Uterine contractility has emerged as a potential key element in the orchestration of female reproductive functions, with specific motility patterns seemingly aligning with hormonal fluctuations throughout the menstrual cycle. These dynamic contractility profiles appear to facilitate various stages of conception, underscoring the importance of maintaining physiological uterine kinetics for fertility. Altered uterine contractility might thus contribute to cases of unexplained infertility. By offering a comprehensive reappraisal of uterine contractility across both physiological and pathological contexts, this review has been undertaken to challenge conventional fertility paradigms. The review outlines uterine anatomy and details the genesis and regulation of uterine contractions, emphasizing the electrophysiological role of uterine pacemaker cells, namely interstitial Cajal-like cells. It also provides a thorough overview of current methodologies for assessing uterine contractility, focusing on non-invasive ultrasound-based approaches, and discussing both innovative applications of established techniques and entirely novel diagnostic methods. The review then evaluates the various physiological uterine contractility patterns observed across the menstrual cycle, and finally presents evidence supporting potential causal links between impaired uterine contractility and fertility-threatening uterine pathologies. Since the directionality of this association remains uncertain, longitudinal studies are needed to determine whether alterations in uterine contractility precede or are a consequence of uterine disease. This is a distinction with critical implications for both treatment and prevention strategies in reproductive medicine.
Research question: How is assisted reproductive technology used by trans and/or non-binary (TNB) individuals and their partners at London Women's Clinic?
Design: This retrospective observational study examined treatments undertaken by TNB people at London Women's Clinic between 2011 and 2025. Demographic information on patients' age, body mass index, anti-Mullerian hormone, antral follicle count and history of gender-affirming hormone therapy/surgery was analysed. Outcomes included the types of treatment pursued, ongoing pregnancies, and live births.
Results: Sixty-four individuals who identified as TNB (n = 42) or had a TNB partner (n = 22) attended the clinic. Treatments included egg freezing (22 cycles), intrauterine insemination (IUI; 17 cycles) and IVF (25 cycles). A minority of IVF cycles involved intra-partner donation (reciprocal IVF; 2/25) or donor eggs (2/25). Three couples' journeys involved surrogacy arrangements. Most TNB individuals attended the clinic with a partner (n = 30), with the exception of those undertaking egg freezing. Of the individuals/couples attempting pregnancy (n =24), most (n =20) were using donor spermatozoa, with the exception of four couples (two involving transgender women who had frozen spermatozoa, and two involving cisgender men). Thirteen live births were achieved and four individuals were discharged from the clinic with ongoing pregnancies.
Conclusions: TNB individuals in the UK are successfully using the spectrum of assisted reproduction options, often with donor gametes and occasionally surrogacy, to build families. In this study, IVF out-performed IUI, underscoring that with inclusive, legally informed care pathways, family formation for TNB patients is both feasible and effective.

