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. 2023 Mar 27;9:24. doi: 10.1038/s41526-023-00272-5

Table 1.

Potential priorities for future space programmes as described in the white paper collection of ESA according to previously identified key knowledge gaps, with a focus on microgravity and/or exploration relevancea.

Physiological changes related to human reproduction and development
• ‘Sex’/‘Gender’ as well as sex steroid hormones in biological systems.
• Teratogenic and oncogenic space related-effects on reproductive systems.
• Foetal development of body systems in space-simulating conditions.
• Age-dependent evaluation of late memory, learning and cognitive performances.
• Long-term effects on gestation under space conditions.
• Monitoring development and function of offspring conceived and developed in space.
Male reproductive health aspects Female reproductive health aspects
• Spermatogenesis relies on testicular spermatogonial stem cells, which require a functional stem cell niche. • Hypothalamic-pituitary-ovarian-endometrial interplay is tightly regulated for normal functioning
• Generation of functional sperm, requires spermatogenesis, spermiogenesis, and final maturation processed in the epididymis. • Quantification of venous thromboembolism risk to female astronauts using the combined oral contraceptive pill.
• Androgens are essential for development and function of the internal and external reproductive organs • Multidisciplinary professional teams are crucial in providing pregnancy and neonatal care.
Timeline of potential research questions regarding reproductive health aspects
Short term • How is the menstrual cycle, including age of menopause, influenced by spaceflight?
• What is the impact of spaceflight on quality and competence of gametes (eggs/sperm)?
• How does space travel impact gynaecological conditions in female astronauts?
• What is the effect of space travel on libido and sexual attraction?
Medium term • How does prolonged exposure to space radiation affect HPG axis regulation in adults?
• How does menstrual suppression affect female astronauts?
• What are the effects of prolonged exposure to the space environment on reproductive organs?
• Can a multidisciplinary team be developed to support pregnancy and birth in space?
• What is the role of hormone replacement therapy in female astronauts?
Long term • How does prolonged exposure to space radiation affect HPG axis during puberty/aging?
• Are there transgenerational effects on gamete quality?
• Is medical assisted reproduction feasible in space?
• Do female astronauts need additional monitoring during a pregnancy after space travel?
• What are the effects of spaceflight during the early postpartum phase?

Timeline: short [3 years], medium [5 years], long [10 years]).

aRef. 1.