1
|
Elenkov A, Melander O, Nilsson PM, Zhang H, Giwercman A. Impact of genetic risk score on the association between male childlessness and cardiovascular disease and mortality. Sci Rep 2021; 11:18526. [PMID: 34535694 PMCID: PMC8448891 DOI: 10.1038/s41598-021-97733-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 08/26/2021] [Indexed: 11/09/2022] Open
Abstract
Childless men are reported to have a higher risk of cardiovascular disease (CVD) and mortality. Information on inherited genetic risk for CVD has improved the predictive models. Presuming that childlessness is a proxy of infertility we aimed to investigate if childless men inherit more often genetic traits for CVD and if combining genetic and parenthood information improves predictive models for CVD morbidity and mortality. Data was sourced from a large prospective population-based cohort where genetic risk score (GRS) was calculated using two sets of either 27 (GRS 27) or 50 (GRS 50) single nucleotide polymorphisms (SNPs) previously found to be associated with CVD. Part of the participants (n = 2572 men) were randomly assigned to a sub-cohort with focus on CVD which served as an exploratory cohort. The obtained statistically significant results were tested in the remaining (confirmatory) part of the cohort (n = 9548 men). GRS distribution did not differ between childless men and fathers (p-values for interaction between 0.29 and 0.76). However, when using fathers with low GRS as reference high GRS was a strong predictor for CVD mortality, the HR (95% CI) increasing from 1.92 (1.10-3.36) for GRS 50 and 1.54 (0.87-2.75) for GRS 27 in fathers to 3.12 (1.39-7.04) for GRS50 and 3.73 (1.75-7.99) for GRS27 in childless men. The confirmatory analysis showed similar trend. Algorithms including paternal information and GRS were more predictive for CVD mortality at 5 and 10 years follow-ups when compared to algorithms including GRS only (AUC 0.88 (95% CI 0.84-0.92) and 0.86 (95% CI 0.84-0.90), and, AUC 0.81 (95% CI 0.75-0.87) and 0.78 (95% CI 0.73-0.82), respectively). Combining information on parental status and GRS for CVD may improve the predictive power of risk algorithms in middle-aged men. Childless men and those with severe infertility problem may be an important target group for prevention of CVD.
Collapse
Affiliation(s)
- Angel Elenkov
- Reproductive Medicine Centre, Skåne University Hospital, Malmö, Sweden. .,Department of Translational Medicine, Clinical Research Centre, Lund University, Jan Waldenströms gata 35, Building 60, Plan 9, 20502, Malmö, Sweden.
| | - Olle Melander
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.,Department of Emergency and Internal Medicine, Skåne University Hospital, Malmö, Sweden
| | - Peter M Nilsson
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.,Department of Emergency and Internal Medicine, Skåne University Hospital, Malmö, Sweden
| | - He Zhang
- Department of Translational Medicine, Clinical Research Centre, Lund University, Jan Waldenströms gata 35, Building 60, Plan 9, 20502, Malmö, Sweden
| | - Aleksander Giwercman
- Reproductive Medicine Centre, Skåne University Hospital, Malmö, Sweden.,Department of Translational Medicine, Clinical Research Centre, Lund University, Jan Waldenströms gata 35, Building 60, Plan 9, 20502, Malmö, Sweden
| |
Collapse
|
2
|
Fuentes A, Sequeira K, Tapia-Pizarro A. Efectos demográficos, clínicos y biológicos de la postergación de la maternidad. REVISTA MÉDICA CLÍNICA LAS CONDES 2021. [DOI: 10.1016/j.rmclc.2020.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|
3
|
Roberts LM, Kudesia R, Zhao H, Dolan S, Rose M. A cross-sectional survey of fertility knowledge in obstetrics and gynecology residents. FERTILITY RESEARCH AND PRACTICE 2020; 6:22. [PMID: 33292597 PMCID: PMC7724860 DOI: 10.1186/s40738-020-00091-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 12/02/2020] [Indexed: 12/14/2022]
Abstract
Background To evaluate fertility knowledge among current Obstetrics and Gynecology (OB-GYN) residents using a recently published validated instrument, the Fertility and Infertility Treatment Knowledge Score (FIT-KS). Methods OB-GYN residents in the United States were recruited through an email to all residency coordinators nationwide. They were asked to voluntarily respond to a short questionnaire including demographic information and the FIT-KS instrument, through an online survey platform. Of approximately 5000 OB-GYN residents in the country, 177 responded. Results The sample was 91% female, with 69% between the ages of 26 and 30. Participants evenly represented all 4 years of training. Mean FIT-KS score was 21.2 (73% correct; range 17–26). No statistically significant differences were noted across the level of training. Several knowledge gaps were noted. Residents could define the common assisted reproductive technologies; however overestimated their success rates per cycle. Conclusions Substantial gaps exist in fertility knowledge among OB-GYN residents, with understanding of male fertility and success rates of Assisted Reproductive Technologies (ART) being particularly limited. Knowledge of fertility does not change throughout residency training, demonstrating consistent gaps in fertility knowledge. Knowledge during post graduate year (PGY)-1 year is consistent with mean scores found in prior research in Internal Medicine residents (65%), as well as a cohort of female medical students and obstetrics and gynecology residents and fellows (64.9%) (Fertil Steril 108:711-7, 2017; Fertil Steril 110:e239, 2018). Supplementary Information The online version contains supplementary material available at 10.1186/s40738-020-00091-2.
Collapse
Affiliation(s)
- Leah May Roberts
- Department of Obstetrics, Gynecology and Reproductive Sciences, Temple University Hospital at the Lewis Katz School of Medicine, 3401 N Broad Street, Philadelphia, PA, 19102, USA.
| | - Rashmi Kudesia
- Division of Reproductive Endocrinology & Infertility, CCRM Houston, Houston, TX, USA.,Division of Reproductive Endocrinology & Infertility, Houston Methodist Hospital, Houston, TX, USA
| | - Huaqing Zhao
- Department of Clinical Sciences, Temple University Hospital at the Lewis Katz School of Medicine, Philadelphia, PA, USA
| | - Shaliz Dolan
- Department of Obstetrics, Gynecology and Reproductive Sciences, Temple University Hospital at the Lewis Katz School of Medicine, 3401 N Broad Street, Philadelphia, PA, 19102, USA
| | - Marisa Rose
- Department of Obstetrics, Gynecology and Reproductive Sciences, Temple University Hospital at the Lewis Katz School of Medicine, 3401 N Broad Street, Philadelphia, PA, 19102, USA
| |
Collapse
|
4
|
Elenkov A, Giwercman A, Søgaard Tøttenborg S, Bonde JPE, Glazer CH, Haervig KK, Bungum AB, Nilsson PM. Male childlessness as independent predictor of risk of cardiovascular and all-cause mortality: A population-based cohort study with more than 30 years follow-up. PLoS One 2020; 15:e0237422. [PMID: 32881896 PMCID: PMC7470262 DOI: 10.1371/journal.pone.0237422] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 07/14/2020] [Indexed: 01/19/2023] Open
Abstract
In a recent population-based study, an elevated risk of the Metabolic syndrome (MetS) and type 2 diabetes was found in childless men compared to those who have fathered one or more children. Therefore, by using a larger cohort of more than 22 000 men from the Malmo Preventive Project (MPP) we aimed to expand our observations in order to evaluate the metabolic profile of childless men and to evaluate if childlessness is an additional and independent predictor of major adverse cardiovascular events (MACE), mortality and incident diabetes when accounting for well-known biochemical, anthropometric, socio-economic and lifestyle related known risk factors. Logistic regression was used to assess risk of MACE, diabetes and MetS at baseline. Multivariate Cox regression was used to evaluate the risks of MACE and mortality following the men from baseline screening until first episode of MACE, death from other causes, emigration, or end of follow-up (31st December 2016) adjusting for age, family history, marital status, smoking, alcohol consumption, educational status, body mass index, prevalent diabetes, high blood lipids, increased fasting glucose and hypertension. Childless men presented with a worse metabolic profile than fathers at the baseline examination, with elevated risk of high triglycerides, odds ratio (OR) 1.24 (95%CI: 1.10–1.42), high fasting glucose OR 1.23 (95%CI: 1.05–1.43) and high blood pressure, OR 1.28 (95%CI: 1.14–1.45), respectively. In the fully adjusted prospective analysis, childless men presented with elevated risk of cardiovascular mortality, HR: 1.33 (95% CI: 1.18–1.49) and all-cause mortality, HR 1.23 (95%CI: 1.14–1.33), respectively. In conclusion, these results add to previous studies showing associations between male reproductive health, morbidity and mortality. Male childlessness, independently of well-known socio-economic, behavioral and metabolic risk factors, predicts risk of cardiovascular disease and mortality. Consequently, this group of men should be considered as target population for preventive measures.
Collapse
Affiliation(s)
- Angel Elenkov
- Department of Translational Medicine, Molecular Reproductive Medicine, Lund University, Malmoe, Sweden
- Reproductive Medicine Center, Skåne University Hospital, Malmoe, Sweden
- * E-mail:
| | - Aleksander Giwercman
- Department of Translational Medicine, Molecular Reproductive Medicine, Lund University, Malmoe, Sweden
- Reproductive Medicine Center, Skåne University Hospital, Malmoe, Sweden
| | | | - Jens Peter Ellekilde Bonde
- Department of Occupational and Environmental Medicine, Bispebjerg Hospital, Copenhagen, Denmark
- Department of Public Health, The Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Katia Keglberg Haervig
- Department of Occupational and Environmental Medicine, Bispebjerg Hospital, Copenhagen, Denmark
| | - Ane Berger Bungum
- Department of Occupational and Environmental Medicine, Bispebjerg Hospital, Copenhagen, Denmark
| | - Peter M. Nilsson
- Department of Clinical Sciences, Internal Medicine Research Group, Skåne University Hospital, Malmoe, Sweden
| |
Collapse
|
5
|
Ahrenfeldt LJ, Möller S, Wensink M, Jensen TK, Christensen K, Lindahl-Jacobsen R. Heritability of subfertility among Danish twins. Fertil Steril 2020; 114:618-627. [DOI: 10.1016/j.fertnstert.2020.03.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 03/05/2020] [Accepted: 03/10/2020] [Indexed: 12/18/2022]
|
6
|
Sylvest R, Koert E, Birch Petersen K, Malling G, Hald F, Nyboe Andersen A, Schmidt L. Attitudes towards family formation among men attending fertility counselling. REPRODUCTIVE BIOMEDICINE & SOCIETY ONLINE 2018; 6:1-9. [PMID: 30182067 PMCID: PMC6120434 DOI: 10.1016/j.rbms.2018.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 04/06/2018] [Accepted: 06/18/2018] [Indexed: 05/08/2023]
Abstract
Men and women are increasingly postponing childbearing until an age where fertility has decreased, meaning that they might have difficulties in achieving their desired family size. This study explored childless men's attitudes towards family formation. Data were collected through semi-structured qualitative interviews with 21 men attending the Fertility Assessment and Counselling Clinic in Copenhagen or Horsens, Denmark. Data were analysed using content analysis. The men envisioned a nuclear family with their own biological children, but they experienced doubts and ambivalence about parenthood and feeling 'ready'. Their lack of readiness was linked to their awareness of the sacrifices and costs involved with parenthood, and their belief that they could safely delay parenthood. The men did not consider that they may be unable to have their own biological children. This study highlights the importance of considering men's attitudes and preferences towards family formation when understanding couples' decision-making. Contrary to common understanding, the findings show that men are as concerned with the planning and timing of parenthood as women, but their knowledge of the age-related decline in fertility is poor. Men need to gain more awareness of the limitations of fertility and the impact of female and male age on the ability to achieve parenthood aspirations.
Collapse
Affiliation(s)
- R. Sylvest
- Fertility Clinic, Department of Obstetrics and Gynaecology, Hvidovre Hospital, University Hospital of Copenhagen, 2650 Hvidovre, Denmark
- Corresponding author.
| | - E. Koert
- Fertility Clinic, University Hospital of Copenhagen, Rigshospitalet, 2100 Copenhagen Ø, Denmark
| | - K. Birch Petersen
- Fertility Clinic, University Hospital of Zealand, 4300 Holbæk, Denmark
| | - G.M.H. Malling
- Department of Public Health, University of Copenhagen, 1014 Copenhagen K, Denmark
| | - F. Hald
- Fertility Clinic, Region Hospital Horsens, 8700, Horsens, Denmark
| | - A. Nyboe Andersen
- Fertility Clinic, University Hospital of Copenhagen, Rigshospitalet, 2100 Copenhagen Ø, Denmark
| | - L. Schmidt
- Department of Public Health, University of Copenhagen, 1014 Copenhagen K, Denmark
| |
Collapse
|
7
|
te Velde E, Habbema D, Nieschlag E, Sobotka T, Burdorf A. Ever growing demand for in vitro fertilization despite stable biological fertility—A European paradox. Eur J Obstet Gynecol Reprod Biol 2017; 214:204-208. [DOI: 10.1016/j.ejogrb.2017.04.030] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Revised: 04/07/2017] [Accepted: 04/15/2017] [Indexed: 11/25/2022]
|
8
|
Ajaero CK, Odimegwu C, Ajaero ID, Nwachukwu CA. Access to mass media messages, and use of family planning in Nigeria: a spatio-demographic analysis from the 2013 DHS. BMC Public Health 2016; 16:427. [PMID: 27220416 PMCID: PMC4877816 DOI: 10.1186/s12889-016-2979-z] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 03/23/2016] [Indexed: 11/24/2022] Open
Abstract
Background Nigeria has the highest population in sub-Saharan Africa with high birth and growth rates. There is therefore need for family planning to regulate and stabilize this population. This study examined the relationship between access to mass media messages on family planning and use of family planning in Nigeria. It also investigated the impacts of spatio-demographic variables on the relationship between access to mass media messages and use of family planning. Methods Data from the 2013 demographic and health survey of Nigeria which was conducted in all the 36 states of Nigeria, and Abuja were used for the study. The sample was weighted to ensure representativeness. Univariate, bivariate and binary logistic regressions were conducted. The relationship between each of the access to mass media messages, and the family planning variables were determined with Pearson correlation analysis. Results The correlation results showed significant but weak direct relationships between the access to mass media messages and use of family planning at p < 0.0001 with access to television messages (r = 0.239) being associated with highest use of family planning. Some of the results of the adjusted regression analysis showed that access to television messages (OR = 1.2.225; p < 0.0001), and radio messages (OR = 1.945; p < 0.0001) increase the likelihood of the use of family planning. The adjusted regression model also indicated increased likelihood in the use of family planning by respondents with secondary education (OR = 2.709; p < 0.0001), the married (OR = 1.274; p < 0.001), and respondents within the highest wealth quintiles (OR = 3.442; p < 0.0001). Conclusions There exist significant variations within spatio-demographic groups with regards to having access to mass media messages on family planning, and on the use of family planning. The results showed that access to mass media messages increases the likelihood of the use of family planning. Also people with higher socioeconomic status and those from the Southern part of the country make more use of family planning. There is need to improve the socioeconomic status of the populations. Also, the quality and regularity of mass media messages should be improved, while other communication avenues such as traditional institutions, blogs, and seminars for youths should be used to make family planning messages more acceptable.
Collapse
Affiliation(s)
- Chukwuedozie K Ajaero
- Department of Geography, University of Nigeria Nsukka, Nsukka, Nigeria. .,Demography and Population Studies Programme, University of the Witwatersrand, Johannesburg, South Africa.
| | - Clifford Odimegwu
- Demography and Population Studies Programme, University of the Witwatersrand, Johannesburg, South Africa
| | - Ijeoma D Ajaero
- Department of Mass Communication, University of Nigeria Nsukka, Nsukka, Nigeria
| | | |
Collapse
|
9
|
Birch Petersen K, Sylvest R, Nyboe Andersen A, Pinborg A, Westring Hvidman H, Schmidt L. Attitudes towards family formation in cohabiting and single childless women in their mid- to late thirties. HUM FERTIL 2016; 19:48-55. [PMID: 27006139 DOI: 10.3109/14647273.2016.1156171] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This study aimed to explore attitudes towards family formation in single or cohabiting childless women of advanced age. The design comprised semi-structured qualitative interviews of 20 women aged 34-39 years attending the Fertility Assessment and Counselling Clinic, Rigshospitalet, Copenhagen. A sample of 10 single women and 10 cohabiting women was chosen with equal distribution of postgraduate education length. Data were analysed using content analysis following the method of Graneheim and Lundman and consolidated criteria for reporting qualitative research (COREQ). The general attitude towards family formation was characterized by a fear of the consequences of choosing motherhood on one hand, and a 'ticking biological clock' and a wish to establish a nuclear family on the other. The women idealized the perception of perfect mothering in terms of uncompromising expectations of child rearing and showed an increasing awareness of solo motherhood as a possible solution to advanced age, the wish of a child and single status compared to earlier studies. Our study contributes to knowledge and understanding of personal considerations related to childbearing in nullipara women in their mid- to late 30s and may be useful in a fertility assessment and counselling setting.
Collapse
Affiliation(s)
- Kathrine Birch Petersen
- a Fertility Clinic, Rigshospitalet , University Hospital of Copenhagen , Copenhagen , Denmark
| | - Randi Sylvest
- a Fertility Clinic, Rigshospitalet , University Hospital of Copenhagen , Copenhagen , Denmark
| | - Anders Nyboe Andersen
- a Fertility Clinic, Rigshospitalet , University Hospital of Copenhagen , Copenhagen , Denmark
| | - Anja Pinborg
- b Department of Obstetrics and Gynecology, Fertility Clinic , Hvidovre Hospital, University of Copenhagen , Hvidovre , Denmark
| | - Helene Westring Hvidman
- a Fertility Clinic, Rigshospitalet , University Hospital of Copenhagen , Copenhagen , Denmark
| | - Lone Schmidt
- c Department of Public Health , University of Copenhagen , Copenhagen , Denmark
| |
Collapse
|
10
|
Rejoinder: The Authors Respond. Epidemiology 2016; 27:462-3. [PMID: 26844412 DOI: 10.1097/ede.0000000000000458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
11
|
Eisenberg ML, Li S, Cullen MR, Baker LC. Increased risk of incident chronic medical conditions in infertile men: analysis of United States claims data. Fertil Steril 2015; 105:629-636. [PMID: 26674559 DOI: 10.1016/j.fertnstert.2015.11.011] [Citation(s) in RCA: 137] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 11/04/2015] [Accepted: 11/05/2015] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To determine the incidence of chronic medical conditions of men with infertility. DESIGN Retrospective cohort study. SETTING Not applicable. PATIENT(S) Subjects contained within the Truven Health MarketScan claims database from 2001 to 2009. INTERVENTION(S) Not applicable. MAIN OUTCOME MEASURE(S) The development of chronic medical conditions including hypertension, diabetes, hyperlipidemia, renal disease, pulmonary disease, liver disease, depression, peripheral vascular disease, cerebrovascular disease, heart disease, injury, alcohol abuse, drug abuse, anxiety disorders, and bipolar disorder. RESULT(S) In all, 13,027 men diagnosed with male factor infertility were identified with an additional 23,860 receiving only fertility testing. The average age was 33.1 years for men diagnosed with infertility and 32.8 years for men receiving testing alone. After adjusting for confounding factors, men diagnosed with male factor infertility had a higher risk of developing diabetes (hazard ratio [HR] 1.30, 95% confidence interval [CI] 1.10-1.53), ischemic heart disease (HR 1.48, 95% CI 1.19-1.84), alcohol abuse (HR 1.48, 95% CI 1.07-2.05), and drug abuse (1.67, 95% CI 1.06-2.63) compared with men who only received infertility testing. Similar patterns were identified when comparing those with male factor infertility to vasectomized men. The association between male factor infertility and later health outcomes were strongest for men with longer follow-up. CONCLUSION(S) In this cohort of patients in a national insurance database, men diagnosed with male factor infertility had a significantly higher risk of adverse health outcomes in the years after an infertility evaluation. These findings suggest the overall importance of men's reproductive health and warrant additional investigation to understand the association and identify interventions to improve outcomes for these patients.
Collapse
Affiliation(s)
- Michael L Eisenberg
- Departments of Urology and Obstetrics/Gynecology, Stanford University School of Medicine, Stanford, California.
| | - Shufeng Li
- Departments of Urology and Dermatology, Stanford University School of Medicine, Stanford, California
| | - Mark R Cullen
- Department of Internal Medicine, Stanford University School of Medicine, Stanford, California
| | - Laurence C Baker
- Department of Health Research and Policy, Stanford University, Stanford, California and National Bureau of Economic Research, Cambridge, Massachusetts
| |
Collapse
|
12
|
Birch Petersen K, Hvidman HW, Sylvest R, Pinborg A, Larsen EC, Macklon KT, Andersen AN, Schmidt L. Family intentions and personal considerations on postponing childbearing in childless cohabiting and single women aged 35-43 seeking fertility assessment and counselling. Hum Reprod 2015; 30:2563-74. [PMID: 26401054 DOI: 10.1093/humrep/dev237] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 08/27/2015] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION What characterizes childless women aged 35 years and above seeking fertility assessment and counselling in relation to their reproduction and are there significant differences between single and cohabiting women? SUMMARY ANSWER Despite the women's advanced age and knowledge of the age-related decline in fecundity, 70% of the single women sought fertility assessment and counselling to gain knowledge regarding the possibility of postponing pregnancy. WHAT IS KNOWN ALREADY Recent studies have indicated an increasing demand for ovarian reserve testing in women without any known fertility problem to obtain knowledge on their reproductive lifespan and pro-fertility advice. Women postpone their first pregnancy, and maternal age at first birth has increased in western societies over the past two to four decades. Postponed childbearing implies a higher rate of involuntary childlessness, smaller families than desired and declining fertility rates. STUDY DESIGN, SIZE, AND DURATION Baseline data from a cross-sectional cohort study of 340 women aged 35-43 years examined at the Fertility Assessment and Counselling (FAC) Clinic at Copenhagen University Hospital from 2011 to 2014. The FAC Clinic was initiated to provide individual fertility assessment and counselling. PARTICIPANTS/MATERIALS, SETTING, METHODS Eligible women were childless and at least 35 years of age. All completed a web-based questionnaire before and after the consultation including socio-demographic, reproductive, medical, lifestyle and behavioural factors. Consultation by a fertility specialist included transvaginal ultrasound, full reproductive history and AMH measurement. MAIN RESULTS AND THE ROLE OF CHANCE The study comprised 140 cohabiting and 200 single women. The majority (82%) were well-educated and in employment. Their mean age was 37.4 years. Nonetheless, the main reasons for attending were to obtain knowledge regarding the possibility of postponing pregnancy (63%) and a concern about their fecundity (52%). The majority in both groups (60%) wished for two or more children. The women listed their ideal age at birth of first child and last child as 33 (±4.7) years and 39 (±3.5) years, respectively. Of the single women, 70% would accept use of sperm donation compared with 25% of the cohabiting women (P < 0.001). In general, 45% considered oocyte vitrification for social reasons, yet only 15% were positive towards oocyte donation. The two groups were comparable regarding lifestyle factors, number of previous sexual partners, pregnancies, and ovarian reserve parameters. LIMITATIONS, REASONS FOR CAUTION The women in the present study were conscious of the risk of infertility with increasing age and attended the FAC Clinic due to a concern about their remaining reproductive lifespan, which in combination with their high educational level could impair the generalizability to the background population. WIDER IMPLICATIONS OF THE FINDINGS The results indicate that in general women overestimate their own reproductive capacity and underestimate the risk of future childlessness with the continuous postponement of pregnancies.
Collapse
Affiliation(s)
- K Birch Petersen
- Fertility Clinic, Copenhagen University Hospital, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
| | - H W Hvidman
- Fertility Clinic, Copenhagen University Hospital, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
| | - R Sylvest
- Fertility Clinic, Copenhagen University Hospital, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
| | - A Pinborg
- Department of Gynaecology/Obstetrics, Copenhagen University Hospital Hvidovre Hospital, Kettegård Alle 30, DK-2650 Hvidovre, Copenhagen, Denmark
| | - E C Larsen
- Fertility Clinic, Copenhagen University Hospital, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
| | - K T Macklon
- Fertility Clinic, Copenhagen University Hospital, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
| | - A Nyboe Andersen
- Fertility Clinic, Copenhagen University Hospital, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
| | - L Schmidt
- Department of Public Health, University of Copenhagen, Oester Farimagsgade 5, PO Box 2099, DK-1071 Copenhagen K, Denmark
| |
Collapse
|
13
|
Joffe M. Selection Bias Due to Parity-conditioning in Studies of Time Trends in Fertility. Epidemiology 2015; 26:e67. [PMID: 26372378 DOI: 10.1097/ede.0000000000000383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Michael Joffe
- Department of Epidemiology and Biostatistics, Imperial College London, St. Mary's Campus, London, United Kingdom,
| |
Collapse
|
14
|
Cabrera-León A, Lopez-Villaverde V, Rueda M, Moya-Garrido MN. Calibrated prevalence of infertility in 30- to 49-year-old women according to different approaches: a cross-sectional population-based study. Hum Reprod 2015; 30:2677-85. [PMID: 26370663 DOI: 10.1093/humrep/dev226] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 08/24/2015] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION How does the estimated prevalence of infertility among 30- to 49-year-old women vary when using different approaches to its measurement? SUMMARY ANSWER The prevalence of women with difficulties in conceiving differed widely according to the measurement approach adopted. WHAT IS KNOWN ALREADY Establishing the true magnitude of infertility as a public health problem is challenging, given that it is not categorized as a disability or chronic condition and may be largely unreported. The time required to conceive is an increasingly frequent concern among couples of reproductive age. Population-based studies do not consider multiple approaches to infertility measurement in the same sample. STUDY DESIGN, SIZE, DURATION A face-to-face cross-sectional population-based survey of 443 women aged between 30 and 49 years residing in Huelva, southern Spain, was carried out. The sample size estimation was based on an assumed prevalence of infertility of 19%, a sampling error of ±4.84 percentage points, a design effect of 1.8 and a 95% confidence level. The information was collected in 2011. PARTICIPANTS/MATERIALS, SETTING, METHODS Self-reported information was gathered on socio-demographic data, pregnancy history, time required to become pregnant and perception of difficulties in becoming pregnant. Eight approaches to the estimation of infertility prevalence were considered: diagnosed infertility, subjective infertility, 1-year infertility, primary infertility, secondary infertility and subfertility based on the time taken to conceive (6, 12 or 24 months). Calibration estimators (indirect estimation techniques) were used to extrapolate the infertility prevalences to the whole of Spain. MAIN RESULTS AND THE ROLE OF CHANCE The response rate was 61.05%. Among 30- to 49-year-old Spanish women, 1.26% had a clinical diagnosis of infertility, 17.58% did not achieve pregnancy in 1 year (1-year infertility), 8.22% perceived difficulties in procreation (subjective infertility), 6.12% had not succeeded in having biological children (primary infertility) and 11.33% had not been able to have another biological child (secondary infertility). Finally, pregnancy was not achieved within 6, 12 and 24 months of starting to attempt conception in 19.98, 11.21 and 4.36% of women, respectively. These approaches to estimate the prevalence of infertility show similar socio-demographic patterns except for educational level. Calibration adjustments allowed extrapolation of these prevalences to Spain and a reduction of from 3.7 to 90.4% in their variances. LIMITATIONS, REASONS FOR CAUTION The response rate was moderate but acceptable in comparison to similar studies. We only asked whether the women had practiced intercourse without contraceptive methods for >1 year. Hence, we could only calculate the time for which a couple were trying to become pregnant when the woman became pregnant, and we do not know whether it was longer than 1 year for the women failing to conceive. Future research should avoid this study weakness by gathering quantitative data on the months during which vaginal sexual intercourse was practiced, with no time limit. The only prevalence with a high coefficient of variation was that for diagnosed infertility, and our estimation for this prevalence should be interpreted with caution. WIDER IMPLICATIONS OF THE FINDINGS Despite major differences according to the approach adopted, the prevalences of infertility estimated in our study are comparable with those obtained in other similar studies. A set of categories to measure infertility including subjective infertility, 1-year infertility and subfertility have been proposed here, which may be useful for cross-disciplinary comparisons of infertility in clinical and population-based studies. These measures may also assist health managers to tailor fertility resources and services to the real needs of the population and provide a more rapid and effective response to couples. Finally, the calibration adjustments (indirect estimation techniques) applied to the infertility prevalences help to maximize their generalization and improve accuracy. This technique may be considered as a model for application in other epidemiological studies.
Collapse
Affiliation(s)
- A Cabrera-León
- Andalusian School of Public Health, Andalusian Ministry of Health, Granada 18080, Spain Biomedical Research Networking Centre on Public Health and Epidemiology (CIBERESP, Spanish Acronym), Madrid 28029, Spain University of Granada, Granada 18071, Spain
| | - V Lopez-Villaverde
- Valme Hospital, Seville, Andalusian Ministry of Health, Andalusian 41014, Spain
| | - M Rueda
- University of Granada, Granada 18071, Spain
| | - M N Moya-Garrido
- Andalusian School of Public Health, Andalusian Ministry of Health, Granada 18080, Spain University of Seville, Seville 41012, Spain
| |
Collapse
|
15
|
Abstract
BACKGROUND Studies of couple fertility over time have often examined study populations with broad age ranges at a cross-section of time. An increase in fertility has been observed in studies that followed episodes of fertility events either prospectively among nulliparous women or retrospectively among parous women. Fertility has a biological effect on parity. If defined at a cross-section of time, parity will also be affected by year of birth, and thus becomes a collider. Conditioning (stratifying, restricting, or adjusting) on a collider may cause selection bias in the studied association. METHODS A study with prospective follow-up was taken as the model to assess the validity of fertility studies. We demonstrate the potential for selection bias using causal graphs and nationwide birth statistics and other demographic data. We tested the existence of parity-conditioning bias in data including both parous and nulliparous women. We also used a simulation approach to assess the strength of the bias in populations with prior at-risk cycles. Finally, we evaluated the potential for selection bias due to conditioning on parity in various sampling frames. RESULTS Analyses indicate that the observed increase in fertility over time can be entirely explained by selection bias due to parity-conditioning. CONCLUSION Heterogeneity in fertility and differential success in prior at-risk cycles are the ultimate factors behind the selection bias. The potential for selection bias due to parity-conditioning varies by sampling frame. A prospective multidecade study with representative sampling of birth cohorts and follow-up from menarche to menopause would bypass the described bias.
Collapse
|
16
|
Tremellen K, Savulescu J. Ovarian reserve screening: a scientific and ethical analysis. Hum Reprod 2014; 29:2606-14. [DOI: 10.1093/humrep/deu265] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
|
17
|
Mortensen LL, Hegaard HK, Andersen AN, Bentzen JG. Attitudes towards motherhood and fertility awareness among 20-40-year-old female healthcare professionals. EUR J CONTRACEP REPR 2014; 17:468-81. [PMID: 23157704 DOI: 10.3109/13625187.2012.728015] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To explore attitudes towards family formation and fertility awareness among Danish female healthcare professionals. METHODS We collected cross-sectional baseline data from a prospective cohort study of 863 women, ranging in age from 20 to 40 years, working at a hospital in Denmark. Information about participants' intentions and attitudes towards family formation and fertility knowledge was gathered by means of a questionnaire. RESULTS Only 2% of the respondents did not want children. Most women believed that motherhood is important, and hoped to have two to three children. About half of the respondents intended to have their last child after the age of 35 years. The most important prerequisites for family formation included: living in a stable relationship, having completed one's studies, a sound financial situation, a job that can be kept when having children, access to public child day care, and the possibility of travelling. As many as 50% of women underrated the impact of a woman's age on fertility, and overestimated the success rates of assisted reproductive technology (ART) treatments. CONCLUSIONS Many female healthcare professionals contemplated giving birth after the age of 35 years. Knowledge of fertility and ART success rates is needed to make well-informed decisions about when to have children.
Collapse
|
18
|
Abstract
OBJECTIVES This study aimed to assess the association of socioeconomic conditions with female fertility impairment among women who delivered a live birth. DESIGN Cross-sectional analysis. SETTING Population-based birth cohort (Generation XXI) assembled in 2005/2006 from five public maternity units in Porto Metropolitan Region, Northern Portugal. PARTICIPANTS 7472 women aged 18 or more with spontaneous conception and no male diagnosis of infertility were recruited and interviewed immediately after birth with structured questionnaires. EXPOSURES OF INTEREST Maternal education, occupation and income were recorded as proxy indicators of social conditions. OUTCOME Impaired female fertility, defined as women who had unsuccessfully tried to conceive for over a year. DATA ANALYSIS Multivariate logistic regression models were fitted to estimate the association between each socioeconomic indicator and impaired female fertility, stratified by previous pregnancy experience and adjusted for age, pregnancy planning and behavioural characteristics. RESULTS Among primigravidae, 7.7% (95% CI 6.8% to 8.6%) presented impaired fertility and the prevalence was 9.6% (95% CI 8.7% to 10.6%) in multigravidae. In crude analysis, we found women with impaired fertility to be older, less educated, more likely to have planned the current pregnancy and to be overweight/obese; they had similar levels of income or occupation. In multivariate models, a significant independent association between educational level and female fertility impairment remained among primigravidae (OR (95% CI) vs ≤6 schooling years: 7-9: 0.85 (0.54 to 1.34); 10-12: 0.34 (0.21 to 0.54); >12: 0.24 (0.14 to 0.40), ptrend<0.001) but not in multigravidae. CONCLUSIONS This study shows that education might be important in understanding female fertility impairment, particularly among first-time pregnant women. It also points out that the association is not totally explained by other sociodemographic and lifestyle characteristics that have been previously found to be important to disclose this relation.
Collapse
Affiliation(s)
- Sofia Correia
- Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal
- Institute of Public Health, University of Porto, Porto, Portugal
| | - Teresa Rodrigues
- Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal
- Institute of Public Health, University of Porto, Porto, Portugal
- Department of Gynaecology and Obstetrics, Hospital Sao Joao-EPE, Porto, Portugal
| | - Henrique Barros
- Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal
- Institute of Public Health, University of Porto, Porto, Portugal
| |
Collapse
|
19
|
Slama R, Ballester F, Casas M, Cordier S, Eggesbø M, Iniguez C, Nieuwenhuijsen M, Philippat C, Rey S, Vandentorren S, Vrijheid M. Epidemiologic tools to study the influence of environmental factors on fecundity and pregnancy-related outcomes. Epidemiol Rev 2013; 36:148-64. [PMID: 24363355 DOI: 10.1093/epirev/mxt011] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Adverse pregnancy outcomes entail a large health burden for the mother and offspring; a part of it might be avoided by better understanding the role of environmental factors in their etiology. Our aims were to review the assessment tools to characterize fecundity troubles and pregnancy-related outcomes in human populations and their sensitivity to environmental factors. For each outcome, we reviewed the possible study designs, main sources of bias, and their suggested cures. In terms of study design, for most pregnancy outcomes, cohorts with recruitment early during or even before pregnancy allow efficient characterization of pregnancy-related events, time-varying confounders, and in utero exposures that may impact birth outcomes and child health. Studies on congenital anomalies require specific designs, assessment of anomalies in medical pregnancy terminations, and, for congenital anomalies diagnosed postnatally, follow-up during several months after birth. Statistical analyses should take into account environmental exposures during the relevant time windows; survival models are an appropriate approach for fecundity, fetal loss, and gestational duration/preterm delivery. Analysis of gestational duration could distinguish pregnancies according to delivery induction (and possibly pregnancy-related conditions). In conclusion, careful design and analysis are required to better characterize environmental effects on human reproduction.
Collapse
Affiliation(s)
- Rémy Slama
- Abbreviations: PROM, premature rupture of the fetal membranes; TTP, time to pregnancy
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Joffe M, Holmes J, Jensen TK, Keiding N, Best N. Time trends in biological fertility in Western Europe. Am J Epidemiol 2013; 178:722-30. [PMID: 23887045 DOI: 10.1093/aje/kwt048] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We investigated trends in biological fertility in a comprehensive analysis of 5 major European data sets with data on time to pregnancy (TTP) and proportion of contraceptive failures. In particular, we distinguished a period effect from a birth cohort effect (lifelong tendency) in both sexes. Attempts at conception not resulting in birth were excluded. We analyzed data on pregnancies occurring in 9,247 couples between 1953 and 1993 and performed sensitivity analyses to check the robustness of findings. Separate analyses of each time effect showed an increasing fertility trend. Mutually adjusted analyses demonstrated that this rise was visible as a male cohort effect for both TTP and contraceptive failure. On the other hand, the female birth cohort effect showed a slight fall in the first half of the study period for both TTP and contraceptive failure. As a period effect, fertility remained generally stable, the slight trends in TTP and contraceptive failure being in opposite directions, likely indicating an artifact. The rising trend accords with most previous evidence. The increasing trend in male fertility does not contradict the previously reported semen quality deterioration, the effects of which are calculated to be small. The declining female fertility accords with a falling dizygotic twinning rate during the same period.
Collapse
Affiliation(s)
- Michael Joffe
- Department of Epidemiology and Biostatistics, Faculty of Medicine Building, School of Public Health, Norfolk Place, London, United Kingdom.
| | | | | | | | | |
Collapse
|
21
|
Priskorn L, Holmboe SA, Jacobsen R, Jensen TK, Lassen TH, Skakkebaek NE. Increasing trends in childlessness in recent birth cohorts - a registry-based study of the total Danish male population born from 1945 to 1980. ACTA ACUST UNITED AC 2012; 35:449-55. [DOI: 10.1111/j.1365-2605.2012.01265.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
|
22
|
Ziomkiewicz A, Wichary S, Bochenek D, Pawlowski B, Jasienska G. Temperament and ovarian reproductive hormones in women: evidence from a study during the entire menstrual cycle. Horm Behav 2012; 61:535-40. [PMID: 22342576 DOI: 10.1016/j.yhbeh.2012.01.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Revised: 01/31/2012] [Accepted: 01/31/2012] [Indexed: 12/15/2022]
Abstract
Personality and temperament were hypothesized to function as important factors affecting life history strategies. Recent research has demonstrated the association between temperamental traits and reproduction in humans, however, the underlying mechanisms are still poorly understood. This study presents evidence for an association between temperamental traits and woman's fecundity, as indicated by levels of ovarian steroid hormones during the menstrual cycle. On a large sample of urban, reproductive age women (n = 108) we demonstrated that activity, endurance and emotional reactivity are associated with levels of estrogen and with a pattern of change of progesterone levels. Women high in activity, high in endurance and low in emotional reactivity had up to twice as high estradiol levels and more favorable progesterone profiles as women low in activity, low in endurance and high in emotional reactivity. The temperamental traits we measured highly overlap with extraversion, neuroticism and negative emotionality that were reported to correlate with reproductive success. Our findings thus suggest a possible explanation for these relationships, linking personality and women's reproductive success through a hormonal pathway.
Collapse
Affiliation(s)
- Anna Ziomkiewicz
- Polish Academy of Sciences, Institute of Anthropology, Kuznicza 35, 50-951 Wroclaw, Poland.
| | | | | | | | | |
Collapse
|
23
|
Slama R, Hansen OKH, Ducot B, Bohet A, Sorensen D, Giorgis Allemand L, Eijkemans MJC, Rosetta L, Thalabard JC, Keiding N, Bouyer J. Estimation of the frequency of involuntary infertility on a nation-wide basis. Hum Reprod 2012; 27:1489-98. [DOI: 10.1093/humrep/des070] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
24
|
Schmidt L, Sobotka T, Bentzen JG, Nyboe Andersen A. Demographic and medical consequences of the postponement of parenthood. Hum Reprod Update 2011; 18:29-43. [PMID: 21989171 DOI: 10.1093/humupd/dmr040] [Citation(s) in RCA: 342] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Across the developed world couples are postponing parenthood. This review assesses the consequences of delayed family formation from a demographic and medical perspective. One main focus is on the quantitative importance of pregnancy postponement. METHODS Medical and social science databases were searched for publications on relevant subjects such as delayed parenthood, female and male age, fertility, infertility, time to pregnancy (TTP), fetal death, outcome of medically assisted reproduction (MAR) and mental well-being. RESULTS Postponement of parenthood is linked to a higher rate of involuntary childlessness and smaller families than desired due to increased infertility and fetal death with higher female and male age. For women, the increased risk of prolonged TTP, infertility, spontaneous abortions, ectopic pregnancies and trisomy 21 starts at around 30 years of age with a more pronounced effects >35 years, whereas the increasing risk of preterm births and stillbirths starts at around 35 years with a more pronounced effect >40 years. Advanced male age has an important but less pronounced effect on infertility and adverse outcomes. MAR treatment cannot overcome the age-related decline in fecundity. CONCLUSIONS In general, women have partners who are several years older than themselves and it is important to focus more on the combined effect of higher female and male age on infertility and reproductive outcome. Increasing public awareness of the impact of advanced female and male age on the reproductive outcome is essential for people to make well-informed decisions on when to start family formation.
Collapse
Affiliation(s)
- L Schmidt
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Denmark.
| | | | | | | | | |
Collapse
|
25
|
Eisenberg ML, Park Y, Hollenbeck AR, Lipshultz LI, Schatzkin A, Pletcher MJ. Fatherhood and the risk of cardiovascular mortality in the NIH-AARP Diet and Health Study. Hum Reprod 2011; 26:3479-85. [PMID: 21946940 DOI: 10.1093/humrep/der305] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Fertility potential and reproductive fitness may reflect a man's future health, given that over one-third of the male human genome is involved in reproduction. We sought to determine if offspring number predicts cardiovascular death in the US men. METHODS Using data from the NIH-AARP Diet and Health Study, 137,903 men (aged 50-71) without prior cardiovascular disease were followed-up for an average of 10.2 years. International Classification of Diseases, ninth edition, codes were used to establish the cause of death, and multivariable Cox proportional hazards modeling was used to estimate the association between offspring number and cardiovascular death while accounting for sociodemographic and lifestyle characteristics. RESULTS Almost all (92%) participants had fathered at least one child and 50% had three or more offspring. A total of 3082 men died of cardiovascular causes during follow-up for an age-adjusted incidence rate of 2.70 per 1000 person-years. Compared with fathers, after adjusting for sociodemographic and lifestyle factors, childless men had a 17% [hazard ratio (HR): 1.17; 95% confidence interval (CI): 1.03-1.32] increased risk of death from cardiovascular disease contracted in the study period, and this elevated risk appeared to extend also to men with only one child. In comparison with fathers of five or more children, adjusted relative hazards for cardiovascular mortality of this sort were 1.06 (95% CI: 0.92-1.22) for four children, 1.02 (0.90-1.16) for three children, 1.02 (0.90-1.16) for two children, 1.11 (0.95-1.30) for one child and 1.21 (1.03-1.41) for no children. CONCLUSIONS Married men who have no children have a higher risk of dying from cardiovascular disease contracted after the age of 50 than men with two or more children.
Collapse
Affiliation(s)
- Michael L Eisenberg
- Department of Urology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305-5118, USA.
| | | | | | | | | | | |
Collapse
|
26
|
Salonia A, Matloob R, Saccà A, Ferrari M, Gallina A, Castiglione F, Abdollah F, Raber M, Brigante C, Candiani M, Rigatti P, Montorsi F. Are Caucasian-European men delaying fatherhood? Results of a 7 year observational study of infertile couples with male factor infertility. ACTA ACUST UNITED AC 2011; 35:125-32. [DOI: 10.1111/j.1365-2605.2011.01197.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
27
|
Demographic age shift toward later conception results in an increased age in the subfertile population and an increased demand for medical care. Fertil Steril 2011; 95:61-3. [DOI: 10.1016/j.fertnstert.2010.05.013] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2009] [Revised: 04/29/2010] [Accepted: 05/03/2010] [Indexed: 11/17/2022]
|
28
|
Breyer BN, Smith JF, Shindel AW, Sharlip ID, Eisenberg ML. The impact of infertility on family size in the USA: data from the National Survey of Family Growth. Hum Reprod 2010; 25:2360-5. [DOI: 10.1093/humrep/deq152] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|