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1.
BMC Psychol ; 10(1): 91, 2022 Apr 07.
Artigo em Inglês | MEDLINE | ID: mdl-35392978

RESUMO

BACKGROUND: Psychological stress is commonly found among infertile women. Untreated stress can affect negatively the success of infertility treatment. Most of the available knowledge is generated from developed countries and is largely based on women undergoing In vitro fertilization (IVF) treatment. However, very little is known on infertile women from Ethiopia including other countries in East Africa. The aim of this study was to determine the prevalence of psychological stress and possible demographic-clinical correlates in Ethiopian women suffering from infertility. METHOD: This cross sectional descriptive correlation study was conducted from May to August, 2021 involving 96 women undergoing a non-IVF treatment for infertility at Gandhi Memorial and Tikur Anbessa hospitals. The sampling was continuous and based on inclusion criteria that include infertility duration of a minimum one year, female sex and Ethiopian nationality. Data on Infertility related stress was collected using the Copenhagen Multi-Centre Psychosocial Infertility-Fertility Problem Stress questionner administered by an interviewer. The socio demographic and clinical factors were collected using Amharic version of structured interviewer administered questionnaire and chart review. The analysis of relationship between infertility related stress and background variables was done with an independent sample t-test or one-way ANOVA statistics supplemented with effect size assessment. RESULTS: The prevalence of infertility related stress was overall 92.71% (95% CI, 87-98%). The personal, marital, and social subdomain mean scores (SD) were 2.74 (.80), 1.54 (.81) and 1.90 (.80), respectively. Infertility related stress was higher for those women who were: aged above 35, living in a cohabitation marital type, has no living children, and with 4-6 years duration of infertility (all P < 0.05). Whereas, there was insufficient evidence to suggest that infertility related stress varies by education, income, knowledge of cause of infertility or history of past treatment (all P > 0.05). CONCLUSIONS: The prevalence of psychological stress among Ethiopia women having infertility was very high. The results provide preliminary evidence that infertility related stress is associated with age, marital status, motherhood status and duration of infertility. Responsible bodies need to avail psychological screening and services prioritizing women at higher risk of developing stress.


Assuntos
Infertilidade Feminina , Idoso , Criança , Estudos Transversais , Feminino , Hospitais , Humanos , Infertilidade Feminina/epidemiologia , Infertilidade Feminina/psicologia , Infertilidade Feminina/terapia , Prevalência , Estresse Psicológico/epidemiologia , Estresse Psicológico/etiologia
2.
Arch Immunol Ther Exp (Warsz) ; 70(1): 13, 2022 Mar 24.
Artigo em Inglês | MEDLINE | ID: mdl-35325391

RESUMO

Increased androgen level, hyperinsulinemia, diabetes, impaired fibrinolysis, obesity, hypertension, chronic inflammation, abnormal immune response to infections and hyperhomocysteinemia are the most common abnormalities related to polycystic ovary syndrome (PCOS) women and are the factors predisposing to the severe course of COVID-19. The SARS-Cov-2 infection during pregnancy is associated with an increased risk of complications (spontaneous abortion), similar to those in PCOS. The treatment of PCOS pregnant women with a history of fertility failures raises many doubts, especially during the COVID pandemic. However, due to the increasing incidence of infections among reproductive people and the potentially more serious course in pregnant women, numerous questions about the safety and effectiveness of the treatment are still very current. In our study we presented a series of cases of recurrent miscarriages or recurrent implantation failure PCOS pregnant women with confirmed COVID-19. The diagnosis of infertility confirmed the presence of plasminogen activator inhibitor type 1 and/or 5,10-methylenetetrahydrofolate reductase polymorphisms in each of them. Moreover, some of the women presented immune dysfunction associated with infertility. We have described the personalized treatments of each pregnant patient included: metformin, enoxaparin and tacrolimus. The treatment applied had the expected effect, supporting the implantation processes. Furthermore, despite the ambiguous data according to immunological therapy of infertile women during the COVID pandemic, we observed a mild or asymptomatic COVID-19 course and we noticed no pregnancy complications.


Assuntos
Aborto Espontâneo , COVID-19 , Infertilidade Feminina , Síndrome do Ovário Policístico , Aborto Espontâneo/epidemiologia , Feminino , Humanos , Infertilidade Feminina/complicações , Infertilidade Feminina/epidemiologia , Infertilidade Feminina/terapia , Pandemias , Síndrome do Ovário Policístico/complicações , Síndrome do Ovário Policístico/epidemiologia , Gravidez , Gestantes , SARS-CoV-2
3.
Reprod Health ; 19(1): 83, 2022 Mar 29.
Artigo em Inglês | MEDLINE | ID: mdl-35351163

RESUMO

BACKGROUND: In vitro fertilization (IVF) births contribute to a considerable proportion of preterm birth (PTB) each year. However, there is no formal surveillance of adverse perinatal outcomes for less invasive fertility treatments. The study objective was to describe associations between fertility treatment (in vitro fertilization, intrauterine insemination, usually with ovulation drugs (IUI), or ovulation drugs alone) and preterm birth, compared to no treatment in subfertile women. METHODS: The Fertility Experiences Study (FES) is a retrospective cohort study conducted at the University of Utah between April 2010 and September 2012. Women with a history of primary subfertility self-reported treatment data via survey and interviews. Participant data were linked to birth certificates and fetal death records to asses for perinatal outcomes, particularly preterm birth. RESULTS: A total 487 birth certificates and 3 fetal death records were linked as first births for study participants who completed questionnaires. Among linked births, 19% had a PTB. After adjustment for maternal age, paternal age, maternal education, annual income, religious affiliation, female or male fertility diagnosis, and duration of subfertility, the odds ratios and 95% confidence intervals (CI) for PTB were 2.17 (CI 0.99, 4.75) for births conceived using ovulation drugs, 3.17 (CI 1.4, 7.19) for neonates conceived using IUI and 4.24 (CI 2.05, 8.77) for neonates conceived by IVF, compared to women with subfertility who used no treatment during the month of conception. A reported diagnosis of female factor infertility increased the adjusted odds of having a PTB 2.99 (CI 1.5, 5.97). Duration of pregnancy attempt was not independently associated with PTB. In restricting analyses to singleton gestation, odds ratios were not significant for any type of treatment. CONCLUSION: IVF, IUI, and ovulation drugs were all associated with a higher incidence of preterm birth and low birth weight, predominantly related to multiple gestation births.


Infertility treatments such as in vitro fertilization are associated with preterm birth, but less is known about how other less invasive treatments contribute to preterm birth. This study compares different types of fertility treatments and rates of preterm birth with women who are also struggling with infertility but did not use fertility treatments at the time of their pregnancy. 490 women were recruited at the University of Utah between 2010 and 2012. Participants were asked to complete a survey and were linked to birth certificate and fetal death certificate data. Women who used in vitro fertilization were 4.24 times more likely to have a preterm birth than those who used no treatment. Use of intrauterine insemination were 3.17 times more likely to have a preterm birth than those who used no treatment at time of conception. Ovulation stimulating drugs were 2.17 times more likely to have a preterm birth. Having female factor infertility was also associated with higher odds of having preterm birth. For those who are having trouble conceiving, trying less invasive treatments to achieve pregnancy might reduce their risk of preterm birth.


Assuntos
Infertilidade Feminina , Nascimento Prematuro , Feminino , Fertilidade , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Infertilidade Feminina/complicações , Infertilidade Feminina/epidemiologia , Infertilidade Feminina/terapia , Masculino , Gravidez , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/etiologia , Estudos Retrospectivos
4.
Fertil Steril ; 117(5): 1038-1046, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35305814

RESUMO

OBJECTIVE: To investigate the association of infertility with atherosclerotic cardiovascular disease (ASCVD) among postmenopausal participants in the Women's Health Initiative (WHI). We hypothesized that nulliparity and pregnancy loss may reveal more extreme phenotypes of infertility, enabling further understanding of the association of infertility with ASCVD. DESIGN: Prospective cohort study. SETTING: Forty clinical centers in the United States. PATIENT(S): A total of 158,787 postmenopausal participants in the Women's Health Initiative cohort. INTERVENTION(S): Infertility, parity, and pregnancy loss. MAIN OUTCOME MEASURE(S): The primary outcome was risk of ASCVD among women with and without a history of infertility, stratified by history of live birth and pregnancy loss. Cox proportional-hazards models were adjusted for demographics and risk factors for ASCVD. RESULT(S): Among 158,787 women, 25,933 (16.3%) reported a history of infertility; 20,427 (80%) had at least 1 live birth; and 9,062 (35%) had at least 1 pregnancy loss. There was a moderate overall association between infertility and ASCVD (adjusted hazard ratio, 1.02; 95% confidence interval [CI], 0.99-1.06) over 19 years of follow-up. Among nulliparous women, infertility was associated with a 13% higher risk of ASCVD (95% CI, 1.04-1.23). Among nulliparous women who had a pregnancy loss, infertility was associated with a 36% higher risk of ASCVD (95% CI, 1.09-1.71). CONCLUSION(S): Women with a history of infertility overall had a moderately higher risk of ASCVD compared with women without a history of infertility. Atherosclerotic cardiovascular disease risk was much higher among nulliparous infertile women and among nulliparous infertile women who also had a pregnancy loss, suggesting that in these more extreme phenotypes, infertility may be associated with ASCVD risk.


Assuntos
Doenças Cardiovasculares , Infertilidade Feminina , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Feminino , Humanos , Infertilidade Feminina/diagnóstico , Infertilidade Feminina/epidemiologia , Masculino , Pós-Menopausa , Gravidez , Estudos Prospectivos , Fatores de Risco , Estados Unidos/epidemiologia , Saúde da Mulher
5.
Sultan Qaboos Univ Med J ; 22(1): 14-27, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-35299802

RESUMO

Domestic violence (DV) against infertile women is an important health concern affecting their well-being. This systematic review and meta-analysis investigated the prevalence of DV against infertile women. The study was done based on the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guideline. Various international electronic databases were utilised in order to retrieve the necessary data. Articles were included if they were cross-sectional studies published in English and in Persian journals and investigated the prevalence of DV against infertile women up to May 2020. Out of 630 studies, 26 cross-sectional studies were systematically reviewed, from which 15 studies were included in the meta-analysis. The experiences of DV varied widely among the infertile women (14.987-88.918%). The results of meta-analysis showed that the prevalence of DV stood at 47.163% (95% Confidence Interval: 34.660-59.850). Psychological and emotional violence were among the most common types of violence. Considering the high rate of DV, it is recommended that policymakers address the issue by providing supportive care to such vulnerable populations, including educational and counselling services.


Assuntos
Violência Doméstica , Infertilidade Feminina , Violência Doméstica/psicologia , Feminino , Humanos , Infertilidade Feminina/epidemiologia , Prevalência
6.
Reprod Biol Endocrinol ; 20(1): 33, 2022 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-35183196

RESUMO

BACKGROUND: Growing evidence suggests that adherence to certain dietary patterns is associated with improved fecundity and reproductive outcomes in the general population and infertile couples assisted reproductive treatments. The objective of this study was to assess if dietary patterns are associated with ovarian reserve in reproductive age women without a history of infertility. METHODS: This was a cross-sectional study of 185 women in the Lifestyle and Ovarian Reserve (LORe) cohort. Women aged 18-44 without a history of infertility were recruited from the local community at an academic medical center. Subjects completed validated food frequency and physical activity questionnaires to assess patterns over the year prior to presentation. Dietary patterns including a Western (including meat, refined carbohydrates, high-calorie drinks), prudent (including fruits, vegetables, olive oil and nuts), fertility (lower intake of trans fat with higher intake of monounsaturated fatty acids, increased intake of plant based protein, high-fat dairy, lower glycemic load carbohydrates and supplemental iron) and profertility diet (PFD) (characterize by whole grains, soy and seafood, low pesticide residue produce, supplemental folic acid, B12 and vitamin D) were identified through principal component analysis. Main outcome measures were serum antimullerian hormone concentration (AMH) (ng/mL) and antral follicle count (AFC) obtained by transvaginal ultrasound. RESULTS: After stratifying by BMI, adjusting for age, smoking and physical activity, dietary patterns were not associated with ovarian reserve in normal weight women. Increased adherence to a profertility diet in overweight and obese women (BMI ≥ 25 kg/m2) was associated with a significantly higher AMH. Women in the third and fourth quartiles of PFD adherence had a mean AMH concentration of 1.45 ng/mL (95%CI 0.33-2.56, p = 0.01) and 1.67 ng/mL (95%CI 0.60-2.74, p = 0.003) higher than women in the lowest quartile respectively. The highest adherence to PFD was also associated with a higher AFC in women with a BMI ≥ 25 kg/m2 (ß = 7.8, 95%CI 0.003-15.34, p < 0.05). Other common dietary patterns were not significantly associated with ovarian reserve. CONCLUSIONS: Increased adherence to a profertility diet is associated with improved markers of ovarian reserve in overweight and obese women. These findings provide novel insight on potential modifiable lifestyle factors associated with ovarian reserve.


Assuntos
Comportamento Alimentar/fisiologia , Obesidade/epidemiologia , Reserva Ovariana/fisiologia , Sobrepeso/epidemiologia , Adolescente , Adulto , Estudos de Coortes , Estudos Transversais , Dieta/estatística & dados numéricos , Feminino , Humanos , Infertilidade Feminina/epidemiologia , Infertilidade Feminina/etiologia , Obesidade/fisiopatologia , Sobrepeso/fisiopatologia , Fatores de Risco , Estados Unidos/epidemiologia , Adulto Jovem
7.
PLoS One ; 17(2): e0264318, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35196329

RESUMO

OBJECTIVE: The objective of this research is to estimate the probability of pregnancy resumption after discontinuing reversible contraceptives-pills, injectables, implants and IUDs, and to examine the factors associated with the resumption of fertility. METHOD: The study uses pregnancy calendar data from Indonesia Demographic and Health Surveys (IDHS) of 2007, 2012 and 2017. A hazard model survival method is used for estimating the time needed to resume pregnancy since discontinuing reversible contraceptives. Retrospective data on 4,573; 5,183 and 5,989 episodes of reversible contraceptive discontinuation at the three surveys respectively have been analysed. RESULTS: This study shows that women regained fecundity within one year of discontinuing IUD, pill, injectables or implants. Women using IUD could resume their pregnancy faster than those using implants, pills and injectables. Over the three IDHS 2007, 2012 and 2017 the age-specific percentages of women becoming pregnant after one year of contraceptive discontinuation vary between 72 and 85 for IUD, 75 and 81 for pills, 72 and 76 for implants and 64 and 67 for injectables, with the percentages being higher among younger women. The analysis further shows that length of contraceptive use, parity, prior sexually transmitted infections, knowledge of fertile period, household wealth status and place of residence have no impact on occurrence of pregnancy after contraceptive discontinuation. CONCLUSION: The analysis disproves a myth that reversible contraceptives make women infertile. Depending on the type of reversible contraceptive used, 65% to 85% of the women were able to conceive after one year of discontinuation.


Assuntos
Anticoncepção/estatística & dados numéricos , Infertilidade Feminina/epidemiologia , Gravidez/estatística & dados numéricos , Adulto , Anticoncepção/efeitos adversos , Anticoncepção/classificação , Comportamento Contraceptivo/estatística & dados numéricos , Demografia/estatística & dados numéricos , Feminino , Inquéritos Epidemiológicos/estatística & dados numéricos , Humanos , Indonésia
8.
Reprod Biol Endocrinol ; 20(1): 27, 2022 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-35120557

RESUMO

BACKGROUND: Gestational trophoblastic disease (GTD) usually affects young women of childbearing age. After treatment for GTD, 86% of women wish to achieve pregnancy. On account of the impacts of GTD and treatments as well as patient anxiety, large numbers of couples turn to assisted reproductive technology (ART), especially in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI). But few studies have investigated whether a history of GTD affects the outcomes of IVF/ICSI in secondary infertile patients and how it occurs. We investigate whether a history of GTD affects the IVF/ICSI outcomes and the live birth rates in women with secondary infertility. METHODS: This retrospective cohort study enrolled 176 women with secondary infertility who underwent IVF/ICSI treatment at the reproductive medical center of Nanjing Drum Tower Hospital from January 1, 2016, to December 31, 2020. Participants were divided into the GTD group (44 women with GTD history) and control group (132 women without GTD history matched from 8318 secondary infertile women). The control group and the study group were matched at a ratio of 3:1 according to patient age, infertility duration, number of cycles and body mass index (BMI). We assessed retrieved oocytes and high-grade embryos, biochemical pregnancy, miscarriage, ectopic pregnancy, gestational age at delivery, delivery mode and live birth rates. RESULT(S): We found a significantly reduced live-birth rate (34.1% vs 66.7%) associated with IVF/ICSI cycles in patients with a GTD history compared to those without a GTD history. The biochemical pregnancy and miscarriage rates of the GTD group were slightly higher than those of the control group. In addition, there was a difference in gestational age at delivery between the GTD and control groups (p < 0.001) but no differences in the mode of delivery (p = 0.267). Furthermore, the number of abandoned embryos in the GTD group was greater than that in the control group (p = 0.018), and the number of good-quality embryos was less than that in the control group (p = 0.019). The endometrial thickness was thinner (p < 0.001) in the GTD group. Immunohistochemistry (IHC) showed abnormal endometrial receptivity in the GTD group. CONCLUSION(S): The GTD history of patients undergoing IVF/ICSI cycles had an impact on the live-birth rate and gestational age at delivery, which might result from the thinner endometrium and abnormal endometrial receptivity before embryo transfer.


Assuntos
Fertilização In Vitro/métodos , Doença Trofoblástica Gestacional/epidemiologia , Doença Trofoblástica Gestacional/terapia , Infertilidade Feminina/terapia , Taxa de Gravidez , Aborto Espontâneo/diagnóstico , Aborto Espontâneo/epidemiologia , Aborto Espontâneo/etiologia , Aborto Espontâneo/terapia , Adulto , Coeficiente de Natalidade , China/epidemiologia , Estudos de Coortes , Feminino , Doença Trofoblástica Gestacional/complicações , Doença Trofoblástica Gestacional/diagnóstico , Humanos , Recém-Nascido , Infertilidade Feminina/diagnóstico , Infertilidade Feminina/epidemiologia , Infertilidade Feminina/etiologia , Masculino , Gravidez , Prognóstico , História Reprodutiva , Estudos Retrospectivos , Injeções de Esperma Intracitoplásmicas , Resultado do Tratamento
9.
Fertil Steril ; 117(3): 612-619, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-35105443

RESUMO

OBJECTIVE: To investigate whether endometrial scratching increases the chance of live birth in women with unexplained infertility attempting to conceive without assisted reproductive technology. DESIGN: Randomized, placebo-controlled, participant-blind, multicenter international trial. SETTING: Fertility clinics. PATIENT(S): Women with a diagnosis of unexplained infertility trying to conceive without assistance. INTERVENTION(S): Participants were randomly assigned to receive an endometrial biopsy or a placebo procedure (placement of a biopsy catheter in the posterior fornix, without inserting it into the external cervical os). Both groups performed regular unprotected intercourse with the intention of conceiving over three consecutive study cycles. MAIN OUTCOME MEASURE(S): The primary outcome was live birth. RESULT(S): A total of 220 women underwent randomization. The live birth rate was 9% (10 of 113 women) in the endometrial-scratch group and 7% (7 of 107 women) in the control group (adjusted OR, 1.39; 95% CI, 0.50-4.03). There were no differences between the groups in the secondary outcomes of clinical pregnancy, viable pregnancy, ongoing pregnancy, and miscarriage. Endometrial scratching was associated with a higher pain score on a 10-point scale (adjusted mean difference, 3.07; 95% CI, 2.53-3.60). CONCLUSION(S): This trial did not find evidence that endometrial scratching improves the live birth rate in women with unexplained infertility trying to conceive without assistance. CLINICAL TRIAL REGISTRATION NUMBER: Australian New Zealand Clinical Trials Registry ACTRN12614000656639.


Assuntos
Cateterismo/métodos , Endométrio/fisiologia , Fertilização/fisiologia , Infertilidade Feminina/epidemiologia , Infertilidade Feminina/terapia , Nascido Vivo/epidemiologia , Biópsia , Cateterismo/instrumentação , Endométrio/patologia , Feminino , Humanos , Infertilidade Feminina/diagnóstico , Internacionalidade , Gravidez , Método Simples-Cego , Resultado do Tratamento
10.
Fertil Steril ; 117(3): 593-602, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-35058044

RESUMO

OBJECTIVE: To investigate hospitalizations up to 8 years after live birth among women who used assisted reproductive technology (ART) or who were subfertile compared with women who conceived naturally. DESIGN: Retrospective cohort. SETTING: Deliveries among privately insured women aged ≥18 years between 2004 and 2017 from Massachusetts state vital records were linked to the Society for Assisted Reproductive Technology Clinic Outcome Reporting System and hospital observational/inpatient stays. PATIENT(S): We compared patients with ART, medically assisted reproduction (MAR), and unassisted subfertile (USF) delivery with those with fertile delivery. INTERVENTION(S): NA. MAIN OUTCOME MEASURE(S): Postdelivery hospitalization information was derived from the International Classification of Diseases codes for discharges and combined by type. The relative risks and 95% confidence intervals (CIs) of hospitalization for up to the first 8 years postdelivery were modeled. RESULT(S): Among 492,515 deliveries, 5.6% used ART, 1.6% used MAR, and 1.8% were USF. Compared with fertile deliveries, deliveries that used ART or MAR or were USF were more likely to have hospital utilization (inpatient or observational stay) for any reason for up to 8 years of follow-up (USF, adjusted relative risk [aRR], 1.18 [95% CI, 1.12-1.25]; MAR, aRR, 1.20 [1.13-1.27]; and ART, aRR, 1.29 [1.25-1.34]). Assisted reproductive technology deliveries had an increased risk of hospitalization for conditions of the cardiovascular system (aRR, 1.31 [95% CI, 1.20-1.41]), overweight/obesity (aRR, 1.30 [1.17-1.44]), diabetes (aRR, 1.25 [1.05-1.49]), reproductive tract (aRR, 1.62 [1.47-1.79]), digestive tract (aRR, 1.39 [1.30-1.49]), thyroid (aRR, 2.02 [1.80-2.26]), respiratory system (aRR, 1.13 [1.03-1.24]), and cancer (aRR, 1.40 [1.18-1.65]) up to 8 years after delivery. Deliveries with MAR and subfertility had similar patterns of hospitalization as ART deliveries. CONCLUSION(S): Women who conceived through fertility treatment or experienced subfertility were at increased risk of subsequent hospitalization resulting from a variety of chronic and acute conditions.


Assuntos
Parto Obstétrico/tendências , Hospitalização/tendências , Infertilidade Feminina/epidemiologia , Infertilidade Feminina/terapia , Técnicas de Reprodução Assistida/tendências , Adulto , Estudos de Coortes , Feminino , Humanos , Recém-Nascido , Massachusetts/epidemiologia , Gravidez , Estudos Retrospectivos
11.
Reprod Health ; 19(1): 13, 2022 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-35042514

RESUMO

BACKGROUND: There is growing interest in long-term outcomes following infertility and infertility treatment. However, there are few detailed longitudinal cohorts available for this work. This study aimed to assemble a historical cohort of women with primary infertility and age-matched controls to evaluate fertility trends, sequelae, and sociodemographic differences. Described here are cohort group characteristics and associated reproductive trends over time. METHODS: A population-based historical cohort was created using the Rochester Epidemiology Project (REP) record-linkage system (Olmsted County, MN). The cohort included women aged 18-50 with a diagnosis of primary infertility between January 1, 1980, and December 31, 1999. As part of a case-control study, we identified 1:1 age-matched female controls from the same community and era. RESULTS: A total of 1001 women with primary infertility and 1001 age-matched controls were identified. The women with primary infertility were significantly more likely to be married, college educated, use barrier contraception, and non-smokers compared to age-matched controls. The incidence of primary infertility increased from 14 to 20 per 10,000 person years from 1980-1985 to 1995-1999. Ovulatory dysfunction and unexplained infertility were the most common causes of primary infertility and clomiphene was the most widely used fertility medication. Rates of in vitro fertilization (IVF) increased from 1.8% during 1980-1985 to 26.0% during 1995-1999. CONCLUSION: Women with primary infertility were found to have unique sociodemographic characteristics compared to age-matched control women, which is consistent with previous research. The incidence of diagnosed primary infertility increased from 1980 to 1999, as did use of IVF.


This study aimed to assemble a historic cohort of women with primary infertility and age-matched control women. The cohort included 1001 women with primary infertility diagnosed between 1980 and 1999 and 1001 age-matched controls from the same community and era. This cohort demonstrated baseline differences between the primary infertility and control groups, including differences in marital status, education, use of barrier contraception and smoking status. Additionally, the cohort showed an increased incidence in diagnosis of primary infertility from 1980 to 1999. Creation of this cohort will enable future research focused on long-term outcomes following primary infertility diagnosis and treatment.


Assuntos
Infertilidade Feminina , Estudos de Casos e Controles , Estudos de Coortes , Feminino , Fertilidade , Fertilização In Vitro , Humanos , Infertilidade Feminina/epidemiologia
12.
Sci Rep ; 12(1): 402, 2022 01 10.
Artigo em Inglês | MEDLINE | ID: mdl-35013422

RESUMO

There is a lack of studies assessing how hearing impairment relates to reproductive outcomes. We examined whether childhood hearing impairment (HI) affects reproductive patterns based on longitudinal Norwegian population level data for birth cohorts 1940-1980. We used Poisson regression to estimate the association between the number of children ever born and HI. The association with childlessness is estimated by a logit model. As a robustness check, we also estimated family fixed effects Poisson and logit models. Hearing was assessed at ages 7, 10 and 13, and reproduction was observed at adult ages until 2014. Air conduction hearing threshold levels were obtained by pure-tone audiometry at eight frequencies from 0.25 to 8 kHz. Fertility data were collected from Norwegian administrative registers. The combined dataset size was N = 50,022. Our analyses reveal that HI in childhood is associated with lower fertility in adulthood, especially for men. The proportion of childless individuals among those with childhood HI was almost twice as large as that of individuals with normal childhood hearing (20.8% vs. 10.7%). The negative association is robust to the inclusion of family fixed effects in the model that allow to control for the unobserved heterogeneity that are shared between siblings, including factors related to the upbringing and parent characteristics. Less family support in later life could add to the health challenges faced by those with HI. More attention should be given to how fertility relates to HI.


Assuntos
Fertilidade , Perda Auditiva/epidemiologia , Audição , Infertilidade Feminina/epidemiologia , Infertilidade Masculina/epidemiologia , Pessoas com Deficiência Auditiva , Reprodução , Adolescente , Fatores Etários , Idoso , Audiometria de Tons Puros , Limiar Auditivo , Criança , Características da Família , Feminino , Perda Auditiva/diagnóstico , Perda Auditiva/fisiopatologia , Humanos , Infertilidade Feminina/diagnóstico , Infertilidade Feminina/fisiopatologia , Infertilidade Masculina/diagnóstico , Infertilidade Masculina/fisiopatologia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Noruega/epidemiologia , Comportamento Reprodutivo , Medição de Risco , Fatores de Risco , Fatores Sexuais , Fatores de Tempo
13.
Stroke ; 53(2): 328-337, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-34983235

RESUMO

BACKGROUND AND PURPOSE: Stroke is one of the leading causes of mortality, and women are impacted more from stroke than men in terms of their absolute number and in having worse outcomes. A growing number of studies have explored the association between pregnancy complications, pregnancy outcomes, and stroke. Limited studies, however, have investigated links involving infertility, miscarriage, and stillbirth, which could plausibly be associated via a background of endocrine conditions, endothelial dysfunction, and chronic systematic inflammation. This review aims to summarize current evidence and provide up-to-date information on the associations of infertility, miscarriage, and stillbirth, with stroke incidence. METHODS: A comprehensive literature search was conducted for cohort and case-control studies on associations between infertility, miscarriage, stillbirth, and stroke up to September 26, 2020. Seven databases were searched: PubMed, Embase, Cochrane, CINIHL, PsyclNFO, Wanfang, and CNKI. Random-effects models were used to estimate the pooled hazard ratios (HRs) and 95% CIs. RESULTS: Sixteen cohort studies and 2 case-control studies enrolling 7 808 521 women were included in this meta-analysis. Women who had experienced miscarriage or stillbirth were at higher risk of stroke (miscarriage: HR, 1.07 [95% CI, 1.00-1.14]; stillbirth: HR, 1.38 [95% CI, 1.11-1.71]) than other women. The HRs of stroke for each additional miscarriage and stillbirth were 1.13 (95% CI, 0.96-1.33) and 1.25 (95% CI, 1.06-1.49), respectively. In subgroup analysis, increased risk of stroke was associated with repeated miscarriages and stillbirths (miscarriage ≥3: HR, 1.42 [95% CI, 1.05-1.90]; stillbirth ≥2: HR, 1.14 [95% CI, 1.04-1.26]). Associations between infertility and stroke were inconsistent and inconclusive (HR, 1.07 [95% CI, 0.87-1.32]). CONCLUSIONS: Miscarriage and stillbirth are associated with increased risk of stroke among women, which could be used as a contributing risk factor to help identify women at higher risk of stroke.


Assuntos
Aborto Espontâneo/epidemiologia , Infertilidade Feminina/epidemiologia , Natimorto/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Feminino , Humanos , Incidência , Infertilidade Feminina/complicações , Gravidez , Resultado da Gravidez
14.
Hum Reprod ; 37(4): 838-847, 2022 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-35020884

RESUMO

STUDY QUESTION: Do fertility drugs increase the risk of thyroid cancer among infertile women? SUMMARY ANSWER: The use of most types of fertility drugs was not associated with an increased risk of thyroid cancer. WHAT IS KNOWN ALREADY: The incidence of thyroid cancer is higher for women than men, especially during reproductive years, indicating that reproductive hormones may be involved in the development of thyroid cancer. Only a few previous studies have examined the association between the use of fertility drugs and incidence of thyroid cancer and the results are inconclusive. STUDY DESIGN, SIZE, DURATION: A retrospective, population-based cohort study including all 146 024 infertile women aged 20-45 years and living in Denmark in the period 1995-2017. The women were followed from the date of entry in the cohort (i.e. date of first infertility diagnosis) until the occurrence of thyroid cancer or any other cancer (except non-melanoma skin cancer), death, emigration, total thyroidectomy or the end of follow-up (31 December 2018), whichever occurred first. The median length of follow-up was 11.3 years. PARTICIPANTS/MATERIALS, SETTING, METHODS: In total, 167 women were diagnosed with thyroid cancer during the follow-up period. Information on the use of specific fertility drugs (clomiphene citrate, gonadotropins, hCGs, GnRH receptor modulators and progesterone), thyroid cancer, covariates and vital status was obtained from the Danish Infertility Cohort and various Danish national registers. Cox proportional hazard regression models were used to calculate hazard ratios (HRs) and 95% CIs for thyroid cancer overall and for papillary thyroid cancer. MAIN RESULTS AND THE ROLE OF CHANCE: After adjustment for the calendar year of infertility diagnosis, the highest obtained level of education, parity status, obesity or thyroid disease and mutual adjustment for other registered fertility drugs, no marked associations were observed between the use of clomiphene citrate, hCG, gonadotropins or GnRH receptor modulators and risk of overall or papillary thyroid cancer. However, ever use of progesterone was associated with an increased rate of both overall (HR 1.63; 95% CI 1.07-2.48) and papillary (HR 1.66, 95% CI 1.04-2.65) thyroid cancer after mutual adjustment for other specific fertility drugs. For most specific fertility drugs, we observed a tendency toward higher associations with thyroid cancer within the first 5 years after the start of drug use than after 5 years from the start of use. No marked associations were detected according to the cumulative dose for any of the specific fertility drugs. LIMITATIONS, REASONS FOR CAUTION: Despite a large study population, the statistical precision in some subgroup analyses may be affected due to the low number of thyroid cancer cases. Although we were able to adjust for a number of potential confounders, residual and unmeasured confounding may potentially have affected the observed associations, as we could not adjust for some factors that may influence the association between fertility drugs and thyroid cancer, including age at menarche and BMI. WIDER IMPLICATIONS OF THE FINDINGS: Although this study, which is the largest to date, provides reassuring evidence that there is no strong link between the use of fertility drugs and thyroid cancer incidence, we observed a modest increased thyroid cancer incidence after the use of progesterone. However, we cannot rule out that this is a chance finding and the potential association between the use of progesterone and thyroid cancer should therefore be investigated further in large epidemiological studies. The results of the present study provide valuable knowledge for clinicians and other health care personnel involved in the diagnosis and treatment of infertility. STUDY FUNDING/COMPETING INTEREST(S): The study was supported by research grants from the Jascha Foundation and the Aase and Ejner Danielsens Foundation. B.N. received honoraria and/or non-financial support by Gedeon Richter Nordics AB, IBSA Nordic APS and Merck KGAA. The remaining authors have no competing interests. TRIAL REGISTRATION NUMBER: N/A.


Assuntos
Fármacos para a Fertilidade , Infertilidade Feminina , Neoplasias da Glândula Tireoide , Adulto , Estudos de Coortes , Dinamarca/epidemiologia , Feminino , Fármacos para a Fertilidade/efeitos adversos , Humanos , Incidência , Infertilidade Feminina/tratamento farmacológico , Infertilidade Feminina/epidemiologia , Pessoa de Meia-Idade , Estudos Retrospectivos , Neoplasias da Glândula Tireoide/induzido quimicamente , Neoplasias da Glândula Tireoide/epidemiologia , Adulto Jovem
15.
Reprod Sci ; 29(5): 1449-1456, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-34731458

RESUMO

Reproductive health can be affected by obesity through various mechanisms. Obesity-associated inflammatory markers and altered hormones can have direct and indirect impacts on female reproductive health. However, little is known about obesity prevalence and trend among infertile women and obesity association with infertility in reproductive-age women of the U.S. In a cross-sectional study, we sought to conduct a secondary analysis of National Survey of Family Growth (NSFG) data from 2011 to 2019. A total of 6,035 infertile and non-pregnant fecund women aged 20-44 years were included in a nationally representative sample of the U.S. The weighted prevalence of obesity (BMI ≥ 30) among infertile women was 41.63% for the period 2011-2019. Obese women had 62% higher odds of infertility (95% CI 1.24, 2.17) compared to non-obese women of reproductive age (20-44 years). However, there was no specific trend of obesity among infertile and non-pregnant fecund women aged 20-44 years in the U.S. from 2011 to 2019. Given the negative impact of obesity on female reproductive health and in light of our results, it is important to counsel obese infertile reproductive-age women of the U.S. about behavioral changes that include weight management. Future longitudinal studies are needed to evaluate the risk of infertility among obese women.


Assuntos
Infertilidade Feminina , Estudos Transversais , Feminino , Humanos , Infertilidade Feminina/complicações , Infertilidade Feminina/epidemiologia , Obesidade/complicações , Obesidade/epidemiologia , Estados Unidos/epidemiologia
16.
Women Health ; 62(1): 3-11, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34852729

RESUMO

Endometriosis Fertility Index (EFI) is a clinical staging system created to predict spontaneous pregnancy outcomes in patients with endometriosis. The present study aimed at evaluating the performance of EFI in symptomatic patients, submitted to laparoscopy for moderate and severe endometriosis associated to infertility in a Brazilian population. Seventy-seven women with endometriosis and pelvic pain, who desired to become pregnant, were selected from a tertiary care unit between those operated on between May 2007 and March 2017. All of them were submitted to laparoscopy for the surgical treatment of endometriosis and allowed to attempt natural conception for 36 months or immediately referred to in vitro fertilization (IVF). EFI was calculated according to surgical description and clinical information in medical records. Pregnancy rates and live birth rates after natural conception or IVF are reported and correlated to EFI. Fifty-three women tried natural conception and 24 were referred to IVF. Of the 53 who tried natural conception, 29 achieved pregnancy (54.7%) and 28 had live birth (52.8%). The majority of pregnancies (82.7%) occurred in the first 12 months after surgery and 75% of the patients who became spontaneously pregnant had EFI ≥ 7. Of the 24 patients referred to IVF, 13 became pregnant (54.1%) and 10 had live birth (41.7%). Infertility duration of 36 months or more and the presence of endometrioma increased the probability of having EFI ≤ 5. The overall live birth rate (LBR) for patients with low EFI scores (2-4) was 17% compared with 83.8% for those with higher EFI scores (6-9). EFI predicts pregnancy rates in patients operated on for moderate and severe endometriosis. Scores seem also to predict pregnancy rates after IVF.


Assuntos
Endometriose , Infertilidade Feminina , Endometriose/complicações , Endometriose/epidemiologia , Endometriose/cirurgia , Feminino , Fertilidade , Humanos , Infertilidade Feminina/epidemiologia , Infertilidade Feminina/etiologia , Infertilidade Feminina/cirurgia , Gravidez , Resultado da Gravidez/epidemiologia , Taxa de Gravidez , Estudos Retrospectivos
17.
Fertil Steril ; 117(1): 171-180, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34809974

RESUMO

OBJECTIVE: To examine the association between dietary folate intake and antral follicle count (AFC) among women seeing treatment for infertility. DESIGN: Cohort study. SETTING: Academic fertility center. PATIENTS: A total of 552 women attending the Massachusetts General Hospital Fertility Center (2007-2019) who participated in the Environment and Reproductive Health Study. INTERVENTIONS: None. Folate intake was measured with a validated food frequency questionnaire at study entry. Multivariable Poisson regression models with robust standard errors were used to estimate the association of folate intake with AFC adjusting for calorie intake, age, body mass index, physical activity, education, smoking status, year of AFC, and intakes of vitamin B12, iron, and vitamin D. Nonlinearity was assessed with restricted cubic splines. MAIN OUTCOME MEASURE: AFC as measured by transvaginal ultrasonography as part of routine care. RESULTS: Among the 552 women (median age, 35.0 years; median folate intake, 1,005 µg/d), total and supplemental folate intake had a significant nonlinear relationship with AFC. There was a positive linear association with AFC up to approximately 1,200 µg/d for total folate intake and up to 800 µg/d for supplemental folate intake; however, there was no additional benefit of higher folate intakes. The magnitude of the association was modest; for example, the predicted adjusted difference in AFC between a woman consuming 400 vs. 800 µg/d of supplemental folate was approximately 1.5 follicles. CONCLUSION: Higher intake of folate, particularly from supplements, was associated with modestly higher ovarian reserve as measured by AFC among women attending a fertility center. CLINICAL TRIAL REGISTRATION NUMBER: This trial was registered at clinicaltrials.gov as NCT00011713.


Assuntos
Ácido Fólico/administração & dosagem , Infertilidade Feminina , Reserva Ovariana/fisiologia , Adulto , Contagem de Células , Estudos de Coortes , Suplementos Nutricionais , Feminino , Clínicas de Fertilização , Humanos , Infertilidade Feminina/dietoterapia , Infertilidade Feminina/epidemiologia , Infertilidade Feminina/patologia , Massachusetts/epidemiologia , Folículo Ovariano/patologia , Reserva Ovariana/efeitos dos fármacos
18.
Ultrasound Obstet Gynecol ; 59(1): 107-113, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34435713

RESUMO

OBJECTIVE: To assess the prevalence and morphological appearance of deep endometriosis and ovarian endometrioma using pelvic ultrasound examination in women attending for an early pregnancy assessment. METHODS: This was a prospective observational study set within a dedicated early pregnancy unit. The study included 1341 consecutive women who attended for an early pregnancy assessment for reassurance or because of suspected early pregnancy complications. All women underwent a transvaginal scan to assess the location and viability of their pregnancy. In addition, a detailed examination of pelvic organs was carried out to detect the presence of endometriosis and other gynecological abnormalities. Data analysis was performed using logistic regression and multivariable analysis. RESULTS: The prevalence of deep endometriosis and/or ovarian endometrioma in women attending our early pregnancy unit was 4.9% (95% CI, 3.8-6.2%). In 33/66 (50.0% (95% CI, 37.9-62.1%)) women with endometriosis, this was a new diagnosis that was made during their early pregnancy scan. On multivariable analysis, the presence of endometriosis was strongly associated with a history of subfertility (odds ratio (OR), 3.15 (95% CI, 1.63-6.07)) and presence of a congenital uterine anomaly (OR, 5.69 (95% CI, 2.17-14.9)) and uterine fibroids (OR, 2.37 (95% CI, 1.31-4.28)). Morphological changes typical of decidualization were seen in 11/33 (33.3% (95% CI, 17.2-49.4%)) women with ovarian endometrioma and 18/57 (31.6% (95% CI, 19.5-43.7%)) women with deep endometriotic nodules. CONCLUSIONS: Deep endometriosis and ovarian endometrioma were present in a significant proportion of women attending for early pregnancy assessment. The prevalence varied depending on a history of subfertility, and therefore is likely to differ significantly among populations, depending on their characteristics. Ultrasound is a useful tool for the detection of endometriosis in early pregnancy and the identification of women who may benefit from specialist antenatal care. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.


Assuntos
Endometriose/epidemiologia , Doenças Ovarianas/epidemiologia , Complicações na Gravidez/epidemiologia , Ultrassonografia Pré-Natal , Adulto , Endometriose/diagnóstico por imagem , Endometriose/patologia , Feminino , Humanos , Infertilidade Feminina/complicações , Infertilidade Feminina/epidemiologia , Razão de Chances , Doenças Ovarianas/diagnóstico por imagem , Doenças Ovarianas/patologia , Gravidez , Complicações na Gravidez/diagnóstico por imagem , Complicações na Gravidez/patologia , Prevalência , Estudos Prospectivos , Anormalidades Urogenitais/diagnóstico por imagem , Anormalidades Urogenitais/epidemiologia , Útero/anormalidades , Útero/diagnóstico por imagem
19.
JBRA Assist Reprod ; 26(1): 13-21, 2022 01 17.
Artigo em Inglês | MEDLINE | ID: mdl-34296832

RESUMO

OBJECTIVE: To evaluate whether platelet-rich plasma (PRP) optimizes endometrial thickness (EMT) and improves live birth rates (LBR) in women with refractory thin endometrium due to varied aetiology during fresh in vitro fertilization (IVF) and frozen-thawed embryo transfer (FET). METHODS: A prospective interventional study was conducted at the ART Centre of a tertiary care academic hospital. Twenty-two infertile women with refractory thin endometrium (<7mm) despite standard hormone replacement therapy were assessed. Twenty patients underwent 26 PRP cycles from December 2018 - June 2020 during fresh IVF-ET and FET. Primary endpoint was expansion of EMT and secondary outcomes were implantation rate (IR), clinical pregnancy rate (CPR) and LBR in fresh and FET cycles and aetiology wise. RESULTS: Mean EMT increased significantly following PRP administration (p<0.001) with average increase of 1.07mm and 0.83mm after first PRP (p<0.001) during fresh IVF and FET, respectively. CPR, IR and LBR showed no significant difference when compared during fresh vs. FET cycles (p>0.05). PRP led to significant increase in EMT in tuberculosis (TB), diminished ovarian reserve (DOR) and polycystic ovary syndrome (PCOS) (p<0.001). There was no significant difference in CPR, IR and LBR among three aetiological factors (p>0.05). Overall, clinical pregnancy and LBR reached up to 20% and 25%, respectively. No adverse reactions were reported. CONCLUSIONS: PRP enhances EMT significantly during fresh and FET cycles in thin endometrium associated with TB, PCOS and DOR, thus improving the CPR and LBR in these low prognosis patients.


Assuntos
Infertilidade Feminina , Plasma Rico em Plaquetas , Criopreservação , Transferência Embrionária , Endométrio , Feminino , Fertilização In Vitro , Humanos , Infertilidade Feminina/epidemiologia , Infertilidade Feminina/terapia , Gravidez , Resultado da Gravidez/epidemiologia , Estudos Prospectivos , Estudos Retrospectivos
20.
Fertil Steril ; 117(1): 144-152, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34863518

RESUMO

OBJECTIVE: To identify, besides maternal age and the number of previous pregnancy losses, additional characteristics of couples with unexplained recurrent pregnancy loss (RPL) that improve the prediction of an ongoing pregnancy. DESIGN: Hospital-based cohort study in couples who visited specialized RPL units of two academic centers between 2012 and 2020. SETTING: Two academic centers in the Netherlands. PATIENTS: Clinical data from 526 couples with unexplained RPL were used in this study. INTERVENTION(S): None. MAIN OUTCOME MEASURES: The final model to estimate the chance of a subsequent ongoing pregnancy was determined using a backward selection process and internally validated using bootstrapping. Model performance was assessed in terms of calibration and discrimination (area under the receiver operating characteristic curve). RESULTS: Subsequent ongoing pregnancy was achieved in 345 of 526 couples (66%). The number of previous pregnancy losses, maternal age, paternal age, maternal body mass index, paternal body mass index, maternal smoking status, and previous in vitro fertilization/intracytoplasmic sperm injection treatment were predictive of the outcome. The optimism-corrected area under the receiver operating characteristic curve was 0.63 compared with 0.57 when using only the number of previous pregnancy losses and maternal age. CONCLUSIONS: The identification of additional predictors of a subsequent ongoing pregnancy after RPL, including male characteristics, is significant for both clinicians and couples with RPL. At the same time, we showed that the predictive ability of the current model is still limited and more research is warranted to develop a model that can be used in clinical practice.


Assuntos
Aborto Habitual/diagnóstico , Infertilidade/diagnóstico , Resultado da Gravidez , Aborto Habitual/epidemiologia , Aborto Habitual/terapia , Adulto , Estudos de Coortes , Características da Família , Feminino , Humanos , Infertilidade/epidemiologia , Infertilidade/etiologia , Infertilidade/terapia , Infertilidade Feminina/complicações , Infertilidade Feminina/diagnóstico , Infertilidade Feminina/epidemiologia , Infertilidade Masculina/complicações , Infertilidade Masculina/diagnóstico , Infertilidade Masculina/epidemiologia , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Países Baixos/epidemiologia , Gravidez , Resultado da Gravidez/epidemiologia , Prognóstico , Adulto Jovem
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