney, Sydney, New South Wales, Australia

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Mathew Leonardi Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada

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George Condous Acute Gynaecology, Early Pregnancy and Advanced Endosurgery Unit, Nepean Hospital, Sydney Medical School Nepean, University of Sydney, Sydney, New South Wales, Australia

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self-limiting shoulder tip pain, which occurs in up to 80% of individuals ( Sao et al. 2019 ) and rarer, but also self-limiting surgical emphysema. In the largest cohort study to date of 29,966 laparoscopic surgeries, the overall complication rate was

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Cecile A Ferrando Center for Urogynecology & Pelvic Reconstructive Surgery, Women’s Health Institute, Center for LGBT Care, Cleveland Clinic, Cleveland, Ohio, USA

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hysterectomy. Hysterectomy is a common gender-affirming surgery that some transmasculine patients undergo. Some transmasculine patients also present for management of pelvic pain and describe endometriosis symptoms. Sometimes, patients seek hysterectomy for a

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Sarah Simko Department of Obstetrics and Gynecology, Adventist Health White Memorial Medical Center, Los Angeles, California, USA

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Kelly N Wright Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California, USA

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recurrence with the excision of all these different lesion types varies significantly, with 30% of patients developing chronic pelvic pain that is unresponsive to surgery, and 50% developing recurrent symptoms within 5 years after treatment ( Zondervan et al

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Scott C Mackenzie MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK

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Catherine A Moakes Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK

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W Colin Duncan MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK

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Stephen Tong Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia

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Andrew W Horne MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK

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treatment failure and require rescue surgery, and little is known about subsequent pregnancy outcomes in this group. We describe subsequent pregnancy outcomes in women with tubal ectopic pregnancy managed with methotrexate using data from a UK multicentre

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R de Koning Department of Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands
Nederlandse Endometriose Kliniek, Reinier de Graaf Gasthuis, Delft, The Netherlands

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A E P Cantineau Department of Obstetrics and Gynaecology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands

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K van der Tuuk Department of Obstetrics and Gynaecology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands

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B De Bie Endometriosis Foundation of the Netherlands (Endometriose Stichting), Sittard, The Netherlands

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H Groen Department of Epidemiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands

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M E van den Akker-van Marle Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, The Netherlands

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A W Nap Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands

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J W M Maas Department of Gynaecology and Grow-school of Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands

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F W Jansen Department of Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands

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A R H Twijnstra Department of Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands

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M D Blikkendaal Department of Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands
Nederlandse Endometriose Kliniek, Reinier de Graaf Gasthuis, Delft, The Netherlands

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levels, lowered endometrium receptivity, associated adenomyosis, a diminished ovarian reserve (in the case of endometriomas or prior ovarian surgery) and adhesion formation that disrupts adnexal anatomy and function ( Zondervan et al. 2020 , Maignien

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Valéria Barradas Department of Surgery, Division of Urology, Human Reproduction Section, Universidade Federal de São Paulo, São Paulo, Brazil

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Mariana Pereira Antoniassi Department of Surgery, Division of Urology, Human Reproduction Section, Universidade Federal de São Paulo, São Paulo, Brazil

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Paula Intasqui Department of Surgery, Division of Urology, Human Reproduction Section, Universidade Federal de São Paulo, São Paulo, Brazil

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Marcilio Nichi Department of Animal Reproduction, School of Veterinary Medicine and Animal Sciences, University of Sao Paulo, São Paulo, Brazil

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Ricardo Pimenta Bertolla Department of Surgery, Division of Urology, Human Reproduction Section, Universidade Federal de São Paulo, São Paulo, Brazil
Hospital São Paulo, São Paulo, Brazil

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Deborah Montagnini Spaine Department of Surgery, Division of Urology, Human Reproduction Section, Universidade Federal de São Paulo, São Paulo, Brazil

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; obesity or overweight; smoking, drinking or drug habits; presence or history of systemic diseases (and their treatments); genital malformation; genetic syndrome; testicular dystopia; and history of inguinal-scrotal surgery, orchitis, epididymitis or

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Fatima Kazue Okada Human Reproduction Section, Division of Urology, Department of Surgery, Federal University of São Paulo, R. Borges Lagoa, São Paulo, São Paulo, Brazil

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Rhayza Roberta Andretta Human Reproduction Section, Division of Urology, Department of Surgery, Federal University of São Paulo, R. Borges Lagoa, São Paulo, São Paulo, Brazil

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Deborah Montagnini Spaine Human Reproduction Section, Division of Urology, Department of Surgery, Federal University of São Paulo, R. Borges Lagoa, São Paulo, São Paulo, Brazil

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According to the World Health Organization guidelines, ejaculatory abstinence (EA) of 2–7 days is recommended for semen analysis. This study aimed to determine how seminal quality may be affected by two EA periods from the same man. Seminal samples from 65 men were evaluated by conventional semen analysis and qualitative characteristics after 1 and 4 days of EA (two samples/man). The semen was qualitatively analyzed by examining oxidative activity (intracellular and seminal plasma), sperm function (acrosome integrity, mitochondrial activity, and nuclear DNA integrity), and epididymal function. As expected, samples collected after 1 day of EA showed a decrease in volume and sperm total number compared to samples collected after 4 days of EA. The sperm motility of the samples collected after 1 day of EA was better compared to samples collected after 4 days of EA. Oxidative activity measured was lower after 1 day of EA compared with those measured after 4 days of EA. With regards to sperm function, samples collected after 1 day of EA showed an increase in acrosome integrity, mitochondrial activity, and nuclear DNA integrity compared with samples collected after 4 days of EA. Epididymal function showed no difference between the two-time points. Although samples collected after 4 days of EA showed better results for sperm quantity, samples collected after 1 day of EA showed better qualitative results, including motility, oxidative activity, and sperm function. Thus, it can be concluded that sperm storage at the epididymal tail may make spermatozoa more susceptible to oxidative damage.

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According to the World Health Organization guidelines, stopping ejaculation for 2 to 7 days is recommended before sperm collection for semen analysis. However, the evidence that supports these recommendations is limited. Our study aimed to compare how sperm quality was affected in samples collected after stopping ejaculation for 1 day and 4 days (two samples per man) in a total of 65 men. Although sample collection after stopping ejaculation for 4 days showed better semen quantity (volume and sperm concentration), sample collection after stopping ejaculation for 1 day showed better sperm motility and function. If not ejaculated, sperm are stored in the epididymis tail located in the scrotum beside the testicles and our study suggests that longer sperm storage may damage sperm quality. The results from this study may be used to inform guidance for sperm collection for use in assisted reproduction techniques, and lead to an improvement in both fertilization and implantation rates.

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Jennifer Dabel Institute of Reproductive and Regenerative Medicine, Centre of Reproductive Medicine and Andrology, Muenster, Germany

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Florian Schneider Institute of Reproductive and Regenerative Medicine, Centre of Reproductive Medicine and Andrology, Muenster, Germany
Department of Clinical Andrology, Centre of Reproductive Medicine and Andrology, Muenster, Germany

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Joachim Wistuba Institute of Reproductive and Regenerative Medicine, Centre of Reproductive Medicine and Andrology, Muenster, Germany

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Sabine Kliesch Department of Clinical Andrology, Centre of Reproductive Medicine and Andrology, Muenster, Germany

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Stefan Schlatt Institute of Reproductive and Regenerative Medicine, Centre of Reproductive Medicine and Andrology, Muenster, Germany

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Nina Neuhaus Institute of Reproductive and Regenerative Medicine, Centre of Reproductive Medicine and Andrology, Muenster, Germany

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highly relevant. Transwomen undergo GAHT prior to gender-affirming surgery (GAS) for physical adaptation to the female body. Generally, GAHT has a negative influence on steroidogenesis as well as spermatogenesis in transwomen. In Germany, GAHT usually

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Kevin KW Kuan Edinburgh Medical School, University of Edinburgh, Edinburgh, UK

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Aileen R Neilson Usher Institute, Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK

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Andrew W Horne MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK

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Lucy HR Whitaker MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK

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national lockdown and outpatient clinics and non-urgent elective surgeries for benign conditions across all specialities were postponed creating a backlog of appointments ( https://www.gov.scot/news/nhs-scotland-placed-on-emergency-footing/ , Carr et al

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