Fertility
AI patch could detect hidden hormone disruptions behind unexplained infertility

Even when standard clinical tests show normal hormone levels, men and women may have hidden problems in how their reproductive hormones are timed and coordinated, potentially affecting fertility, new research suggests.
The findings suggest reproductive health may depend not only on hormone levels in the bloodstream but also on the rhythm, timing and synchronisation of hormone changes across hours, days and the menstrual cycle.
Researchers said a wearable skin sensor patch, combined with artificial intelligence, could help detect endocrine dysfunction earlier and support more personalised fertility care.
Unexplained infertility affects about 15 to 30 per cent of couples and is diagnosed when standard investigations reveal no clear cause.
In men, current tests for infertility or hypogonadism, defined clinically as low testosterone, often include a single morning serum testosterone measurement.
In women, fertility assessment typically examines menstrual cycle characteristics and reproductive hormones such as luteinising hormone, follicle-stimulating hormone, oestradiol and progesterone.
However, reproductive hormones are not static markers. They are dynamic biological signals that rise and fall in regulated patterns throughout the day and across the menstrual cycle.
Testosterone, for example, follows a diurnal rhythm, meaning it changes across the day, while female reproductive hormones act through coordinated feedback loops involving the hypothalamic, pituitary and ovarian systems.
A single blood test may therefore miss clinically important disruption in hormonal timing.
In one study, Dr Tinatin Kutchukhidze, from the University of Oxford, examined 102 men in Georgia and the UK.
The participants were aged 22 to 38 and had normal morning total testosterone levels, measured at 12 to 35 nanomoles per litre, with or without infertility or symptoms of hypogonadism.
Hypogonadism is a condition in which the body produces too little testosterone or other sex hormones.
Kutchukhidze and colleagues used wearable AI-enabled skin sensor patches to measure testosterone levels every 15 minutes across four days.
The team found that men with symptoms had significantly disrupted testosterone rhythms, despite standard laboratory tests showing normal testosterone levels.
These previously undetected rhythm abnormalities were also associated with reduced sperm concentration and symptoms of androgen deficiency.
Androgens are hormones, including testosterone, that play an important role in reproductive health.
Kutchukhidze said: “For the first time, we have been able to track androgen patterns in real time across several days with a novel, non-invasive, continuous, AI-driven testosterone monitoring patch, compatible with Android and iPhone mobile devices.
“Previous research suggests that a normal morning testosterone level is sufficient to exclude clinically significant androgen deficiency. However, our findings challenge that assumption by demonstrating that men with normal serum testosterone may still exhibit marked disturbances in hormonal rhythmicity associated with reproductive dysfunction.”
According to the abstract, the study compared 54 men with infertility or hypogonadal symptoms with 48 age-matched healthy controls.
Mean morning serum testosterone did not differ significantly between symptomatic men and controls, at 22.4 ± 3.1 compared with 23.1 ± 3.5 nanomoles per litre.
Continuous AI-assisted monitoring, however, revealed significant differences in androgen dynamics.
Men with symptoms had lower diurnal amplitude than controls, at 5.2 ± 1.1 compared with 8.7 ± 1.4 nanomoles per litre.
The AI-derived rhythm indices predicted subclinical dysfunction with an area under the curve of 0.87, compared with 0.61 for static serum testosterone testing.
In diagnostic research, the area under the curve is used to assess how well a test distinguishes between groups, with higher values indicating stronger discrimination.
A second study by Kutchukhidze’s team examined female reproductive hormone rhythms.
The researchers developed an AI-driven metric called Endocrine Rhythm Integrity to assess whether reproductive hormones were changing in the correct pattern, at the correct time and in the correct relationship to one another across the menstrual cycle.
Endocrine refers to the hormone system, while endocrine dysfunction means hormones are not being produced or regulated in a typical way.
The team analysed data from 312 women aged 18 to 22 who had self-reported regular menstrual cycles.
Participants included fertile controls and women with unexplained infertility.
The researchers assessed key reproductive hormones during the luteal phase, including luteinising hormone, follicle-stimulating hormone, oestradiol and progesterone.
The luteal phase is the part of the menstrual cycle after ovulation. Ovulation is the release of an egg from the ovary.
They also incorporated physiological data such as basal body temperature, heart rate and sleep patterns.
Basal body temperature is the body’s resting temperature and can shift slightly around ovulation.
The study found that women with unexplained infertility had lower Endocrine Rhythm Integrity scores even when conventional hormone levels appeared normal.
Lower scores predicted infertility and were also associated with a higher incidence of implantation failure, when an embryo does not successfully attach to the womb lining.
Kutchukhidze said: “Our study reveals that a woman may have a seemingly healthy menstrual cycle and normal hormone levels but still experience hidden endocrine dysfunction that affects her ability to conceive.
“Rather than analysing hormone levels as isolated values, Endocrine Rhythm Integrity evaluates whether reproductive hormones are changing in the correct pattern, at the correct time and in the correct relationship to one another across the menstrual cycle.”
In the female study, mean cycle length did not differ significantly between fertile and infertile groups, at 28.9 ± 2.3 compared with 28.9 ± 2.5 days.
Endocrine Rhythm Integrity scores, however, were lower in the infertility group, at 0.61 ± 0.12 compared with 0.78 ± 0.10.
Disrupted endocrine rhythm integrity was observed in 64 per cent of infertile participants despite hormonally normal mid-luteal progesterone levels.
The metric independently predicted infertility status after adjustment for age, body mass index and anti-Müllerian hormone.
Anti-Müllerian hormone is made by reproductive tissues and is best known as a marker of ovarian reserve, meaning an estimate of the number of eggs remaining in the ovaries.
Receiver operating characteristic analysis indicated that Endocrine Rhythm Integrity identified infertility more effectively than cycle length or single-time-point progesterone assessment.
Lower Endocrine Rhythm Integrity scores were also associated with a higher incidence of implantation failure.
Kutchukhidze said: “Our AI-driven rhythm analyses were significantly better at identifying subclinical reproductive dysfunction than conventional testing, suggesting that both female and male endocrine disorders may not simply be disorders of hormone quantity, but rather disorders of hormonal timing, synchronisation and biological rhythm.”
The team will next assess whether the tool can reliably predict fertility outcomes across different reproductive conditions in larger and more diverse populations.
Insight
Fertility rate in England and Wales hits record low, new figures reveal

The fertility rate in England and Wales fell to a record low of 1.39 children per woman in 2025, down from 1.41 a year earlier.
New figures show that parts of London and cities with major universities accounted for many of the areas with the lowest local fertility rates.
The City of London recorded the lowest rate in 2025 at 0.37 children per woman, followed by Cambridge at 0.87 and the London boroughs of Islington and Westminster at 0.90.
The Office for National Statistics (ONS) defines the fertility rate as the average number of live children women would expect to have over their childbearing lives.
Brighton & Hove recorded a rate of 0.95, followed by Southwark at 0.97 and Norwich at 0.98.
Exeter, Oxford and York, along with the London boroughs of Camden and Hammersmith & Fulham, each recorded 1.01 children per woman.
At the other end of the table, Pendle in Lancashire and Luton in Bedfordshire had the highest rate at 1.93.
They were followed by Oldham in Greater Manchester at 1.87, Bradford in West Yorkshire at 1.84 and Barking & Dagenham in London at 1.83.
The overall fertility rate for England and Wales declined from 1.41 in 2024 to 1.39 in 2025.
A rate of around 2.1 is needed for a population to remain stable over time when the impact of migration is excluded.
Twelve of the 25 local authorities with the lowest fertility rates in 2025 were in London.
In Wales, Swansea recorded the lowest fertility rate at 1.18, while Carmarthenshire, the Isle of Anglesey and Newport each had the highest rate at 1.48.
There were 585,396 live births in England and Wales in 2025, down from 594,677 in 2024 and the lowest number since 1977.
Live births fell across every region in England. The West Midlands recorded the largest percentage decline at 3.1 per cent, while the North East had the smallest at 0.3 per cent.
The average age of parents also increased slightly.
Mothers had a provisional standardised mean age of 31.1 in 2025, compared with 31.0 in 2024. Fathers had an average age of 34.0, up from 33.9.
In 1975, the average age was 26.4 for mothers and 29.5 for fathers.
The proportion of births where the mother was born outside the UK also increased, from 20.8 per cent in 2005 to 27.5 per cent in 2015 and 34.6 per cent in 2025.
India was the most common country of birth for non-UK-born mothers in 2025 for the fourth consecutive year.
It was followed by Pakistan, Nigeria and Romania.
In 2025, 56.4 per cent of births were to parents who were both born in the UK, down from 62.7 per cent in 2015.
Wellness
Weight loss surgery improves menstrual health and PMOS symptoms, study finds

Weight loss surgery was linked to more regular periods and fewer polyendocrine metabolic ovarian syndrome (PMOS) symptoms in women aged 18 to 45 living with obesity in a recent study.
The researchers recommend that women undergoing the procedure have access to preconception care and reproductive counselling to support their reproductive health.
Researchers at the University of Surrey analysed data over 24 months from 84 women who underwent bariatric surgery and 18 women living with obesity who did not have surgery.
Of those who underwent surgery, 49 had gastric bypass procedures and 35 had gastric sleeve surgery.
Women who underwent metabolic bariatric surgery lost more than 30kg on average at 12 and 24 months after the procedure.
Among women with polycystic ovaries, the condition persisted in only 10 per cent after 24 months.
Women also reported a resolution of clinical hirsutism, or excess body hair, by 12 months.
Women who had previously experienced irregular periods reported more regular menstrual cycles after surgery.
Professor Martin Whyte, co-author of the study and professor of metabolic medicine at the University of Surrey, said: “A large proportion of those undergoing bariatric surgery are women of reproductive age, who may be planning a pregnancy in the coming years.
“So much remains unknown about the impact of this type of surgery on women who are planning to have children.
“This raises the question of when the ideal time after surgery is to conceive.”
Women have a higher prevalence of obesity than men, with 57 per cent of women in the UK classified as overweight and 27 per cent living with obesity, which can affect fertility and the health of an unborn baby.
The researchers said 17 women had healthy pregnancies following surgery.
Although this was not specifically examined in the study, no difference in birth weight was observed between babies conceived within or after the first year.
Dr Kathryn Hart, co-author of the study and associate professor in nutrition and dietetics at the University of Surrey, said: “What we have found is that bariatric surgery positively affects the reproductive health of women living with obesity and can improve the likelihood of them having a healthy pregnancy after surgery.
“Dysregulated hormone levels, irregular periods and conditions such as polycystic ovaries are affected by obesity.
“By reducing this, what we have seen is that it can lead to improvements without the need for medication.
“We would suggest that clinicians consider medical intervention for obesity to treat irregularities in the menstrual cycle and issues with fertility.”
Fertility
Scottish gov to consider IVF for single women

The Scottish government has launched a national review into whether NHS IVF access should be extended to single women.
The review will also consider whether wider access should be offered to couples who have children from previous relationships.
Health secretary Angela Constance said: “Access to NHS IVF treatment should be fair, timely and reflect the way people’s lives and families look today.”
Most single women are not currently eligible for NHS IVF treatment in Scotland.
Campaigners have welcomed the review.
Katie Rollings of Fertility Action said: “It’s an essential and long-awaited decision that will impact a huge number of people who are struggling to grow their families.
She said there is “no evidence” that having two parents rather than one determines whether a child will thrive.
She added: “What matters is whether a child is loved, safe, supported and has stable, positive relationships around them.”
Figures from the Human Fertilisation and Embryology Authority show Scotland is the only UK nation where NHS-funded IVF cycles outnumber privately funded cycles.
In 2024, more than 6,000 cycles of fertility treatment were carried out among more than 4,000 patients in Scotland. Both figures were slightly lower than the record highs recorded in 2022.
The past 20 years have also seen a rise in the number of same-sex female couples and single women receiving fertility treatment.
In 2024, 625 IVF cycles were carried out for women in same-sex couples in Scotland, with more than one third funded by the NHS.
There were 330 cycles involving single women, of which 50 were NHS-funded.
In England, single women can access IVF through the NHS, although eligibility varies according to the local health trust’s policy.
Current Scottish rules state that couples are eligible if they have been living in a stable relationship for two years and neither partner has been sterilised.
Couples where one partner already has a child can be eligible, but those where both partners have children from previous relationships are not.
Eligibility rules also require a body mass index above 18.5 and below 30, and state that couples must not smoke, drink alcohol or take drugs during treatment. The mother must be under 42.
The Scottish government said the review would also examine consistency of access to fertility preservation, including during cancer treatment, as well as reducing waiting times for donor eggs and sperm.
Same-sex female couples already have access to NHS IVF, but they can face long waits for donor eggs or sperm, as can heterosexual couples who require donor treatment.
The National Fertility Group will lead the review and make “costed, demand-modelled recommendations”, which are due to be published by early summer 2027.
The group will include fertility experts from Scotland’s four NHS-assisted conception units in Glasgow, Edinburgh, Aberdeen and Dundee.
Prof Sarah Martins Da Silva, an NHS consultant and chair of fertility medicine at Dundee University, said there were questions to be answered in a resource-stretched NHS.
“As a fertility specialist I’m never going to be disappointed if the criteria is widened,” she said.
“But with single people, as an NHS clinician looking at the competing demands we have, I’d ask the question about whether being single is a health condition that needs to be funded.”
Da Silva said NHS waiting lists were full of couples who require donated eggs or sperm because of medical conditions including cancer and could face longer waits.
“It’s slightly a disservice to them,” she said.
“There would need to be a real investment and resource without making everybody wait an extraordinary long time.
“With the current financial environment we work in, if you’re talking about new money, where would that come from?”
She said she would welcome changes that encouraged more people to donate eggs or sperm and questioned whether arguments about children needing two parents were necessarily relevant to the debate.
“On the one hand bringing up a child is quite an expensive process, and if you don’t have that support, it can be very difficult.
“But on the other hand, many people start off as a couple and divorce.”
Da Silva also welcomed plans for the review to consider eligibility for couples who already have children, describing the move as “fantastic”.
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