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"Infertility - epidemiology"
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Fertility and pregnancy : an epidemiologic perspective
\"Fertility and Pregnancy: An Epidemiologic Perspective offers an overview of human reproduction - how it works, and what causes it to go wrong. Weaving together history, biology, obstetrics, pediatrics, demography, infectious diseases, molecular genetics, and evolutionary biology, Allen Wilcox brings a fresh coherence to the epidemiologic study of reproduction and pregnancy. Along the way, he provides entertaining anecdotes, superb graphs, odd tidbits, and occasional humor that bring the topic to life.\"--BOOK JACKET.
Book
Long term exposure to road traffic noise and air pollution and risk of infertility in men and women: nationwide Danish cohort study
AbstractObjectiveTo investigate associations between long term residential exposure to road traffic noise and particulate matter with a diameter <2.5 µm (PM2.5) and infertility in men and women.DesignNationwide prospective cohort study.SettingDenmark.Participants526 056 men and 377 850 women aged 30-45 years, with fewer than two children, cohabiting or married, and residing in Denmark between 2000 and 2017.Main outcome measureIncident infertility in men and women during follow-up in the Danish National Patient Register.ResultsInfertility was diagnosed in 16 172 men and 22 672 women during a mean follow-up of 4.3 years and 4.2 years, respectively. Mean exposure to PM2.5 over five years was strongly associated with risk of infertility in men, with hazard ratios of 1.24 (95% confidence interval 1.18 to 1.30) among men aged 30-36.9 years and 1.24 (1.15 to 1.33) among men aged 37-45 years for each interquartile (2.9 µg/m3) higher PM2.5 after adjustment for sociodemographic variables and road traffic noise. PM2.5 was not associated with infertility in women. Road traffic noise (Lden, most exposed facade of residence) was associated with a higher risk of infertility among women aged 35-45 years, with a hazard ratio of 1.14 (1.10 to 1.18) for each interquartile (10.2 dB) higher five year mean exposure. Noise was not associated with infertility among younger women (30-34.9 years). In men, road traffic noise was associated with higher risk of infertility in the 37-45 age group (1.06, 1.02 to 1.11), but not among those aged 30-36.9 years (0.93, 0.91 to 0.96).ConclusionsPM2.5 was associated with a higher risk of an infertility diagnosis in men, whereas road traffic noise was associated with a higher risk of an infertility diagnosis in women older than 35 years, and potentially in men older than 37 years. If these results are confirmed in future studies, higher fertility could be added to the list of health benefits from regulating noise and air pollution.
Journal Article
Epidemiology of varicocele
Varicocele is a common problem in reproductive medicine practice. A varicocele is identified in 15% of healthy men and up to 35% of men with primary infertility. The exact pathophysiology of varicoceles is not very well understood, especially regarding its effect on male infertility. We have conducted a systematic review of studies evaluating the epidemiology of varicocele in the general population and in men presenting with infertility. In this article, we have identified some of the factors that can influence the epidemiological aspects of varicoceles. We also recognize that varicocele epidemiology remains incompletely understood, and there is a need for well-designed, large-scale studies to fully define the epidemiological aspects of this condition.
Journal Article
Global, regional, and national prevalence and years lived with disability due to infertility, 1990–2021: Results from the Global Burden of Disease Study 2021
Abstract
Background:
Infertility is a burdensome, often overlooked condition. This study aimed to investigate the global distribution and trends in the burden of infertility from 1990 to 2021.
Methods:
We obtained data on the prevalence and years lived with disability (YLDs) related to infertility from the Global Burden of Disease 2021 study and evaluated them by calculating the estimated annual percentage change in age-standardized rates. We investigated the relationship between sociodemographic index (SDI) and the burden of infertility on the global, regional, and national levels.
Results:
In 2021, there were 143,261,562 female and 55,481,380 male infertility cases worldwide, respectively. In China, female and male infertility cases accounted for 23.59% and 21.47% of the global totals, reaching 33,795,944 and 11,909,889, respectively. Compared with 2019, the global number of female and male infertility cases increased by 5,286,227 in females and 2,017,271 in males. In contrast, China saw a decline in both female and male infertility cases, with reductions of 698,735 and 154,591, respectively. From 1990 to 2021, the age-standardized prevalence rate (ASPR) and age-standardized YLDs rate (ASYR) for female infertility both increased by 0.59% annually, whereas these two corresponding indicators for male infertility increased by 0.50% annually worldwide. The burden of female infertility was consistently higher than that of male infertility and demonstrated a faster rate of increase. East Asia had the highest ASPR and ASYR for female infertility, whereas Eastern Europe had the highest metrics for male infertility. A horizontal S-shaped association was observed between the SDI and ASPR and ASYR of infertility, with a rapid decline in the infertility burden when the SDI exceeded 0.7.
Conclusions:
The global burden of infertility has increased over the years, with a higher burden on women and underdeveloped regions. These findings emphasize the need to prioritize healthcare for patients with infertility to address the rising burden.
Journal Article
Fertility after uterine artery embolization for symptomatic multiple fibroids with no other infertility factors
Objectives
To evaluate the fertility of women eligible for surgical multiple myomectomy, but who carefully elected a fertility-sparing uterine artery embolization (UAE).
Methods
Non-comparative open-label trial, on women ≤40 years, presenting with multiple symptomatic fibroids (at least 3, ≥3 cm), immediate pregnancy wish, and no associated infertility factor.
Women had a bilateral limited UAE using tris-acryl gelatin microspheres ≥500 μm.
Fertility, ovarian reserve, uterus and fibroid sizes, and quality of life questionnaires (UFS-QoL) were prospectively followed.
Results
Fifteen patients, aged 34.8 years (95%CI 32.2–37.5, median 36.0, q1–q3 29.4–39.5) were included from November 2008 to May 2012.
During the year following UAE, 9 women actively attempting to conceive experienced 5 live-births (intention-to-treat fertility rate 33.3%, 95%CI 11.8%–61.6%). Markers of ovarian reserve remained stable. The symptoms score was reduced by 66% (95%CI 48%–85%) and the quality of life score was improved by 112% (95%CI 21%–204%). Uterine volume was reduced by 38% (95%CI 24%–52%).
Women were followed for 43.1 months (95%CI 32.4–53.9), 10 live-births occurred in 8 patients, and 5 patients required secondary surgeries for fibroids.
Conclusion
Women without associated infertility factors demonstrated an encouraging capacity to deliver after UAE. Further randomized controlled trials comparing UAE and myomectomy are warranted.
Key points
•
Women without infertility factors showed an encouraging delivery rate after UAE.
•
For women choosing UAE over abdominal myomectomy, childbearing may not be impaired
.
•
Data are insufficient to definitively recommend UAE as comparable to myomectomy.
•
Further randomized trials comparing fertility after UAE or myomectomy are warranted.
Journal Article
The effect of oral melatonin supplementation on MT-ATP6 gene expression and IVF outcomes in Iranian infertile couples: a nonrandomized controlled trial
This study aims to evaluate the effect of melatonin supplementation on the outcomes of in vitro fertilization (IVF) and mitochondrial adenosine triphosphate production (MT-ATP6) gene expression in Iranian infertile couples. A single-blind nonrandomized controlled trial was conducted, recruiting 90 infertile couples who underwent IVF at an infertility center in Tehran, Iran. Patients who were assigned to the intervention group received melatonin as a supplementation to the standard controlled ovarian stimulation (COS). The control group received a COS protocol only. Primary outcome was the mRNA level of the MT-ATP6 gene in cumulus cells of ovarian follicles. Secondary outcomes were the mean number of mature oocytes retrieved, the embryo quality, and biochemical and clinical pregnancy rates. The mRNA level of the MT-ATP6 gene in cumulus cells between intervention and control groups was not statistically different (0.931 vs.1;
P
˃ 0.05). The mean number of poor-quality embryos was significantly lower in the intervention group than that in the control group (0.27 vs. 0.80;
P
= 0.028). The biochemical and clinical pregnancy rates were higher in the intervention group (24% vs. 14%,
P
= 0.089, and 14% vs. 7%,
P
= 0.302, respectively); however, the difference was not significant. Melatonin supplementation did not increase the odds of clinical pregnancy and the number of mature oocytes retrieved, but significantly reduced the number of low-quality embryos. More extensive studies focusing on the level of MT-ATP6 gene expression in the oocyte or blastomere cells may further elucidate the effect of supplementation with melatonin in infertile couples who have poor clinical outcomes. Trial registration: Current Controlled Trials: IRCT2015042912307N4.
Journal Article
Association between depression and infertility based on the PHQ-9 score: Analyses of NHANES 2013–2018
Over the past decade, nationally representative research elucidating the association between depression and infertility has been notably lacking. Our study aimed to investigate the association between depression and infertility among women of childbearing age.
Our study encompassed 3,654 women aged 18 to 45 years from the National Health and Nutrition Examination Survey (NHANES) 2013-2018. Infertility was defined as a positive response to the query: \"Have you attempted to conceive for a minimum of one year without achieving pregnancy?\" Depression was evaluated by the Patient Health Questionnaire (PHQ-9) score (range, 0-27). Multiple logistic regression analyses and subgroup analyses stratified by age and race/ethnicity were conducted to investigate the association between depression and infertility. Furthermore, fitted smoothing curves and threshold effect analysis were utilized to depict the nonlinear relationship.
Total PHQ-9 score was associated with infertility in the fully adjusted model (OR 1.04, 95% CI 1.01-1.07, P = 0.010), and this relationship exhibited a non-linear pattern, reaching a saturation point at 13, as substantiated by the fitting of smoothed curves. Additionally, the association remained robust when stratified by age but not by race/ethnicity.
Cross-sectional design and recall biases.
In this cross-sectional study, depression was associated with infertility among women of childbearing age in the fully adjusted models. This observed association holds potential relevance for clinicians tasked with enhancing psychological well-being during infertility management strategies.
Journal Article
Time-lapse technology improves total cumulative live birth rate and shortens time to live birth as compared to conventional incubation system in couples undergoing ICSI
PurposeThe improvement of clinical outcome provided by time-lapse technology (TLT) in IVF over conventional incubation (CI) still remains controversial. This study aimed at evaluating whether the exclusive use of time-lapse technology (TLT) during whole IVF care improves total cumulative live birth rate (TCLBR) and shortens time to live birth (TTLB) as compared to the use of CI in couples undergoing ICSI.MethodsThis retrospective cohort study was conducted in couples with male infertility undergoing their first ICSI cycle in 2014–2015 and for whom embryo culture system remained the same during their whole IVF care, i.e., TLT or CI. Couples were followed up up to 2020, including all following frozen-embryo transfers and ICSI cycles (if any). Survival analysis was used to compare clinical outcome and time-related endpoints between both groups.ResultsA total of 151 and 250 couples underwent their whole IVF care with the exclusive use of TLT and CI, respectively. Survival analysis showed that TCLBR after whole IVF care was significantly higher in TLT than in CI group (66.9 vs 56.4%, p=0.02, log-rank test). Median live birth time was significantly shorter in TLT than CI group (464 vs 596 days, p=0.01).ConclusionsWe found that TCLBR and TTLB were significantly improved with TLT over CI in couples undergoing ICSI for male factor. This study fuels the debate on the clinical benefit of using TLT. The use of time-related endpoints adds important information for both patients and practitioners.
Journal Article
Condition, disease, disability: how the label used to describe infertility may affect public support for fertility treatment coverage
PurposeTo assess public attitudes towards fertility treatment coverage and whether attitudes are influenced by infertility labels.MethodsCross-sectional, web survey-based experiment using a national sample of 1226 United States adults. Participants read identical descriptions about infertility, with the exception of random assignment to infertility being labeled as a “condition,” “disease,” or “disability.” Participants then responded to questions measuring their beliefs and attitudes towards policies related to the diagnosis and treatment of infertility. We measured public support for infertility policies, public preference for infertility labels, and whether support differed by the randomly assigned label used. We also queried associations between demographic data and support for infertility policies.ResultsSupport was higher for insurance coverage of infertility treatments (p=.014) and fertility preservation (p=.017), and infertility public assistance programs (p=.036) when infertility was described as a “disease” or “disability” compared to “condition.” Participants who were younger, were planning or trying to conceive, had a family member or friend with infertility, and/or had a more liberal political outlook were more likely to support infertility policies. A majority of participants (78%) felt the term “condition” was the best label to describe infertility, followed by “disability” (12%). The least popular label was “disease” (10%). Those preferring “condition” were older (p<.001), more likely to be non-Hispanic White (p=.046), and less likely to have an infertility diagnosis (p<.001).ConclusionWhile less commonly identified as the best descriptors of infertility, labeling infertility as a “disease” or “disability” may increase support for policies that improve access to infertility care
Journal Article
Infertility and risk of postmenopausal breast cancer in the women’s health initiative
Purpose
Although infertility (i.e., failure to conceive after ≥ 12 months of trying) is strongly correlated with established breast cancer risk factors (e.g., nulliparity, number of pregnancies, and age at first pregnancy), its association with breast cancer incidence is not fully understood. Previous studies were primarily small clinic-based or registry studies with short follow-up and predominantly focused on premenopausal breast cancer. The objective of this study was to assess the relationship between infertility and postmenopausal breast cancer risk among participants in the Women’s Health Initiative (analytic sample = 131,784; > 25 years of follow-up).
Methods
At study entry, participants were asked about their pregnancy history, infertility history, and diagnosed reasons for infertility. Incident breast cancers were self-reported with adjudication by trained physicians reviewing medical records. Cox proportional hazards models were used to estimate risk of incident postmenopausal breast cancer for women with infertility (overall and specific infertility diagnoses) compared to parous women with no history of infertility. We examined mediation of these associations by parity, age at first term pregnancy, postmenopausal hormone therapy use at baseline, age at menopause, breastfeeding, and oophorectomy.
Results
We observed a modest association between infertility (
n
= 23,406) and risk of postmenopausal breast cancer (HR = 1.07; 95% CI 1.02–1.13). The association was largely mediated by age at first term pregnancy (natural indirect effect: 46.4% mediated, CI 12.2–84.3%).
Conclusion
These findings suggest that infertility may be modestly associated with future risk of postmenopausal breast cancer due to age at first pregnancy and highlight the importance of incorporating reproductive history across the life course into breast cancer analyses.
Journal Article