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CDC Releases a National Public Health Action Plan for the Detection, Prevention, and Management of Infertility
... Infertility is a growing public health problem in the United States. 1 Identifying ways to help maintain and preserve fertility and promote prevention, early detection, and treatment of medical conditions that threaten fertility are a national priority. 2,3 The CDC National Survey of Family Growth (2011-2015) determined that 6.7% of American women of reproductive age are infertile, and 7.3 million have used infertility services. 4 This increase is partially due to larger numbers of couples seeking relational and economic stability before having children, thus prolonging the time before they attempt to start a family. ...
... endometriosis or an inherited chromosome abnormality such as Klinefelter syndrome), environment, infectious agents, and lifestyle factors that play significant roles. 2,3,5,6 The psychological impacts related to in vitro fertilization (IVF), not specific to the associated genetic technologies, have been fairly well studied. Infertility treatment is physically, emotionally, and socially difficult, 7,8 and there are psychological costs that are often overlooked as infertility is treated as a medical condition. ...
Objective
Decision-making and patient experiences with embryo selection during in vitro fertilization often include genetic testing options. The purpose of this study was to gain insight about the experiences and perspectives of women using in vitro fertilization and genetic technologies.
Methods
Interviews ( n = 37) were conducted among female patients who had undergone in vitro fertilization, underwent expanded carrier screening, and were offered pre-implantation genetic testing for aneuploidy between July 2016 and July 2017. The interviews were transcribed and a content analysis was conducted on the transcripts.
Results
Categories that emerged from the data analysis included unexpected outcomes, uncertainty, unanticipated emotional consequences, too much emphasis on the woman’s contributions and questions about embryo viability. Patient experiences with genetic technologies during in vitro fertilization played a significant role within these results.
Conclusion
The emotional and psychological impacts of infertility during in vitro fertilization were the primary concerns discussed by participants. Future research is needed to identify ways to help manage unexpected outcomes and continuous uncertainty, including the increasing use of genetic technologies, to not add to the psychological burden of infertility. There is a need to explore more support options or counseling services for patients struggling with infertility during in vitro fertilization treatment.
... The World Health Organization has categorized infertility as a societal disorder, and the U.S. Centers for Disease Control and Prevention (CDC) has designated it a public health priority. Therefore, identifying potential risk factors and reliable markers for the prevention and management of infertility holds significant public health importance (3)(4)(5). ...
Background
The use of visceral obesity as an indicator for predicting female infertility risk has not been well established. The body roundness index (BRI) is a novel, non-invasive indicator of visceral fat; however, previous reports have not addressed the relationship between the BRI and female infertility. This study sought to fill this research gap by investigating the association between the BRI and the risk of female infertility.
Methods
This cross-sectional study examined 3,528 women aged 18 to 45 who participated in the National Health and Nutrition Examination Survey (NHANES) from 2013 to 2018. Infertility was defined based on responses to the reproductive health questionnaire. The BRI was calculated using waist circumference and height. Covariates included demographic traits, physical exam results, laboratory test findings, and survey data. Weighted multivariable logistic regression models and spline smoothing analysis assessed the relationship between the BRI and infertility. Bayesian statistics were used to examine the robustness of significant associations.
Results
Based on their self-report data, 407 (11.54%) participants were classified as having infertility. A significantly higher percentage of participants with a higher BRI were found to have infertility. Multivariable logistic regression revealed that the BRI was significantly associated with increased female infertility risk, regardless of independent variable analysis by continuous variable or quartile (Q1 to Q4) in the fully adjusted model (Model 3, continuous variable: OR = 1.1, 95% confidence interval [CI] = 1.05–1.16, p = 0.0009; Q4 vs. Q1: OR = 2.16, 95% CI = 1.38–3.39, p = 0.0035, Ptrend = 0.004). Non-linear and threshold effects in the relationship between the BRI and female infertility were identified, with an inflection point of 6.36. Subgroup analyses showed that this positive association remained consistent across most demographic and health-related categories. The Bayesian statistics analyses further confirmed the robustness of these findings.
Conclusion
A positive non-linear relationship exists between the BRI and the risk of female infertility, suggesting that the BRI could serve as a valuable indicator in female fertility assessments.
... Health Organization (WHO) have argued for defining infertility as a disease of the reproductive system [8,9]. Moreover, a previous report showed that in the U.S., those who considered infertility a "disease" rather than a "condition" were more interested in fertility treatment (p = 0.014) and fertility preservation (p = 0.017), and they were more likely to use treatments covered by insurance [10]. ...
Objective: This study aimed to evaluate the change in the patient’s background and attitude toward infertility treatment both before and after the initiation of insurance coverage and to explore future issues from the patients’ perspectives.
Materials and methods: A cross-sectional survey was conducted in a fertility clinic in Japan from February to June 2022. An original questionnaire was given for two groups of new patients at a fertility clinic on their first visit: before fertility treatment insurance coverage started (Before-coverage) and after fertility treatment insurance coverage started (After-coverage).
Results: The study included 75 patients (Before-coverage = 25; After-coverage = 50). Multivariate analysis revealed increases among patients who consider infertility a “disease” rather than a “condition” (odds ratio (OR): 5.03, p < 0.05), those preferring in vitro fertilization (IVF) as an initial treatment (OR: 2.54, p = 0.03), and those who recommend oocyte freezing for one’s child (OR: 3.88, p = 0.04), with statistical significance in the After-coverage group compared with the Before-coverage group. However, the anticipated financial burden did not change significantly (e.g., cost per IVF, cost to achieve pregnancy).
Conclusions: More patients had an impression of infertility as a “disease” and preferred IVF as the first treatment option after coverage than before coverage. Furthermore, many patients wanted to recommend oocyte freezing for their children despite the lack of insurance coverage. However, patients’ anticipated economic burden for treatment was not different between both groups. The economic burden anticipated by patients remained unchanged, revealing the challenge of disseminating information to patients in the future.
... Infertility is the inability to conceive within 1 year of unprotected intercourse and has been identified as a public health priority (1). In recent years, the incidence of infertility has increased annually, and the prevalence of infertility is about 25% among couples of reproductive age in China (2). ...
Purpose
Propofol, a widely utilized anesthetic, is employed to alleviate pain and anxiety in outpatient oocyte retrieval procedures. However, its potential impact and safety profile in the context of in vitro fertilization and embryo transfer (IVF-ET) remain unclear.
Methods
This retrospective study enrolled 1187 patients undergoing IVF-ET, and divided into two groups depending on whether they received propofol (propofol group, n=140) or not (control group, n=1047) for anesthesia during oocyte retrieval.
Results
The baseline characteristics were comparable between the groups. Compared with control group, the number of oocytes retrieved in propofol group was more (p=0.012), while both the estradiol (E2) level on the trigger day and the pre-ovulatory follicle count were higher in propofol group ((p<0.01). Additionally, the rate of preterm delivery was significantly higher in the propofol group (p<0.001). To further analyze the effect of propofol on the oocyte retrieval rate, patients were divided into three subgroups depending on the pre-ovulatory follicle count (≤10, 11–20, and >20) to eliminate the influence of inconsistency in the estimation of the pre-ovulatory follicle count between the two groups. Analysis revealed that the use of propofol during oocyte retrieval was particularly advantageous in the subgroup with a pre-ovulatory follicle count of 11–20, yielding a higher oocyte retrieval rate (p<0.001).
Conclusion
The use of propofol in oocyte retrieval did not adversely affect fertilization, embryo quality, or clinical outcomes. Moreover, it was found to increase the oocyte retrieval rate among patients with an estimated pre-ovulatory follicle count of 11–20. These findings offer valuable evidence supporting the clinical application of propofol in oocyte retrieval procedures.
... Infertile couples struggle with problems such as high treatment costs, depression, anxiety, stress, hopelessness, sexual dysfunction, social stigma, and decreases in self-esteem decline. It is considered as a factor for divorce in Iran because of the specific cultural and social context (7). ...
Objectives: Considering that the prevalence of infertility in Iran is higher than the world average and there is no system for recording these individuals’ data, this study aimed at designing and validating infertility data recording tools in Iran. Materials and Methods: This questionnaire study was conducted in Tabriz in 2019. Five areas were prepared for the questionnaire (i.e., in vitro fertilization or intracytoplasmic sperm injection, intrauterine insemination, ovulation induction) and treatment outcomes) and used after reviewing the studies. The Delphi quantitative technique was applied to standardize and validate the questionnaire through evaluating five infertility specialists. The content validity index (CVI), content validity ratio (CVR), and coefficient of agreement (Cohen’s kappa coefficient) were employed to assess content validity through a quantitative approach. Finally, the reliability of the questionnaire was evaluated using the Kuder-Richardson formula through the evaluation of 50 infertile couples visiting AL-Zahra specialized and super-specialized hospital in Tabriz. Results: The CVI and CVR of all items were calculated and obtained greater than 0.8 except for items 8, 17, and 18 and thus were identified as appropriate items in the questionnaire. Kappa coefficients (k) were also calculated and found to be greater than 0.8 for all items except for the three above-mentioned items. The items with lower than an acceptable CVI, CVR, and k were modified, and the k of the total items was obtained as 0.95. Eventually, the reliability of the questionnaire and its domains were assessed, and the reliability coefficient of the questionnaire was higher than 0.64, which was acceptable. Conclusions: A questionnaire was designed to evaluate the history and clinical problems of infertile couples with 5 domains and 61 items to record their information (desirable validity and reliability) in their clinical records.
... Given this consideration, when women seek medical assistance for infertility, healthcare providers are presented with a distinctive opportunity to offer guidance to women in their reproductive years regarding behavioral modifications that could potentially reduce the likelihood of developing chronic diseases in the future. It is crucial to address these matters while women are still capable of implementing such changes (50). ...
Background
The Life’s Simple 7 (LS7) metric is a comprehensive measure of cardiovascular health (CVH) that encompasses seven distinct risk factors and behaviors associated with cardiovascular disease (CVD). Some studies have shown an association between infertility and CVD. The present study aimed to explore the potential association between the LS7 factors and infertility.
Methods
A cross-sectional study was conducted on a sample of 3537 women aged 18-44 years from the National Health and Nutrition Examination Survey (NHANES) spanning the years 2013-2018. The LS7 metrics encompassed various factors including physical activity, smoking habits, body mass index, blood pressure levels, dietary patterns, blood glucose levels, and total cholesterol levels. We computed a 14-point LS7 score based on participants’ baseline data, classifying them as “inadequate” (3-6), “average” (7-10), or “ideal” (11-14). Infertility is defined as an affirmative answer to either of two questions on the NHANES questionnaire: “Have you tried to conceive for at least one year without success?” and “Have you sought medical help for your inability to conceive?” Logistic regression was utilized to estimate odds ratios (O.R.s) and 95% confidence intervals (C.I.s).
Results
In total, 17.66% of participants were classified as individuals who reported experiencing infertility. In the continuous analysis, each one-unit increase in LS7 score was associated with a significantly decreased odds of infertility (OR=0.88 [0.77-0.89]). Analyzing the categorical representation of LS7 score, compared to individuals with poor scores, those with ideal scores exhibited a substantial 58% reduction in the odds of infertility (OR=0.42 [0.26-0.69]). Additionally, the observed interaction suggested that the influence of age on the relationship between LS7 and infertility is not consistent across different age groups (P for interaction < 0.001). Among individuals aged 35 or younger, each unit increase in LS7 score was associated with a substantial 18% (OR=0.82 [0.76-0.89]) decrease in the odds of infertility. However, in the older age group (>35), the association was attenuated and non-significant.
Conclusions
Our research suggests a significant inverse association between LS7 scores and infertility. Age demonstrated a varying impact on this relationship, with a more pronounced impact observed among individuals aged 35 or younger.
... Infertility is characterized by the inability to achieve a clinical pregnancy after one year or more of unprotected and frequent intercourse [1,2]. Among infertility cases, one-third can be attributed to female factors. ...
Female infertility represents a significant global medical concern, attributable to a spectrum of disorders affecting the reproductive system, which encompasses premature ovarian insufficiency (POI), polycystic ovary syndrome (PCOS), Asherman syndrome (AS), endometriosis, preeclampsia, ovarian cancer, and endometrial cancer. It exerts a pervasive impact on women's reproductive well-being on a global scale. Recent years have witnessed a mounting body of evidence, drawing from investigations employing murine models and human clinical data, which elucidates the dysfunction of microRNAs (miRNAs) in various reproductive pathologies. This dysfunction, it appears, plays a pivotal role in the context of female gametogenesis and fertility. Nonetheless, the precise mechanistic links between miRNA dysfunction and the pathogenesis of these disorders remain, in many cases, inadequately understood. This comprehensive review endeavors to shed light on recent advancements in research pertaining to the regulatory functions of miRNAs in the etiology of diverse reproductive disorders that culminate in infertility. Furthermore, it addresses the potential utility of miRNAs as diagnostic biomarkers and therapeutic targets for these conditions. The paper also examines the existing limitations and challenges inherent to the clinical application of miRNAs in this context.
... Infertility is the inability to conceive within one year of unprotected intercourse and is identified as a public health issue due to dramatically rising infertility rates in the recent decade [1]. Globally, infertility affects up to 15% of couples of reproductive age [2,3]. ...
Background
In Indian context, infertility is often a silent struggle. Despite the high prevalence of infertility in the country, the majority of couples do not share their struggles with family or friends due to social stigma, thus increasing their psychological vulnerability. Heartfulness meditation has shown to decrease stress, anxiety, loneliness and improve sleep along with quality of life.
Objectives
The current retrospective series evaluated the effectiveness of Heartfulness-based integrative therapy on infertility outcomes.
Methods
The program consisted of a 5- day onsite lifestyle modification workshop and online follow up meditation sessions.
Results
54 couples with infertility participated in the program with a mean age of 30.74 years (SD 5.04) for females and 34.03 years (SD 4.54) for males. 15 couples presented with male infertility, 16 couples presented with female infertility and in 5 couples both partners had infertility problems. Further, 18 couples had unexplained infertility. 24 couples conceived with 18 natural conceptions, five via assisted reproductive technology and one spontaneous abortion.
Conclusion
The program was beneficial in the cohort who utilized it as prescribed resulting in conception of 24 out of 54 couples. Future research investigating the causal relationship of Heartfulness meditation on fertility outcomes in a randomized control study could solidify this treatment method to be used independently or as an adjuvant therapy with assisted reproductive technologies.
... Infertility is a top public health concern which is defined as the failure to conceive within a year of unprotected sexual activity (1,2). The United States' Centers for Disease Control and Prevention (CDC) underlined that infertility was a serious public health concern with significant quality-of-life effects, such as psychological suffering, social stigma, financial strain, and marital discord (3). ...
Background
Although many studies have proven the harmful effects of smoking on human health, the associations between smoking status and infertility are limited in large epidemiologic studies. We aimed to investigate the associations between smoking status and infertility among child-bearing women in the United States of America (USA).
Methods
A total of 3,665 female participants (aged 18-45) from the National Health and Nutrition Examination Survey (NHANES) (2013-2018) were included in this analysis. All data were survey-weighted, and corresponding logistic regression models were performed to investigate the associations between smoking status and infertility.
Results
In a fully adjusted model, the risk of infertility was found to be increased by 41.8% among current smokers compared to never smokers (95% CI: 1.044-1.926, P=0.025). In the subgroup analysis, the odds ratios (95% CI) of the risk of infertility for current smokers were 2.352 (1.018-5.435) in the unadjusted model for Mexican American, 3.675 (1.531-8.820) in the unadjusted model but 2.162 (0.946-4.942) in fully adjusted model for people aged 25-31, 2.201 (1.097-4.418) in the unadjusted model but 0.837 (0.435-1.612) in fully adjusted model for people aged 32-38.
Conclusion
Current smokers was associated with a higher risk of infertility. The underlying mechanism of these correlations still needs more research. Our findings indicated that quitting smoking may serve as a simple index to reduce the risk of infertility.
... Infertility has increased in many populations and has been identified as a global public health priority. 1 The infertility rate has increased from 6.7% to 15.5% among women of reproductive age in the world over the past two decades, 2 3 and there are around 48 million infertile couples. 4 Infertility causes psychological distress, social stigmatisation, marital discord and heavy financial burden in families. ...
Purpose
The Anhui Maternal–Child Health Study (AMCHS) aims to examine determinants of reproduction, pregnancy and postpartum maternal and child health outcomes in Chinese women who received assisted reproductive technology (ART).
Study design and participants
AMCHS is an ongoing cohort study starting from May 2017. AMCHS recruits participants from all couples who sought ART treatment in the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China. The participants are interviewed to document baseline sociodemography, lifestyles, dietary intake and environmental exposure. Their clinical characteristics are obtained from hospital records. Samples of blood, follicular fluid and semen are collected at the clinic. Participants receive a standard long pituitary downregulation or a short protocol with an antagonist for the treatment. They are followed up from preconception to delivery, or discontinuation of ART treatment. Details of their children’s health are documented through a questionnaire focusing on developmental status and anthropometry measurement.
Findings to date
Until April 2021, AMCHS had recruited 2042 couples in the study. 111 women withdrew from the study and 19 failed to retrieve oocytes. Among the 1475 confirmed pregnancies, 146 had miscarriages or terminated their pregnancies, 9 had stillbirths and 263 were ongoing pregnancies. The implantation failure increased with maternal age; adjusted OR was 1.43 (95% CI 1.16 to 1.77) in the age of 31–35 years, 1.97 (95% CI 1.46 to 2.66) in 35–39 years and 6.52 (95% CI 3.35 to 12.68) in ≥40 years compared with those aged 20–30 years. Among the 1057 couples with successful ART who were followed up for delivering babies, 576 had their children examined at age 30–42 days, 459 at 6 months and 375 at 12 months.
Future plans
The AMCHS will identify comprehensive risk factors for poor ART outcomes and explore potential interaction effects of multiple factors including sociopsychological aspects of environmental exposure, dietary intake and genetics on maternal and child health.
... Personalized nutrition is a tool to preserve health rather than treat a condition. Since infertility is a social problem and an emerging priority for public health [459], we think that a change in the cultural mindset is required and that healthier and personalized nutrition shall be suggested earlier and be continued throughout life in order to prevent infertility, rather than to treat it [253]. ...
Increasing evidence on the significance of nutrition in reproduction is emerging from both animal and human studies, suggesting a mutual association between nutrition and female fertility. Different “fertile” dietary patterns have been studied; however, in humans, conflicting results or weak correlations are often reported, probably because of the individual variations in genome, proteome, metabolome, and microbiome and the extent of exposure to different environmental conditions. In this scenario, “precision nutrition”, namely personalized dietary patterns based on deep phenotyping and on metabolomics, microbiome, and nutrigenetics of each case, might be more efficient for infertile patients than applying a generic nutritional approach. In this review, we report on new insights into the nutritional management of infertile patients, discussing the main nutrigenetic, nutrigenomic, and microbiomic aspects that should be investigated to achieve effective personalized nutritional interventions. Specifically, we will focus on the management of low-grade chronic inflammation, which is associated with several infertility-related diseases.
... In 2014, the Centers for Disease Control and Prevention (CDC) released its first National Public Health Action Plan for the Detection, Prevention, and Management of Infertility, 16 which calls for eliminating disparities in access to high-quality infertility services. State infertility insurance mandates have emerged as a key mechanism for increasing access to care in the United States. ...
Importance
Prior studies have demonstrated that state mandated coverage of in-vitro fertilization (IVF) may be associated with increased utilization, fewer embryos per transfer, and lower multiple birth rates, but also lower overall live birth rates. Given new legislation and the delay between enactment and effect, revisiting this analysis is warranted.
Objective
To characterize the current impact of comprehensive state IVF insurance mandates on IVF utilization, live birth rates, multiple birth rates, and embryo transfer practices.
Study Design
We conducted a retrospective cohort study of IVF cycles reported by the 2018 Centers for Disease Control Assisted Reproductive Technology Fertility Clinic Success Rates Report in the United States. IVF cycles were stratified according to state mandate: comprehensive (providing coverage for IVF with minimal restrictions) and non-comprehensive. US Census estimates for 2018 were used to calculate the number of reproductive-age women in each state. Outcomes of interest (stratified by state mandate status) included utilization rate of IVF per 1,000 women ages 25 to 44, live birth rate, multiple birth rate, number of embryo transfer procedures (overall and subdivided for fresh vs. frozen cycles), and percent of transfers performed with frozen embryos. Additional sub-analyses were performed stratifying outcomes by patient age group.
Results
In 2018, 134,997 IVF cycles from 456 clinics were reported. Six states had comprehensive mandates; 32,029 and 102,968 cycles were performed in states with and without comprehensive IVF mandates, respectively. IVF utilization in states with comprehensive mandates was 132% higher than non-comprehensive states after age adjustment; increased utilization was observed regardless of age stratification. Live birth rate per cycle was significantly higher in states with comprehensive mandates (35.4% vs 33.4%, p<0.001), especially among older age groups. Multiple birth rate as a percentage of all births was significantly lower in states with comprehensive mandates (10.2% vs 13.8%, p<0.001), especially among younger patients. Mean number of embryos per transfer was significantly lower in states with comprehensive mandates (1.30 vs 1.36, p<0.001). Significantly fewer frozen transfers were performed as a percentage of all embryo transfers in states with comprehensive mandates (66.1% vs 76.3%, p<0.001). Among fresh embryo transfers, significantly fewer embryos were transferred in comprehensive states among all patients (1.55 vs. 1.67, p<0.001).
Conclusions
Comprehensive state mandated insurance coverage for IVF services is associated with greater utilization of these services, fewer embryos per transfer, fewer frozen embryo transfers, lower multiple birth rates, and higher live birth rates. These findings have important public health implications for reproductive-age individuals in the US and present significant opportunities for research on access to fertility care.
... B lack women in the United States have twice the prevalence of infertility (14%) than non-Hispanic White women (7%), and they are half as likely to seek treatment for family building (1)(2)(3)(4)(5). In the United States, it is estimated that 7.4 million women of childbearing ages 15-44 years have used some type of infertility service for family building (6), with the majority being White women who are older, wealthy, highly educated, and married (1)(2)(3)(4). It is known that up to 50% of White women who experience infertility seek treatment (5). ...
Objective
To provide a comprehensive multidimensional description and conceptualization of Black women’s experiences with seeking treatment for infertility
Design
Convergent Parallel Mixed Methods Study combining retrospective chart review data and semi-structured interview data
Setting
Private Infertility Clinic
Patients
African American/Black women between the ages of 18 and 44 years old, who presented for an initial infertility evaluation with a male partner between January 2015 and September 2019 at an infertility clinic in the metropolitan Washington D.C area.
Intervention
None
Main Outcome
Treatment Seeking
Measures
Psychobiological, Clinical, and Sociocultural Factors
Results
Along the psychobiological, clinical, and sociocultural domains, we understood that Black women who sought treatment for infertility were older, overweight, had complex gynecological diagnoses, and experienced infertility for long amounts of time. This delay in treatment seeking was possibly due to a low perceived risk for infertility, poor understanding of treatment options, inadequate referral patterns of primary care providers, and limited social support. Further, Black women experienced delays in treatment seeking as they attempted their own lifestyle interventions prior to considering medical interventions. Facilitators to care included psychological distress, complex gynecological medical history, and finding culturally competent providers.
Conclusion
The study findings shows us that Black women in the U.S. are vulnerable to disparities in healthcare delivery especially within reproductive endocrinology. Our findings highlight areas where Black women are experiencing missed opportunities for teaching, early identification, and early referrals for infertility related concerns. Future studies should seek to reduce barriers to infertility treatment at the clinical and policy levels.
... Infertility is the inability to conceive after 12 months of frequent coitus without using contraceptives. About 25% of couples in the developing countries suffer from this problem [3]. Infertility has negative effects on various aspects of couples' lives [4] and can increase marital conflicts and Sexual Dysfunction (SD), especially in females [5]. ...
Background:
The aim of this study is to compare anxiety, depression, body image, self-esteem, sexual function, and quality of life (QoL) between infertile women and control fertile women undergoing tubal ligation (TL) and using condom.
Methods:
This cross-sectional study was conducted on 600 women in three groups of infertile and control fertile women with or without TL (200 women in each group), who met the inclusion criteria. They were selected from Royan Institute and a number of health care centers in Tehran (Iran) from May 2017 to February 2019. The subjects were asked to fill out the Short Form Health Survey (SF-12), Female Sexual Function Index (FSFI), Hospital Anxiety and Depression Scale (HADS), Body Image Concern Inventory (BICI), and Rosenberg' Self-Esteem Scale (RSES). One-way ANOVA was used to identify the possible statistical differences between the three groups of participants.
Results:
The mean scores of all FSFI domains were lower in the control TL women, and the differences between the three groups in all dimensions were statistically significant. In addition, the TL group had more female sexual dysfunction (FSD) comparing to the infertile and condom group (22.43 ± 5.30, 24.79 ± 4.74, and 28.03 ± 3.29, respectively P < 0.001). There was a significant difference between the three groups in SF-12 scores (76.59 ± 13.14, 68.49 ± 14.47, and 78.87 ± 12.62, respectively P < 0.001). Also there was a significant difference between the three groups in anxiety, depression, and total scores of HADS (P < 0.001). Furthermore, infertile women had lower body image (P < 0.05) and the TL group had lower self-esteem comparing to the two other groups (P < 0.05).
Conclusions:
The findings revealed the adverse effects of using TL on the anxiety, depression, sexual life, body image, and QoL of women. It is recommended that health-care professionals should increase their awareness and knowledge regarding the side-effects of using TL on women's lives and share this information with the patients.
... Moreover, during this stage the current market for infertility test was investigated; it is forecasted to have positive trend, due to the declining fertility rates across the globe, the increasing of the age for the first-time pregnancy and the introduction of user-friendly fertility monitors which facilitate the whole pregnancy path for the couple (11)(12)(13). The analysis of the competitors was also carried out, and it turned out that the main competitors of KronosDNA are to be considered companies that already produce diagnostic kits for NGS. ...
... Infertility is the inability to conceive after 12 months of frequent coitus without contraceptives, which accounts for 25 percent of couples in developing countries (3). Infertility imposes a great deal of psychological burden to couples and has negative effects on various aspects of their lives(4) and can increase marital con icts and sexual dysfunction (5). ...
Background: The aim of this study is to compare anxiety, depression, body image, self-esteem, sexual function (SF), and quality of life (QoL) between infertile women and women with or without tubal ligation (TL).
Methods: This cross-sectional study was conducted on 600 women, distributed equally as infertile women, women with or without TL, who met the inclusion criteria. They were selected from the Royan Institute in Tehran (Iran) and a number of health care centers in Tehran (Iran) from May 2017 to February 2019. The subjects were asked to fill out the Short Form Health Survey (SF-12), Female Sexual Function Index (FSFI), Hospital Anxiety and Depression Scale (HADS), Body Image Concern Inventory (BICI), and Rosenberg’ Self-Esteem Scale (RSES). One-way ANOVA was used to find the statistical differences between the three groups.
Results: Mean scores of all FSFI domains were found to be lower in the TL women and the differences between the three groups were statistically significant in all domains. Women with TL had more female sexual dysfunction (FSD) (22.43±5.30 vs 24.79±4.74 vs 28.03±3.29, P˂0.001). There was a significant difference between the three groups in SF-12 scores (76.59±13.14 vs 68.49±14.47 vs 78.87±12.62, P˂0.001). Also, there was a significant difference between the three groups in anxiety, depression, and total scores HADS (P˂0.001). Infertile women had lower body image (P˂0.05) and self-esteem was lower in the TL group (P˂0.05).
Conclusions: Our findings reveal the adverse effects of TL on the anxiety and depression, sexual life, body image, and QoL of women. It is recommended that the awareness and knowledge of health-care professionals regarding the side-effects of TL in the above-mentioned aspects of women’s lives should be increased and discussed with patients.
... Distance, cost, health literacy, ethnicity, and expertise are important factors that in uence whether and how patients seek health care [6][7][8][9] . As assisted reproductive technology (ART) involves multiple consultative appointments, complex diagnosis, invasive therapies and partner-based care, disparity of burden on patients with infertility could be greatly magni ed. ...
Background: Infertility is a global health problem that carries a high social and economic burden. Assisted reproductive technology (ART) has been developed in mainland China for over 30 years. We aimed to evaluate the accessibility and equity of distribution of ART facilities in mainland China from 2006 to 2018, and quantify the population with reduced geographic access to ART services.
Method: A retrospective study was conducted to describe the trend and analyze the equity of distribution of ART clinics in 2006, 2012, and 2018. Coverage rates were calculated by city and by population. Size of population living in areas with different regional choice of ART services was identified. The Gini coefficients were calculated to measure the equity of the distribution of ART clinics.
Results: There were 85 ART clinics (not counting artificial insemination clinics) in mainland China in 2006, 356 in 2012, and 498 in 2018 . The coverage rate of ART clinics was increased significantly (P＜0.05). Eastern China had the most extensive coverage, followed by the central region, while the western region had the least coverage (P＜0.05). At the end of 2018, 171.4 million people in 47 cities had no access to in vitro fertilization (IVF) clinics, but had access to at least one artificial insemination clinic in their own cities. There were still 354.9 million people (25.4% of the population) living in 148 cities without any ART clinics, indicating that 179.5 million people of reproductive age had no access to ART services. The Gini coefficients for the distribution of IVF clinics in mainland China in 2006, 2012, and 2018 were 0.389, 0.275 and 0,267 respectively, and for the distribution of ART clinics in 2012, and 2018 were 0.222 and 0.213.
Conclusion(s): The accessibility of ART clinics in mainland China increased significantly in the twelve years to 2018. The equity of distribution of ART clinics was quite balanced over the country. However, underserved areas still exist, especially in the western region, which has spurred more targeted policies and cost-effective measures to improve the accessibility and availability of ART services in such areas.
... Impaired fecundity affects 12% of reproductive aged women in the United States (US) (Warner et al. 2015). With increasing female age, the prevalence of infertility and potential of fertility treatment success decreases. ...
Introduction
Reproductive life planning is an important aspect of OBGYN resident education. Despite learning about declining fertility and the implications associated with delaying pregnancy, OBGYN residents overestimate the age when fertility declines and fertility treatment success rates.
Objective
To characterize attitudes towards infertility, pregnancy timing, and fertility preservation among OBGYN residents at academic programs in the United States.
Methods
Cross sectional study of female trainees from 27 academic OBGYN residency programs. A voluntary, anonymous online survey was used to assess reproductive experiences and characterize attitudes towards personal family planning and infertility.
Results
Of 756 trainees who were sent the survey, 487 opened the email, and 309 participated (63.4% response rate per opened email, 40.9% overall). The majority of residents expressed a desire to have children, but had not started childbearing (75.8%, n = 210) with a planned delay for career/educational reasons (84.5%, n = 196). The majority planned to have children before age 35 (90%, n = 210). Of those not finished with childbearing, 78.5% reported worrying about infertility (n = 205) and 40.8% reported considering fertility preservation (n = 111). If interested in fellowship, trainees were more worried about infertility (p = 0.01, OR 2.74 (95% CI 1.24 –6.04)).
Conclusions for Practice
Female OBGYN residents learn to help patients with reproductive planning and many may personally delay family building. To help alleviate anxiety, improve reproductive autonomy, and prevent future regret, OBGYN residents may benefit from counseling regarding declining fertility with age and the advantages and disadvantages of fertility preservation, specifically emphasizing the realistic chance of success with oocyte cryopreservation compared to conception at a young age.
... The field of reproductive medicine has established protocols that clinicians follow to diagnose, manage, and treat infertile couples that are published by various well-respected societies and organizations [17][18][19][20][21][22][23][24][25][26]. For the couples that seek treatment, the male and female should be seen together by the clinician to make an accurate evaluation. ...
Clinically, infertility is defined as the inability to conceive after a certain period. In contrast, sterility is defined as the inability to produce a biological child; however, this is not a practical definition that can be applied in a clinical setting to a patient's diagnosis. Unlike infertility, sterility is rarely discussed in biomedical and clinical literature and is often used synonymously with infertility. Infertility affects about 10% of couples globally, but the prevalence of sterility remains unknown. We divide sterility into three subtypes natural, clinical, and hardship. To estimate sterility prevalence, we analyzed primary literature and meta-analysis papers on the rates of live births and pregnancies throughout several treatments of infertile couples (e.g., untreated patients, in vitro fertilization-treated, and patients administered other treatments). This analysis indicates that all treatments fail in delivering a biological child to most couples, suggesting that most infertile couples may fail to conceive. More comprehensive primary studies are needed to provide a precise estimate of sterility. Furthermore, research is needed to study the causes of sterility, as well as develop methods for diagnosis and treatment that are financially affordable and emotionally tolerable. Altogether, sterility is an under-discussed condition that is more common than expected, as many infertile couples are unable to conceive and are, in effect, sterile.
... Moreover, during this stage the current market for infertility test was investigated; it is forecasted to have positive trend, due to the declining fertility rates across the globe, the increasing of the age for the first-time pregnancy and the introduction of user-friendly fertility monitors which facilitate the whole pregnancy path for the couple (11)(12)(13). The analysis of the competitors was also carried out, and it turned out that the main competitors of KronosDNA are to be considered companies that already produce diagnostic kits for NGS. ...
Background:
Life Sciences research, enhancing the occurrence of innovation, is able to impact clinical decision-making, both at diagnosis and therapy. Indeed, starting from the knowledge of specific needs and of technical-scientific demands, researchers can conceive and experiment innovative solutions. Despite these strengths, transferring research to the market in Life Sciences shows considerable criticalities. The aim of this paper is to provide concrete evidences on the processes of technology transfer based on the exploitation of the results obtained by KronosDNAsrl, an academic spin-off focused on reproductive medicine.
Methods:
Different tools were used to evaluate the technical feasibility (validation of the results obtained with the prototype) and to manage the technology transfer process of One4Two®.
Results:
The different analyses we carried out showed the feasibility of the proposed solution. As a result, the One4Two® prototype has been developed and validated.
Conclusions:
Here, we provide a strength of evidences on how knowledge obtained by translational research on "bench" can be used to be transferred to the market on "benchmark" enabling innovation in Laboratory Medicine. In addition, the model described for One4Two® can be easily transferred to other products.
... Infertility, a disease of the reproductive system, is defined as the inability to conceive despite 12 months of unprotected sexual intercourse, 1 and this disorder has become a worldwide public health issue. 2 Globally, it is estimated that approximately 15% of all couples suffer from infertility, 3 and results from the systematic analysis for the Global Burden of Disease Study 2015 showed that there were 113 million infertile individuals and 752.4 thousand years lived with disability (YLDs) worldwide in 2015. 4 Unexplained infertility, a form of infertility that cannot be explained by anovulation, poor sperm quality, tubal pathology, or without any known cause, 5 is one of the most common infertility diagnoses, and there are about 30% of global infertile couples diagnosed with unexplained infertility. ...
Background
Lower serum homocysteine (Hcy) levels are found to correlate with a better chance of clinical pregnancy and better embryo grades in assisted reproductive technology (ART). However, there is little knowledge on the association between Hcy level and unexplained infertility until now.
Methods
A total of 388 infertile women undergoing IVF/ICSI treatments were recruited, including 129 women with unexplained causes (case group) and 259 women with known causes (control group), and the case group was further divided into subgroups A (≤8 μmol/L), B (>8 and <15 μmol/L), and C (≥15 μmol/L) based on the serum Hcy level. The associations between serum Hcy level and IVF/ICSI pregnancy outcomes were examined in infertile women with unknown causes.
Results
A significantly higher serum Hcy level was measured in the case group than in the control group (P = .008). Subgroup analysis revealed a significant difference in the total number of oocytes retrieved among subgroups A, B, and C (P = .031), and no significant difference was seen among these three groups in terms of age, BMI, E2 level on the hCG day, number of M‐II oocytes, number of fertilized oocytes, or total number of high‐quality embryos (P > .05). Spearman correlation analysis revealed a negative correlation between serum Hcy level and total number of oocytes retrieved (r = −.406, P = .019). Univariate and multivariate linear regression analyses revealed that serum Hcy level had no correlations with any IVF/ICSI outcomes.
Conclusion
Serum Hcy level has no associations with IVF/ICSI pregnancy outcomes.
... In conclusion, this study further supports a link between the use of infertility treatment and HDP. Given this relationship, the consultation for infertility treatment provides an opportunity to counsel a highly motivated population to optimize lifestyle/health in order to mitigate the negative sequela associated with cardiovascular disease [7,40]. It is important to continue to track maternal morbidity outcomes as patients transition care from their reproductive endocrinology practices to obstetric perinatal and postpartum care. ...
Purpose
To explore associations between infertility treatment and hypertensive disorders of pregnancy.
Methods
We collated multi-year as well as multi-state data from a national representative survey examining the association between self-reported infertility treatment (i.e., medication, intrauterine insemination, or assisted reproductive technology) and hypertensive disorders of pregnancy (i.e., high blood pressure, pregnancy-induced hypertension (PIH), preeclampsia, and toxemia). Data were analyzed using logistic regression. A total of 21,884 women in the United States (U.S.), from the Centers for Disease Control and Prevention’s (CDC) Pregnancy Risk Assessment Monitoring System (PRAMS) survey (2009–2015), participated in the study.
Results
In our analysis, 12.91% women reported a history of infertility treatment and 15.19% reported a history of hypertensive disorder of pregnancy. Compared with women who had never had infertility treatment, women who reported infertility treatment had 1.18 (adjusted OR, 95% confidence interval (CI) 1.05, 1.33) higher odds of reporting hypertensive disorder of pregnancy. Neither types of infertility treatment nor proximity of treatment to pregnancy were independently associated with hypertensive disorder of pregnancy.
Conclusions
Our results suggest that among U.S. women, the treatment of infertility may be associated with hypertension disorder of pregnancy regardless of type of treatment.
... 3,4 Recent studies suggest the incidence of infertility has markedly increased over the past decade. 5,6 A complete infertility evaluation includes a thorough history and physical examination, assessment of ovarian reserve and ovulation, assessment of the uterus and fallopian tubes typically with a hysterosalpingogram (HSG), and assessment of male sperm with a semen analysis. 1,2 Etiologies of infertility are divided into subcategories including ovulatory dysfunction, tubal factor, endometriosis, uterine factor, male factor, and unexplained. ...
... The Centers for Disease Control and Prevention's recently released National Public Health Action Plan for the Detection, Prevention, and Management of Infertility outlines a number of research priorities and data sources that can be used to address these priorities. 21,22 The action plan highlights the need for comparable populationbased data on infertility prevalence and information on associated risk factors, outcomes, and subpopulations, such as people with cancer or others who might benefit from fertility preservation. While various approaches for estimating infertility have their pros and cons, agreement on definition and instruments used to assess this important condition are needed to make meaningful comparisons across populations and over time. ...
Purpose This study aims to investigate the epidemiological data and trends of male infertility aged 20 to 49 years in Asia from 1990 to 2021. Methods Data for this study was obtained from the GBD 2021 public database. Trends in prevalence, disability-adjusted life years (DALYs), age-standardized prevalence rate (ASPR), and age-standardized DALY rate (ASDR), along with their correlation with the Socio-Demographic Index, were analyzed. A join-point regression model was developed to assess trends across different time segments. Additionally, an autoregressive integrated moving average (ARIMA) model was employed for predictions extending to 2040. Results The burden of male infertility among individuals aged 20 to 49 years significantly increased globally and in East Asia, South Asia, and Southeast Asia from 1990 to 2021, with the South Asia region exhibiting the largest increase and the fastest growth rate. East Asia exhibited the highest disease burden, whereas Central Asia and the high-income Asia Pacific region had the lowest. Predictions for 2040 indicate that this upward trend will continue both globally and within Asian regions. Conclusion The disease burden in East Asia, South Asia, and Southeast Asia remains significant, with a notable upward trend observed in South Asia and Southeast Asia. Targeted interventions and policies are needed based on the epidemiological characteristics and changing trends of different Asian regions.
Purpose
To compare risks of neonatal anomalies and obstetric complications among frozen–thawed embryo transfer (FET), fresh embryo transfer (FreshET), and non‐assisted reproductive technology (non‐ART) treatments in infertile women.
Methods
This retrospective cohort study analyzed 7378 singleton births (2643 non‐ART, 4219 FET, 516 FreshET) from 2013 to 2022. Outcomes were compared using inverse probability weighting regression adjustment, with adjustment for maternal factors.
Results
After adjustment, the risk of neonatal anomalies did not differ significantly between FET and non‐ART, or FreshET and non‐ART. FET was associated with increased risks of obstetric complications compared with non‐ART, including placenta accreta (adjusted risk difference [ARD] 3.61%, 95% CI 2.95–4.28), placenta previa (ARD 0.55%, 95% CI 0.14–0.96), postpartum hemorrhage (ARD 7.08%, 95% CI 6.03–8.13), gestational hypertension (ARD 3.57%, 95% CI 2.47–4.68), gestational diabetes (ARD 0.96%, 95% CI 0.17–1.75), and preterm birth (ARD 2.13%, 95% CI 1.23–3.02). FET also showed higher risk of high birth weight (ARD 0.97%, 95% CI 0.42–1.52). FreshET showed no significant differences in obstetric complications.
Conclusions
While the risk of neonatal anomalies did not differ among treatments, FET was associated with increased obstetric complication risks. These findings underscore the need for careful management of FET pregnancies and further research to improve treatment protocols.
Millions of women worldwide suffer from infertility associated with gynecologic disorders such as premature ovarian insufficiency, polycystic ovary syndrome, Asherman syndrome, endometriosis, preeclampsia, and fallopian tube obstruction. These disorders can lead to infertility and thereby affect the quality of life of the infertile couple because of their psychological impact and significant costs. In recent years, stem cell therapy has emerged as a therapeutic approach to repair or replace damaged tissues or organs. This review describes the recent development as well as the underlying mechanisms of stem cell therapy for a variety of female reproductive diseases, offering us new therapeutic options for the treatment of female reproductive and endocrine dysfunction.
Objective
To determine the prevalence of physical intimate partner violence (IPV) among postpartum women reporting preconception fertility treatment compared to those who conceived without the use of assisted reproduction.
Design
Cross-sectional population-based study.
Setting
Twelve U.S. states with at least a 50% PRAMS survey response rate.
Subjects
Postpartum respondents of the Centers for Disease Control (CDC) Pregnancy Risk Assessment Monitoring System (PRAMS) survey.
Exposure
Preconception fertility treatment utilization.
Main Outcome Measures
Physical Intimate Partner Violence (IPV).
Results
Of the 43,999 respondents included in this analytic sample, roughly 2% reported physical IPV. Respondents reporting preconception fertility treatment (12.6%) were less likely to endorse physical IPV than those who conceived without fertility treatment exposure (OR 0.5, 95% CI 0.4-0.7). In the multivariate regression model, the odds of physical IPV were similar among postpartum women regardless of fertility treatment exposure (aOR 1.2, 95% CI 0.8-2.0). Residing in a household with an income under the federal poverty level and increased preconception stressors were predictive of reported physical IPV. There was no difference in type of fertility treatment and report of physical IPV. Among women exposed to fertility treatment, predictors of physical IPV included self-identification of Black (p<0.0001) or Hispanic (p=0.0352) race/ethnicity as well as report of 4 or more stressors in the 12 months prior to the most recent delivery (p<0.0001).
Conclusion
The use of fertility treatment did not confer greater risk of physical IPV within this postpartum population. However, there are many individuals with infertility who never present for an assessment, proceed with treatment, or are unsuccessful, thus the extent to which infertility and fertility treatment exposure is associated with physical IPV remains to be elucidated. Women reporting a greater number of stressors may be uniquely at risk despite access and exposure to fertility treatment. The preconception period, inclusive of encounters with infertility specialists, represents a unique opportunity to screen and counsel all women for IPV.
Purpose
Propofol is a common anesthetic agent used for oocyte retrieval procedures to reduce the pain and fear in outpatients. However, the potential effects and safety of propofol on in vitro fertilization and embryo transfer (IVF-ET) is not clear yet.
Methods
A total of 1187 patients undergoing IVF-ET were recruited in this retrospective study and divided into two groups depending on whether they received propofol (propofol group, n = 140) or not (control group, n = 1047) for anesthesia during oocyte retrieval.
Results
Baseline information did not differ between the two groups (p > 0.05). Compared with control group, the number of oocytes retrieved in propofol group was more (p = 0.012), while both the estradiol (E2) level on the trigger day and the pre-ovulatory follicle count were higher in propofol group ((p < 0.01). Furthermore, the preterm delivery rate was higher in the propofol group (p < 0.001). To further analyze the effect of propofol on the oocyte retrieval rate, patients were divided into three subgroups depending on the pre-ovulatory follicle count (≤ 10, 11–20, and > 20) to eliminate the influence of inconsistency in the estimation of the pre-ovulatory follicle count between the two groups. Data showed that oocyte retrieval with propofol was beneficial for getting more oocytes in the pre-ovulatory follicle count 11–20 subgroup (p < 0.001).
Conclusion
Oocyte retrieval with propofol had no negative effect on fertilization, embryo quality, and clinical outcomes, and could raise the oocyte retrieval rate in patients with an estimated pre-ovulatory follicle count 11–20. These findings provided evidence for further clinical applications of this technique.
Objective
The purpose of this systematic review is to provide a comprehensive review of the literature that examines facilitators and barriers to infertility treatment seeking among women who experience infertility in the United States.
Evidence Review
This review followed the PRISMA guidelines and has a registered protocol. Studies were included if they reported factors specifically influencing treatment seeking patterns of women for infertility as defined above. The search was conducted in January 2020 in four databases and updated in February 2021. We utilized a combination of free texts, index, and truncated terms. The following terms and concepts were used: infertility [or] subfertility, woman [or] women [or] female, patient acceptance of health care [or] help-seeking [or] health seeking behaviors [or] treatment seeking. The search terms were purposely used to include variations of terms that were synonymous with treatment seeking. Included studies must have been original research studies written in English that explicitly discussed the relationship of variables that influenced treatment seeking among women in the United States. Quality assessment was conducted using the critical appraisal tool from the Joana Briggs Institute.
Results
The final sample included a total of 23 articles (6 qualitative, 17 quantitative) that examined facilitators and barriers that influenced treatment seeking among women who experienced infertility in the United States; these articles were synthesized using Chrisman’s Health-Seeking Model. Findings suggest there are multi-factorial facilitators and barriers that influence treatment seeking. Common facilitators to treatment seeking were high desire for parenthood, especially when their partners also agreed; high social support encouraging treatment; and advanced health literacy. Common barriers to treatment seeking were internalized stigma, having access limited by professional careers, low or no social support supporting treatment seeking, and negative perceptions of the clinical environment.
Conclusion
Overall, many of the facilitators and barriers found were a dynamic blend of perceptions of the biological, clinical, and social implications of disease and treatment access. Many of these facilitators and barriers were influenced by social cues and perceived access to care. More research is needed to further elucidate variations in treatment seeking among diverse samples of racial/ethnic, gender, and sexual minority groups.
Infertility is a global health problem that carries a high social and economic burden. Assisted reproductive technology (ART) has been developed in mainland China for over 30 years. We aimed to evaluate the accessibility and equity of distribution of ART facilities in mainland China from 2006 to 2018 and quantify the population with reduced geographic access to ART services. A retrospective study was conducted to describe the trend and analyse the equity of distribution of ART clinics in 2006, 2012, and 2018. The accessibility of ART clinics in mainland China increased significantly in the 12 years to 2018 (p ˂ 0.05). Eastern China had the most extensive coverage, followed by the central region, while the western region had the least coverage (p ˂ 0.05). The Gini coefficient for the distribution of ART clinics in 2018 was 0.213, indicating that the equity of distribution of ART clinics was relatively balanced over the country. However, at the end of 2018, there were still 354.9 million people (25.4% of the population) living in 148 cities without access to any ART clinics, which has spurred more targeted policies and cost-effective measures to improve the accessibility and availability of ART services in such areas.
Background:
The association of abnormal blood pressure levels (including hypertension and prehypertension) with reduced fecundability among young childbearing-age couples is not yet elucidated completely.
Objective:
The purpose of this study was to investigate the association between abnormal preconception blood pressure level and time to pregnancy among couples who are attempting to conceive their first pregnancy.
Study design:
A total of 2,234,350 eligible couples (with no previous gravidity and whose female partners were 20-49 years old) participated in the National Free Preconception Check-up Projects from January 1, 2015, to December 31, 2016. Each couples' preconception blood pressure levels were measured, and time to pregnancy was recorded. Cox models for discrete survival time were used to estimate fecundability odds ratios and their corresponding 95% confidence intervals after adjustment for age, ethnicity, educational level, occupation, household registration, region, tobacco exposure, alcohol intake, body mass index, duration of marriage of the couples, and fasting plasma glucose levels of the female partner.
Results:
Compared with normotensive women, those women with hypertension (systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg) had a 21% lower pregnancy rate (fecundability odds ratio, 0.79; 95% confidence interval, 0.78-0.81). A similar finding was found among men (fecundability odds ratio, 0.89; 95% confidence interval, 0.88-0.90). Prehypertension (systolic blood pressure between 120 and 139 mm Hg, and/or a diastolic blood pressure between 80 and 89 mm Hg) in both male and female partners was associated slightly with reduced fecundability odds ratios. Compared with couples in which both partners were normotensive, the pregnancy rate was reduced by 27% (fecundability odds ratio, 0.73; 95% confidence interval, 0.69-0.77) among couples in which both partners had hypertension.
Conclusion:
Abnormal preconception blood pressure levels were associated with prolonged time to pregnancy among couples who were attempting to conceive their first pregnancy; the mechanism is worth further investigation.
Problem/condition:
Since the first U.S. infant conceived with assisted reproductive technology (ART) was born in 1981, both the use of ART and the number of fertility clinics providing ART services have increased steadily in the United States. ART includes fertility treatments in which eggs or embryos are handled in the laboratory (i.e., in vitro fertilization [IVF] and related procedures). Women who undergo ART procedures are more likely than women who conceive naturally to deliver multiple-birth infants. Multiple births pose substantial risks to both mothers and infants, including obstetric complications, preterm delivery, and low birthweight infants. This report provides state-specific information for the United States (including the District of Columbia and Puerto Rico) on ART procedures performed in 2014 and compares birth outcomes that occurred in 2014 (resulting from ART procedures performed in 2013 and 2014) with outcomes for all infants born in the United States in 2014.
Period covered:
2014.
Description of system:
In 1996, CDC began collecting data on ART procedures performed in fertility clinics in the United States as mandated by the Fertility Clinic Success Rate and Certification Act of 1992 (FCSRCA) (Public Law 102-493). Data are collected through the National ART Surveillance System (NASS), a web-based data collection system developed by CDC. This report includes data from 52 reporting areas (the 50 states, the District of Columbia, and Puerto Rico).
Results:
In 2014, a total of 169,568 ART procedures (range: 124 in Wyoming to 21,018 in California) with the intent to transfer at least one embryo were performed in 458 U.S. fertility clinics and reported to CDC. These procedures resulted in 56,028 live-birth deliveries (range: 52 in Wyoming to 7,230 in California) and 68,782 infants born (range: 64 in Wyoming to 8,793 in California). Nationally, the total number of ART procedures performed per million women of reproductive age (15-44 years), a proxy measure of the ART usage rate, was 2,647 (range: 364 in Puerto Rico to 6,726 in Massachusetts). ART use exceeded the national average in 13 reporting areas (Connecticut, Delaware, the District of Columbia, Hawaii, Illinois, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Virginia). Eight reporting areas (Connecticut, the District of Columbia, Hawaii, Illinois, Maryland, Massachusetts, New Jersey, and New York) had rates of ART use exceeding 1.5 times the national average. Nationally, among ART transfer procedures in patients using fresh embryos from their own eggs, the average number of embryos transferred increased with increasing age of the woman (1.7 among women aged <35 years, 1.9 among women aged 35-37 years, and 2.3 among women aged >37 years). Among women aged <35 years, who typically are considered to be good candidates for elective single embryo transfer (eSET) procedures, the national eSET rate was 28.5% (range: 4.3% in Puerto Rico to 67.9% in Delaware). In 2014, ART contributed to 1.6% of all infants born in the United States (range: 0.4% in Puerto Rico to 4.7% in Massachusetts) and 18.3% of all multiple-birth infants (range: 5.5% in Alaska and West Virginia to 37.3% in Hawaii), including 18.0% of all twin infants (range: 5.2% in some states to 36.2% in Hawaii) and 26.4% of all triplets and higher-order infants (range: 0% in some states to 65.2% in Hawaii). Percentages of live births that were multiple-birth deliveries were higher among infants conceived with ART (39.4%; range: 11.5% in Delaware to 55.6% in Puerto Rico) than among all infants born in the total birth population (3.5%; range: 2.2% in Puerto Rico to 4.4% in New Jersey). Approximately 38.0% of ART-conceived infants were twin infants, and 2.0% were triplets and higher-order infants. ART-conceived twins accounted for approximately 95.3% of all ART-conceived infants born in multiple deliveries. Nationally, infants conceived with ART contributed to 5.5% of all low birthweight (<2,500 g) infants (range: 1.2% in West Virginia to 14.2% in Massachusetts). Among ART-conceived infants, 27.8% were low birthweight (range: 10.6% in Delaware to 44.4% in Puerto Rico), compared with 8.0% among all infants (range: 5.9% in Alaska to 11.3% in Mississippi). ART-conceived infants contributed to 4.7% of all preterm (<37 weeks) infants (range: 1.2% in Puerto Rico to 13.4% in Massachusetts). Percentages of preterm births were higher among infants conceived with ART (33.2%; range: 18.9% in the District of Columbia to 45.9% in Puerto Rico) than among all infants born in the total birth population (11.3%; range: 8.5% in California to 16.0% in Mississippi). The percentage of ART-conceived infants who were low birthweight was 8.9% (range: 3.2% in some states to 16.1% in Vermont) among singletons and 55.2% (range: 38.5% in Delaware to 77.8% in Alaska) among twins; the corresponding percentages of low birthweight infants among all infants born were 6.3% for singletons (range: 4.6% in Alaska, North Dakota, and Oregon to 9.5% in Puerto Rico) and 55.2% for twins (range: 46.1% in Alaska to 65.6% in Mississippi). The percentage of ART-conceived infants who were preterm was 13.2% (range: 7.5% in Rhode Island to 23.4% in West Virginia) among singletons and 62.2% (range: 33.3% in some states to 81.4% in Mississippi) among twins; the corresponding percentages of preterm infants among all infants were 9.7% for singletons (range: 1.7% in the District of Columbia to 14.2% in Mississippi) and 56.6% for twins (range: 47.2% in Vermont to 66.9% in Wyoming).
Interpretation:
The percentage of infants conceived with ART varied considerably by reporting area. Multiple births from ART contributed to a substantial proportion of all twins, triplets, and higher-order infants born. Low birthweight and preterm infant birth rates were disproportionately higher among ART-conceived infants than among the overall birth population. Although women aged <35 years are typically considered good candidates for eSET, on average two embryos were transferred per ART procedure with women in this group. Compared with ART-conceived singletons, ART-conceived twins were approximately five times more likely to be born preterm and approximately six times more likely to be born with low birthweight. Singleton infants conceived with ART had higher percentages of preterm birth and low birthweight than all singleton infants born in the United States. ART use per population unit was geographically variable, with 13 reporting areas showing ART use higher than the national rate. Of the four states (Illinois, Massachusetts, New Jersey, and Rhode Island) with comprehensive statewide-mandated health insurance coverage for ART procedures (i.e., coverage for at least four cycles of IVF), three (Illinois, Massachusetts, and New Jersey) had rates of ART use exceeding 1.5 times the national rate. This type of mandated insurance has been associated with greater use of ART and likely accounts for some of the difference in per capita ART use observed among states.
Public health action:
Reducing the number of embryos transferred and increasing use of eSET when clinically appropriate could help reduce multiple births and related adverse health consequences. Because twins account for the majority of ART-conceived multiple births, improved provider practices and patient education and counseling on the maternal and infant health risks of having twins are needed. Although ART contributes to high percentages of multiple births, other factors not investigated in this report (e.g., delayed childbearing and use of non-ART fertility treatments) also contribute to multiple births and warrant further study.
Hepatic dysfunction can develop due to ROS and lipid peroxide and may lead to primary liver cancer. Hepatic dysfunction may also develop from tetracycline, an antibiotic with a broad-spectrum of bacteriostatic mechanisms, as it can induce hepatotoxicity and reprotoxicity. In addition, liver tumors secrete hormones that can result to testicular atrophy. Thus, there is a need to address liver and testicular damage. Preliminary phytochemical analysis indicated the presence of bioactive compounds with histoprotective potentials in Balakat tree (Ziziphus talanai), which is used in Antique against urinary tract infection. Twelve male mice were divided into four groups of three mice each. Treatments were administered via intragastric gavage technique for 30 days. T0 is the negative control group treated only with water at a dose level of 0.5 ml/20 g body weight (bw). T+ is the positive control group treated only with tetracycline at a dosage level of 0.5ml/20 g bw. T1 and T2 received 0.3 ml/20 g bw and 0.5 ml/20 g bw Z. talanai ethanol leaf extract, respectively.Histopathological evaluation revealed that T+ mice showed hepatotoxicity based on central vein rupture, fibrosis, vacuolations, cytoplasmic degeneration, lymphocyte infiltration, small amount of glycogen deposits and fibrous septa. Reprotoxicity was also observed as indicated by formation of irregularly shaped tubules, narrowing of tubule diameter, widening of the lumen, germinal epithelium exfoliation, reduction in tubules’ cross-sectional areas, absence of germ cell bundles and blood-testis barrier destruction. T1 and T2 mice showed normal liver and seminiferous tubule architectural design as compared to those of T+ mice. Thus, the Z. talanai leaf extract mitigated the hepatotoxicity and reprotoxicity effects of tetracycline causing an improvement in the hepatological and testicular parameters. The ethanolic leaf extract of Z. talanai (Blanco) Merr. Contains bioactive compounds with histoprotective potentials.
PurposeOur goal was to determine if there are differences by place of residence in visiting a doctor for help getting pregnant in a population-based study. Methods
Using data from the Furthering Understanding of Cancer, Health, and Survivorship in Adult (FUCHSIA) Women's Study, a cohort study of fertility outcomes in reproductive-aged women in Georgia, we fit models to estimate the association between geographic type of residence and seeking help for becoming pregnant. FindingsThe prevalence of visiting a doctor for help getting pregnant ranged from 13% to 17% across geographic groups. Women living in suburban counties were most likely to seek medical care for help getting pregnant compared with women living in urbanized counties (adjusted prevalence ratio (aPR) = 1.14, 95% CI: 0.74-1.75); among women who reported infertility this difference was more pronounced (aPR = 1.59, 95% CI: 1.00-2.53). Women living in rural counties were equally likely to seek fertility care compared with women in urbanized counties in the full sample and among women who experienced infertility. Conclusions
Women living in urban and rural counties were least likely to seek infertility care, suggesting that factors including but not limited to physical proximity to providers are influencing utilization of this type of care. Increased communication about reproductive goals and infertility care available to meet these goals by providers who women see for regular care may help address these barriers.
Despite its great potential, high-throughput functional genomic data are rarely integrated and applied to characterizing the genomic basis of fertility. We obtained and reprocessed over 30 functional genomics datasets from human and mouse germ cells to perform genome-wide prediction of genes underlying various reproductive phenotypes in both species. Genes involved in male fertility are easier to predict than their female analogs. Of the multiple genomic data types examined, protein-protein interactions are by far the most informative for gene prediction, followed by gene expression, and then epigenetic marks. As an application of our predictions, we show that copy number variants (CNVs) disrupting predicted fertility genes are more strongly associated with gonadal dysfunction in male and female case-control cohorts when compared to all gene-disrupting CNVs (OR = 1.64, p < 1.64 × 10(-8) vs. OR = 1.25, p < 4 × 10(-6) ). Using gender-specific fertility gene annotations further increased the observed associations (OR = 2.31, p < 2.2 × 10(-16) ). We provide our gene predictions as a resource with this article.
Fertility counselling and treatment can help women achieve their desired family size; however, disparities exist in the utilisation of this care.
This study examines the persistence of a racial disparity in visiting a doctor for help getting pregnant by estimating the direct effect of this association using data from the Furthering Understanding of Cancer Health and Survivorship in Adult Women's Study, a population-based cohort study. This cohort included 1073 reproductive age women (22-45 years) with 28% reporting infertility. We fit log binomial models to quantify the magnitude of the racial difference in reported care seeking after adjustment for hypothesised mediators using inverse probability weighting.
Compared with white women, black women were less likely to visit a doctor in the total population [adjusted risk ratio (RR) 0.57, 95% confidence interval (CI) 0.41, 0.80] and in the subgroup of women with infertility [RR 0.75, 95% CI 0.56, 0.99]. In addition, black women waited twice as long, on average, before seeking help compared with white women.
There were notable racial differences in visiting a doctor for help getting pregnant in this study although reports of infertility were similar by race. These differences may be mitigated through improved communication about the range of counselling and treatment options available.
© 2015 John Wiley & Sons Ltd.
Background: Available evidence suggests that 50% of couples with infertility are male related. Over 40% of these males consume alcohol which has been reported to be a reproductive toxicant causing depletions in the epithelium of seminiferous tubules hence reducing sperm counts and sperm morphology.
Objective: To determine the effects of aqueous leaf extract of Telfairia occidentalis on alcohol-induced cyto-architectural changes in the testis.
Methods: Aqueous leaf extract of Telfairia occidentalis (T. occidentalis) was administered by gastric gavage at a dose of 250 mg/kg and 500 mg/kg body weight daily, while 2 g/kg body weight of ethanol at 30% v/v was administered daily to mature male Sprague–Dawley rats. The experiment was in 2 phases. Phase 1 had groups A1–F1 and lasted for 4 weeks while phase 2 had groups A2–F2 and lasted 8 weeks. Parameters tested include: testicular histology, relative volume density, sperm parameters, malondialdehyde (MDA), superoxide dismutase (SOD) and reduced glutathione.
Results: In both phases, there were depletions in the seminiferous epithelium, decreased sperm quality and increased MDA and SOD in animals that received alcohol only compared to control. Likewise, a significant increase of seminiferous epithelium of animals that received respective doses of 250 mg/kg and 500 mg/kg of T. occidentalis only compared to control. Animals that received T. occidentalis and alcohol simultaneously had a significant increase in seminiferous epithelium and sperm quality with decreased MDA level.
Conclusion: T. occidentalis attenuated the deleterious effects of alcohol to the cyto-architecture of the testis, protected the seminiferous epithelium, reduced oxidative stress and promoted spermatogenesis.
Patients undergoing IVF may receive either acupuncture or whole-systems traditional Chinese medicine (WS-TCM) as an adjuvant IVF treatment. WS-TCM is a complex intervention that can include acupuncture, Chinese herbal medicine, dietary, lifestyle recommendations. In this retrospective cohort study, 1231 IVF patient records were reviewed to assess the effect of adjuvant WS-TCM on IVF outcomes compared among three groups: IVF with no additional treatment; IVF and elective acupuncture on day of embryo transfer; or IVF and elective WS-TCM. The primary outcome was live birth. Of 1069 non-donor cycles, WS-TCM was associated with greater odds of live birth compared with IVF alone (adjusted odds ratio [AOR] 2.09; 95% confidence interval [CI] 1.36 to 3.21), or embryo transfer with acupuncture only (AOR 1.62; 95% CI 1.04 to 2.52). Of 162 donor cycles, WS-TCM was associated with increased live births compared with all groups (odds Ratio [OR] 3.72; 95% CI 1.05 to 13.24, unadjusted) or embryo transfer with acupuncture only (OR 4.09; 95% CI: 1.02 to 16.38, unadjusted). Overall, IVF with adjuvant WS-TCM was associated with greater odds of live birth in donor and non-donor cycles. These results should be taken cautiously as more rigorous research is needed.
Copyright © 2015 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.
To evaluate assisted reproductive technology (ART) ET practices in the United States and assess the impact of these practices on multiple births, which pose health risks for both mothers and infants.
Retrospective cohort analysis using the National ART Surveillance System data.
US fertility centers reporting to the National ART Surveillance System.
Noncanceled ART cycles conducted in the United States in 2012.
None.
Multiple birth (birth of two or more infants, at least one of whom was live-born).
Of 134,381 ART transfer cycles performed in 2012, 51,262 resulted in live births, of which 13,563 (26.5%) were multiple births: 13,123 twin and 440 triplet and higher order births. Almost half (46.1%) of these multiple births resulted from the following four cycle types: two fresh blastocyst transfers among favorable or average prognosis patients less than 35 years (1,931 and 1,341 multiple births, respectively), two fresh blastocyst transfers among donor-oocyte recipients (1,532 multiple births), and two frozen/thawed ETs among patients less than 35 years (1,452 multiple births). More than half of triplet or higher order births resulted from the transfer of two embryos (52.5% of births among fresh autologous transfers, 67.2% of births among donor-oocyte recipient transfers, and 42.9% among frozen/thawed autologous transfers).
A substantial reduction of ART-related multiple (both twin and triplet or higher order) births in the United States could be achieved by single blastocyst transfers among favorable and average prognosis patients less than 35 years of age and donor-oocyte recipients.
Copyright © 2015 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.
Objectives-This report compares data on births resulting from assisted reproductive technology (ART) procedures from 2011 birth certificates with data from the 2011 National ART Surveillance System (NASS) among the subset of jurisdictions that adopted the 2003 revised birth certificate as of January 1, 2011, with information on ART. Methods-Birth certificate data are based on 100% of births registered in 27 states and the District of Columbia. NASS data included all ART cycles initiated in 2010 or 2011 for which a live birth in 2011 was reported. The same reporting area was used for both data sources and represents 67% of all births in the United States in 2011. A ratio was computed by dividing the percentage of births resulting from ART procedures for NASS data by the percentage for birth certificate data. A ratio of 1.0 represents equivalent levels of reporting. Because this reporting area is not a random sample of births, the results are not generalizable to the United States as a whole. Results-Overall, the percentage of births resulting from ART procedures was 2.06 times higher for NASS data (1.44%) compared with birth certificate data (0.70%). The ratio for each jurisdiction varied from 1.04 for Utah and Wisconsin to 7.50 for Florida. Higher-risk groups had more consistent reporting between data sources [e.g., triplet or higher-order multiples (1.36) compared with singletons (2.11)]. Conclusions-Births resulting from ART procedures appear to be underreported on the birth certificate; however, the magnitude of underreporting varied by jurisdiction and maternal-infant health characteristics.
All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.
The advent of fertility treatments has led to an increase in the rate of multiple births in the United States. However, the trends in and magnitude of the contribution of fertility treatments to the increase are uncertain.
We derived the rates of multiple births after natural conception from data on distributions of all births from 1962 through 1966 (before fertility treatments were available). Publicly available data on births from 1971 through 2011 were used to determine national multiple birth rates, and data on in vitro fertilization (IVF) from 1997 through 2011 were used to estimate the annual proportion of multiple births that were attributable to IVF and to non-IVF fertility treatments, after adjustment for maternal age. Trends in multiple births were examined starting from 1998, the year when clinical practice guidelines for IVF were developed with an aim toward reducing the incidence of multiple births.
We estimated that by 2011, a total of 36% of twin births and 77% of triplet and higher-order births resulted from conception assisted by fertility treatments. The observed incidence of twin births increased by a factor of 1.9 from 1971 to 2009. The incidence of triplet and higher-order births increased by a factor of 6.7 from 1971 to 1998 and decreased by 29% from 1998 to 2011. This decrease coincided with a 70% reduction in the transfer of three or more embryos during IVF (P<0.001) and a 33% decrease in the proportion of triplet and higher-order births attributable to IVF (P<0.001).
Over the past four decades, the increased use of fertility treatments in the United States has been associated with a substantial rise in the rate of multiple births. The rate of triplet and higher-order births has declined over the past decade in the context of a reduction in the transfer of three or more embryos during IVF. (Funded by the Centers for Disease Control and Prevention.).
To examine sociodemographic differences based on patient race/ethnicity among infertility patients seeking care in a state with mandated coverage of infertility treatment.
Cross-sectional survey.
University-hospital-based fertility center.
A total of 1,500 consecutive women who presented for infertility care.
None.
Self-report questionnaire assessing patient race/ethnicity, diagnosis, income, education level, and duration of infertility before seeking care.
African American women experienced a significantly longer duration of infertility before seeking care compared with Caucasian women (4.3 vs. 3.3 years, respectively; P=.03). With regard to infertility diagnosis, a significantly greater proportion of African American and Hispanic women had tubal factor infertility compared with Caucasian women (24.0% and 27.3% vs. 5.3%, respectively; P=.001). Looking at the highest level of education attained by patients, a significantly greater proportion of African American and Hispanic women had less than a 4-year college degree compared with Caucasian women (48% and 40.9% vs. 13.2%, respectively; P<.001). Examining the gross annual household income of patients, a significantly greater proportion of African American and Hispanic women had household incomes below $100,000 compared with Caucasian women (72% and 68.2% vs. 37.3%, respectively; P<.01).
African American women are more likely to seek infertility treatment after a longer duration of failed conception compared with Caucasian women. Furthermore, African American, and Hispanic women are more likely to have tubal factor infertility, a lower education level, and a lower household income compared with Caucasian women.
This evidence-based review focuses on the impact of potentially modifiable, non-communicable lifestyle factors on reproductive performance in the general population and the infertile population undergoing assisted reproductive technology (ART) treatment. The impact of several lifestyle factors including; age, weight, smoking, diet, exercise, psychological stress, caffeine consumption, alcohol consumption and exposure to environmental pollutants are included in the review. The databases of Medline, PubMed and Cinahl were searched to identify relevant publications. There is strong evidence that age, weight and smoking impact on general health and adversely on reproductive performance. However there is a need for further research focusing specifically on the relationship between diet and various levels of exercise on reproductive performance. There are several other factors such as psychological stress, caffeine consumption, alcohol consumption and exposure to environmental pollutants that have been implicated but the evidence is equivocal. It is concluded that lifestyle modification can assist couples to conceive spontaneously or optimize their chances of conception with ART treatment.
Objectives:
This report presents nationally representative estimates and trends for infertility and impaired fecundity-two measures of fertility problems-among women aged 15-44 in the United States. Data are also presented on a measure of infertility among men aged 15-44.
Methods:
Data for this report come primarily from the 2006-2010 National Survey of Family Growth (NSFG), which consisted of 22,682 interviews with men and women aged 15-44, conducted from June 2006 through June 2010. The response rate for women in the 2006-2010 NSFG was 78%, and for men was 75%. Selected trends are shown based on prior NSFG years.
Results:
The percentage of married women aged 15-44 who were infertile fell from 8.5% in 1982 (2.4 million women) to 6.0% (1.5 million) in 2006-2010. Impaired fecundity among married women aged 15-44 increased from 11% in 1982 to 15% in 2002, but decreased to 12% in 2006-2010. Among all women, 11% had impaired fecundity in 2006-2010. Both infertility and impaired fecundity remain closely associated with age for nulliparous women. Among married, nulliparous women aged 35-44, the percentage infertile declined from 44% in 1982 to 27% in 2006-2010, reflecting greater delays in childbearing over this period. Among married women in 2006-2010, non-Hispanic black women were more likely to be infertile than non-Hispanic white women. Some form of infertility (either subfertility or nonsurgical sterility) was reported by 9.4% of men aged 15-44 and 12% of men aged 25-44 in 2006-2010, similar to levels seen in 2002.
Objectives:
This report presents nationally representative estimates and trends for infertility service use among women aged 15-44 and 25-44 in the United States in 1982-2010. While greater detail on types of infertility service is shown for women, basic data on types of infertility service use, as reported by men aged 25-44, are also presented.
Methods:
Data for this report come primarily from the 2006-2010 National Survey of Family Growth (NSFG), consisting of 22,682 interviews with men and women aged 15-44, conducted from June 2006 through June 2010. The response rate for females in the 2006-2010 NSFG was 78%, and for males was 75%. Selected trends are shown based on prior NSFG cycles.
Results:
Twelve percent of women aged 15-44 in 2006-2010 (7.3 million women), or their husbands or partners, had ever used infertility services. Among women aged 25-44, 17% (6.9 million) had ever used any infertility service, a significant decrease from 20% in 1995. Thirty-eight percent of nulliparous women with current fertility problems in 2006-2010 had ever used infertility services, significantly less than 56% of such women in 1982. In all survey years, ever-use of medical help to get pregnant was highest among older and nulliparous women, non-Hispanic white women, women with current fertility problems, and women with higher levels of education and household income. The most commonly used infertility services among women aged 25-44 in 2006-2010 were advice, testing, medical help to prevent miscarriage, and ovulation drugs. Ever-use of infertility services was reported by 9.4% of men aged 25-44 in 2006-2010, similar to levels seen in 2002.
Infertility treatments that include ovulation stimulation, both assisted reproductive technologies (ARTs) and non-ART ovulation stimulation, are associated with increased risks of multiple birth and concomitant sequelae and adverse outcomes, even among singletons. While a US surveillance system for ART-induced births is ongoing, no population-based tracking system exists for births resulting from non-ART treatments. The authors developed a multistage model to estimate the uncertain proportion of US infants born in 2005 who were conceived by using non-ART ovulation treatments. Using published surveillance data, they estimated proportions of US multiple births conceived naturally and by ART and assumed that the remainder were conceived with non-ART treatments. They used Bayesian meta-analyses to summarize published clinical studies on the multiple-gestation risk associated with non-ART ovulation treatments, applied a fetal survival factor, and used this multiple-birth risk estimate and their own estimate of the proportion of US multiple births attributable to non-ART ovulation stimulation to estimate the total (and, through subtraction, singleton) proportion of infants conceived with such treatments. On the basis of the model, the authors estimate that 4.6% of US infants born in 2005 (95% uncertainty range: 2.8%-7.1%) resulted from non-ART ovulation treatments. Notably, this figure is 4 times greater than the ART contribution.
Many definitions used in medically assisted reproduction (MAR) vary in different settings, making it difficult to standardize and compare procedures in different countries and regions. With the expansion of infertility interventions worldwide, including lower resource settings, the importance and value of a common nomenclature is critical. The objective is to develop an internationally accepted and continually updated set of definitions, which would be utilized to standardize and harmonize international data collection, and to assist in monitoring the availability, efficacy, and safety of assisted reproductive technology (ART) being practiced worldwide.
Seventy-two clinicians, basic scientists, epidemiologists and social scientists gathered together at the World Health Organization headquarters in Geneva, Switzerland, in December 2008. Several months before, three working groups were established as responsible for terminology in three specific areas: clinical conditions and procedures, laboratory procedures, and outcome measures. Each group reviewed the existing International Committee for Monitoring Assisted Reproductive Technology glossary, made recommendations for revisions and introduced new terms to be considered for glossary expansion.
A consensus was reached on 87 terms, expanding the original glossary by 34 terms, which included definitions for numerous clinical and laboratory procedures. Special emphasis was placed in describing outcome measures, such as cumulative delivery rates and other markers of safety and efficacy in ART.
Standardized terminology should assist in analysis of worldwide trends in MAR interventions and in the comparison of ART outcomes across countries and regions. This glossary will contribute to a more standardized communication among professionals responsible for ART practice, as well as those responsible for national, regional, and international registries.
In 2002, 2 million American women of reproductive age were infertile. Infertility is also common among men. The Centers for Disease Control and Prevention (CDC) conducts surveillance and research on the causes of infertility, monitors the safety and efficacy of infertility treatment, and sponsors national prevention programs. A CDC-wide working group found that, despite this effort, considerable gaps and opportunities exist in surveillance, research, communication, and program and policy development. We intend to consult with other federal agencies, professional and consumer organizations, the scientific community, the health care community, industry, and other stakeholders, and participate in the development of a national public health plan for the prevention, detection, and management of infertility.
The risk of birth defects in infants born following assisted reproductive technology (ART) treatment is a controversial question. Most publications examining the prevalence of birth defects in ICSI and IVF infants compared to spontaneously conceived infants have serious methodological limitations; despite this, most researchers have concluded that there is no increased risk.
We carried out a systematic review to identify all papers published by March 2003 with data relating to the prevalence of birth defects in infants conceived following IVF and/or ICSI compared with spontaneously conceived infants. Independent expert reviewers used criteria defined a priori to determine whether studies were suitable for inclusion in a meta-analysis. Fixed effects meta-analysis was performed for all studies and reviewer-selected studies.
Twenty-five studies were identified for review. Two-thirds of these showed a 25% or greater increased risk of birth defects in ART infants. The results of meta-analyses of the seven reviewer-selected studies and of all 25 studies suggest a statistically significant 30-40% increased risk of birth defects associated with ART.
Pooled results from all suitable published studies suggest that children born following ART are at increased risk of birth defects compared with spontaneous conceptions. This information should be made available to couples seeking ART treatment.