1
|
Bao S, Yin T, Liu S. Ovarian aging: energy metabolism of oocytes. J Ovarian Res 2024; 17:118. [PMID: 38822408 PMCID: PMC11141068 DOI: 10.1186/s13048-024-01427-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 04/30/2024] [Indexed: 06/03/2024] Open
Abstract
In women who are getting older, the quantity and quality of their follicles or oocytes and decline. This is characterized by decreased ovarian reserve function (DOR), fewer remaining oocytes, and lower quality oocytes. As more women choose to delay childbirth, the decline in fertility associated with age has become a significant concern for modern women. The decline in oocyte quality is a key indicator of ovarian aging. Many studies suggest that age-related changes in oocyte energy metabolism may impact oocyte quality. Changes in oocyte energy metabolism affect adenosine 5'-triphosphate (ATP) production, but how related products and proteins influence oocyte quality remains largely unknown. This review focuses on oocyte metabolism in age-related ovarian aging and its potential impact on oocyte quality, as well as therapeutic strategies that may partially influence oocyte metabolism. This research aims to enhance our understanding of age-related changes in oocyte energy metabolism, and the identification of biomarkers and treatment methods.
Collapse
Affiliation(s)
- Shenglan Bao
- Reproductive Medical Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Tailang Yin
- Reproductive Medical Center, Renmin Hospital of Wuhan University, Wuhan, China.
| | - Su Liu
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-Implantation, , Shenzhen Zhongshan Institute for Reproductive Medicine and Genetics, Shenzhen Zhongshan Obstetrics & Gynecology Hospital (Formerly Shenzhen Zhongshan Urology Hospital), Shenzhen, China.
| |
Collapse
|
2
|
Yeung E, Biedrzycki RJ, Gómez Herrera LC, Issarapu P, Dou J, Marques IF, Mansuri SR, Page CM, Harbs J, Khodasevich D, Poisel E, Niu Z, Allard C, Casey E, Berstein FM, Mancano G, Elliott HR, Richmond R, He Y, Ronkainen J, Sebert S, Bell EM, Sharp G, Mumford SL, Schisterman EF, Chandak GR, Fall CHD, Sahariah SA, Silver MJ, Prentice AM, Bouchard L, Domellof M, West C, Holland N, Cardenas A, Eskenazi B, Zillich L, Witt SH, Send T, Breton C, Bakulski KM, Fallin MD, Schmidt RJ, Stein DJ, Zar HJ, Jaddoe VWV, Wright J, Grazuleviciene R, Gutzkow KB, Sunyer J, Huels A, Vrijheid M, Harlid S, London S, Hivert MF, Felix J, Bustamante M, Guan W. Maternal age is related to offspring DNA methylation: A meta-analysis of results from the PACE consortium. Aging Cell 2024:e14194. [PMID: 38808605 DOI: 10.1111/acel.14194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 04/16/2024] [Accepted: 04/19/2024] [Indexed: 05/30/2024] Open
Abstract
Worldwide trends to delay childbearing have increased parental ages at birth. Older parental age may harm offspring health, but mechanisms remain unclear. Alterations in offspring DNA methylation (DNAm) patterns could play a role as aging has been associated with methylation changes in gametes of older individuals. We meta-analyzed epigenome-wide associations of parental age with offspring blood DNAm of over 9500 newborns and 2000 children (5-10 years old) from the Pregnancy and Childhood Epigenetics consortium. In newborns, we identified 33 CpG sites in 13 loci with DNAm associated with maternal age (PFDR < 0.05). Eight of these CpGs were located near/in the MTNR1B gene, coding for a melatonin receptor. Regional analysis identified them together as a differentially methylated region consisting of 9 CpGs in/near MTNR1B, at which higher DNAm was associated with greater maternal age (PFDR = 6.92 × 10-8) in newborns. In childhood blood samples, these differences in blood DNAm of MTNR1B CpGs were nominally significant (p < 0.05) and retained the same positive direction, suggesting persistence of associations. Maternal age was also positively associated with higher DNA methylation at three CpGs in RTEL1-TNFRSF6B at birth (PFDR < 0.05) and nominally in childhood (p < 0.0001). Of the remaining 10 CpGs also persistent in childhood, methylation at cg26709300 in YPEL3/BOLA2B in external data was associated with expression of ITGAL, an immune regulator. While further study is needed to establish causality, particularly due to the small effect sizes observed, our results potentially support offspring DNAm as a mechanism underlying associations of maternal age with child health.
Collapse
Affiliation(s)
- Edwina Yeung
- Epidemiology Branch, Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
| | - Richard J Biedrzycki
- Division of Intramural Research, Glotech Inc., Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
| | - Laura C Gómez Herrera
- ISGlobal, Institute for Global Health, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Prachand Issarapu
- MRC Unit the Gambia at the London School of Hygiene and Tropical Medicine (LSHTM), Banjul, The Gambia
| | - John Dou
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Irene Fontes Marques
- Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Sohail Rafik Mansuri
- Genomic Research on Complex Diseases (GRC-Group), CSIR-Centre for Cellular and Molecular Biology, Hyderabad, Telangana, India
| | - Christian Magnus Page
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Justin Harbs
- Department of Diagnostics and Intervention, Oncology, Umeå University, Umeå, Sweden
| | - Dennis Khodasevich
- Environmental Health Sciences, Berkeley Public Health, CERCH, University of California, Berkeley, California, USA
| | - Eric Poisel
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Zhongzheng Niu
- Department of Population and Public Health Science, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Catherine Allard
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke (CHUS), Sherbrooke, Quebec, Canada
| | - Emma Casey
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Fernanda Morales Berstein
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Bristol Medical School Population Health Sciences, University of Bristol, Bristol, UK
| | - Giulia Mancano
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Bristol Medical School Population Health Sciences, University of Bristol, Bristol, UK
| | - Hannah R Elliott
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Bristol Medical School Population Health Sciences, University of Bristol, Bristol, UK
| | - Rebecca Richmond
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Bristol Medical School Population Health Sciences, University of Bristol, Bristol, UK
| | - Yiyan He
- Research Unit of Population Health, University of Oulu, Oulu, Finland
| | | | - Sylvain Sebert
- Research Unit of Population Health, University of Oulu, Oulu, Finland
| | - Erin M Bell
- Department of Environmental Health Sciences and Epidemiology and Biostatistics, University at Albany School of Public Health, Albany, New York, USA
| | - Gemma Sharp
- Department of Psychology, University of Exeter, Exeter, UK
| | - Sunni L Mumford
- Department of Biostatistics, Epidemiology and Informatics and Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Enrique F Schisterman
- Department of Biostatistics, Epidemiology and Informatics and Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Giriraj R Chandak
- Genomic Research on Complex Diseases (GRC-Group), CSIR-Centre for Cellular and Molecular Biology, Hyderabad, Telangana, India
| | - Caroline H D Fall
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK, UK
| | | | - Matt J Silver
- MRC Unit the Gambia at the London School of Hygiene and Tropical Medicine (LSHTM), Banjul, The Gambia
| | - Andrew M Prentice
- MRC Unit the Gambia at the London School of Hygiene and Tropical Medicine (LSHTM), Banjul, The Gambia
| | - Luigi Bouchard
- Department of Biochemistry and Functional Genomics, Centre intégré Universitaire de santé et de Services Sociaux (CIUSSS) du Saguenay-Lac-St-Jean, Université de Sherbrooke, Sherbrooke, Quebec, Canada
- Department of Laboratory Medicine, CIUSSS du Saguenay-Lac-Saint-Jean - Hôpital de Chicoutimi, Chicoutimi, Quebec, Canada
| | - Magnus Domellof
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | - Christina West
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | - Nina Holland
- Environmental Health Sciences, Berkeley Public Health, CERCH, University of California, Berkeley, California, USA
| | - Andres Cardenas
- Department of Epidemiology and Population Health, Stanford University, Stanford, California, USA
| | - Brenda Eskenazi
- Environmental Health Sciences, Berkeley Public Health, CERCH, University of California, Berkeley, California, USA
| | - Lea Zillich
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Stephanie H Witt
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Tabea Send
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Carrie Breton
- Department of Population and Public Health Science, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Kelly M Bakulski
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - M Daniele Fallin
- Dean's Office, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Rebecca J Schmidt
- Department of Public Health Sciences and the M.I.N.D. Institute, School of Medicine, University of California, Davis, California, USA
| | - Dan J Stein
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- South African Medical Research Council (SAMRC) Unit on Risk and Resilience in Mental Disorders, University of Cape Town, Cape Town, South Africa
| | - Heather J Zar
- South African Medical Research Council (SAMRC) Unit on Risk and Resilience in Mental Disorders, University of Cape Town, Cape Town, South Africa
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Vincent W V Jaddoe
- Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - John Wright
- Bradford Institute for Health Research, Temple Bank House, Bradford Royal Infirmary, Bradford, UK
| | | | - Kristine Bjerve Gutzkow
- Division of Climate and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Jordi Sunyer
- ISGlobal, Institute for Global Health, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- IMIM-Parc Salut Mar, Barcelona, Spain
| | - Anke Huels
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Martine Vrijheid
- ISGlobal, Institute for Global Health, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Sophia Harlid
- Department of Diagnostics and Intervention, Oncology, Umeå University, Umeå, Sweden
| | - Stephanie London
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, Durham, North Carolina, USA
| | - Marie-France Hivert
- Division of Chronic Disease Research across the Lifecourse (CoRAL); Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
- Diabetes Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Janine Felix
- Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Mariona Bustamante
- ISGlobal, Institute for Global Health, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Weihua Guan
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| |
Collapse
|
3
|
Baldwin K. "You feel like you're fairly disadvantaged with an advert over your head saying 'in final years of reproduction'": social egg freezing, dating and the (unequal) politics of reproductive ageing. CULTURE, HEALTH & SEXUALITY 2024:1-15. [PMID: 38739479 DOI: 10.1080/13691058.2024.2341852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 04/08/2024] [Indexed: 05/16/2024]
Abstract
Recent decades have seen an increasing gap occurring between the 'desired' and 'actual' family size of middle-class and professional women. This situation of 'unrealised fertility' and 'incomplete families' carries implications at a population, but also couple and individual level. This paper explores how middle-class professional women make decisions about partnering and parenthood and how these are shaped by a contemporary neoliberal feminist discourse which articulates the possibility of 'having it all' through engagement in careful life planning, appropriate self-investment, and by drawing on new technologies of reproductive biomedicine. Informed by semi-structured interviews with UK and US women conducted at two different points in time, it explores how they approach and experience the process of relationship formation in the face of age-related fertility decline. It also examines how the use of social egg freezing shape their romantic and family building expectations but also their interactions with (potential) partners. In doing so, it explores how gendered cultural dating scripts and unequal gender power relations shape the formation and progression of intimate relationships in a manner which can disempower women as they age. It therefore questions whether egg freezing may be the 'great equaliser' that some have hoped.
Collapse
Affiliation(s)
- Kylie Baldwin
- Centre for Reproduction Research, Faculty of Health and Life Sciences, De Montfort University, Leicester, UK
| |
Collapse
|
4
|
Desy A, Marre D. The reproductive journeys of French women over 40 seeking assisted reproductive technology treatments in Spain. Soc Sci Med 2024; 351:116951. [PMID: 38743990 DOI: 10.1016/j.socscimed.2024.116951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 05/02/2024] [Accepted: 05/06/2024] [Indexed: 05/16/2024]
Abstract
Fertility decline is a complex phenomenon resulting from converging social and cultural changes that are governed through politics. As it has been discussed in many studies, the European's low fertility rate goes hand in hand with the trend of maternity postponement. Although in many European countries over the last decades reproduction is envisaged as an individual choice that can be made at older ages, having a child after a certain age can be impossible -either "naturally" or using assisted reproductive technology-depending on the medical and legislative possibilities and limits of the country in which people live. In the extremely diverse European reproscape, reproductive legislations have forced but also allowed many people to seek reproductive treatments outside their home countries. Spain is a leading destination in Europe for cross border reproductive travel and, of the foreigners it receives, the French are the largest group. Despite having a history of strong pro-natalist policies, France has been one of the strictest European countries regarding access to medically assisted procreation. Until 2022, only heterosexual couples in which women were under 43 years of age could access treatments. Despite the recent opening of access to "all women", including single women and same-sex female couples, women over 43 years of age were once again excluded from the new legal framework and therefore remain condemned to travel abroad to access reproductive treatments. In this article, we analyze the experience of French women over 40 who cross the Spanish border to access reproductive treatments in order to fulfill their desire to have children. Through ethnographic data emerging from six years of participant observation and in-depth interviews with 15 women, we explore why they remain excluded from the French system of reproductive governance and the obstacles they face during their reproductive journey.
Collapse
Affiliation(s)
- Alexandra Desy
- AFIN Barcelona Research Group and Outreach Center, Department of Social and Cultural Anthropology, Autonomous University of Barcelona, Spain, c/Vila i Puig s/n, 08193, Cerdanyola del Vallès, Barcelona, Spain.
| | - Diana Marre
- AFIN Barcelona Research Group and Outreach Center, Department of Social and Cultural Anthropology, Autonomous University of Barcelona, Spain, c/Vila i Puig s/n, 08193, Cerdanyola del Vallès, Barcelona, Spain
| |
Collapse
|
5
|
Araya BM, Aldersey HM, Camara S, Alemu K, Dyer S, Velez MP. The varying estimation of infertility in Ethiopia: the need for a comprehensive definition. BMC Womens Health 2024; 24:280. [PMID: 38720297 PMCID: PMC11077700 DOI: 10.1186/s12905-024-03118-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 04/28/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Infertility is a marginalized sexual and reproductive health issue in low-resource settings. Globally, millions are affected by infertility, but the lack of a universal definition makes it difficult to estimate the prevalence of infertility at the population level. Estimating the prevalence of infertility may inform targeted and accessible intervention, especially for a resource-limited country like Ethiopia. This study aims to estimate the prevalence of female infertility in Ethiopia using the Demographic and Health Survey (DHS) through two approaches: (i) the demographic approach and (ii) the current duration approach. METHODS Data from 15,683 women were obtained through the 2016 Ethiopian DHS. The demographic approach estimates infertility among women who had been married/in a union for at least five years, had never used contraceptives, and had a fertility desire. The current duration approach includes women at risk of pregnancy at the time of the survey and determines their current length of time-at-risk of pregnancy at 12, 24, and 36 months. Logistic regression analysis estimated the prevalence of infertility and factors associated using the demographic approach. Parametric survival analysis estimated the prevalence of infertility using the current duration approach. All estimates used sampling weights to account for the DHS sampling design. STATA 14 and R were used to perform the statistical analysis. RESULTS Using the demographic definition, the prevalence of infertility was 7.6% (95% CI 6.6-8.8). When stratified as primary and secondary infertility, the prevalence was 1.4% (95% CI 1.0-1.9) and 8.7% (95% CI 7.5-10.1), respectively. Using the current duration approach definition, the prevalence of overall infertility was 24.1% (95% CI 18.8-34.0) at 12-months, 13.4% (95% CI 10.1-18.6) at 24-months, and 8.8% (95% CI 6.5-12.3) at 36-months. CONCLUSION The demographic definition of infertility resulted in a lower estimate of infertility. The current duration approach definition could be more appropriate for the early detection and management of infertility in Ethiopia. The findings also highlight the need for a comprehensive definition of and emphasis on infertility. Future population-based surveys should incorporate direct questions related to infertility to facilitate epidemiological surveillance.
Collapse
Affiliation(s)
- Bilen Mekonnen Araya
- Department of Rehabilitation Science, School of Rehabilitation Therapy, Queen's University, Kingston, Canada.
- Department of Clinical Midwifery, School of Midwifery, University of Gondar, Gondar, Ethiopia.
| | | | - Saionara Camara
- Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Kassahun Alemu
- Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Silke Dyer
- Department of Obstetrics & Gynaecology, Faculty of Health Sciences, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Maria P Velez
- Department of Obstetrics and Gynaecology, School of Medicine, Queen's University, Kingston, Canada.
| |
Collapse
|
6
|
Kaltsas A, Zikopoulos A, Vrachnis D, Skentou C, Symeonidis EN, Dimitriadis F, Stavros S, Chrisofos M, Sofikitis N, Vrachnis N, Zachariou A. Advanced Paternal Age in Focus: Unraveling Its Influence on Assisted Reproductive Technology Outcomes. J Clin Med 2024; 13:2731. [PMID: 38792276 PMCID: PMC11122544 DOI: 10.3390/jcm13102731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 04/28/2024] [Accepted: 05/06/2024] [Indexed: 05/26/2024] Open
Abstract
As global demographics shift toward increasing paternal age, the realm of assisted reproductive technologies (ARTs), particularly in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI), faces new challenges and opportunities. This study provides a comprehensive exploration of the implications of advanced paternal age on ART outcomes. Background research highlights the social, cultural, and economic factors driving men toward later fatherhood, with a focus on the impact of delayed paternity on reproductive outcomes. Methods involve a thorough review of existing literature, centering on changes in testicular function, semen quality, and genetic and epigenetic shifts associated with advancing age. Study results point to intricate associations between the father's age and ART outcomes, with older age being linked to diminished semen quality, potential genetic risks, and varied impacts on embryo quality, implantation rates, and birth outcomes. The conclusions drawn from the current study suggest that while advanced paternal age presents certain risks and challenges, understanding and mitigating these through strategies such as sperm cryopreservation, lifestyle modifications, and preimplantation genetic testing can optimize ART outcomes. Future research directions are identified to further comprehend the epigenetic mechanisms and long-term effects of the older father on offspring health. This study underscores the need for a comprehensive approach in navigating the intricacies of delayed fatherhood within the context of ART, aiming for the best possible outcomes for couples and their children.
Collapse
Affiliation(s)
- Aris Kaltsas
- Third Department of Urology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.K.); (M.C.)
- Laboratory of Spermatology, Department of Urology, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece;
| | - Athanasios Zikopoulos
- Department of Obstetrics and Gynecology, Royal Cornwall Hospital, Truro TR1 3LJ, UK;
| | - Dionysios Vrachnis
- Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece;
| | - Chara Skentou
- Department of Obstetrics and Gynaecology, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece;
| | - Evangelos N. Symeonidis
- Department of Urology, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (E.N.S.); (F.D.)
| | - Fotios Dimitriadis
- Department of Urology, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (E.N.S.); (F.D.)
| | - Sofoklis Stavros
- Third Department of Obstetrics and Gynecology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (S.S.)
| | - Michael Chrisofos
- Third Department of Urology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.K.); (M.C.)
| | - Nikolaos Sofikitis
- Laboratory of Spermatology, Department of Urology, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece;
| | - Nikolaos Vrachnis
- Third Department of Obstetrics and Gynecology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (S.S.)
- Vascular Biology, Molecular and Clinical Sciences Research Institute, St George’s University of London, London SW17 0RE, UK
| | - Athanasios Zachariou
- Laboratory of Spermatology, Department of Urology, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece;
| |
Collapse
|
7
|
Verghote K, Neeser N, Pennings G, Elger B, Provoost V. "It was not an accident": Women's experiences of renewing motherhood at 40. J Women Aging 2024; 36:181-196. [PMID: 38009748 DOI: 10.1080/08952841.2023.2286835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 11/20/2023] [Indexed: 11/29/2023]
Abstract
In recent decades, there has been an increase in motherhood at an advanced age that has raised several medical and social concerns. We conducted a qualitative interview study, guided by Interpretative Phenomenological Analysis, to focus on the motivations and experiences of Belgian women who 'renewed' their motherhood later in life, meaning they had one or several children and then (at least 10 years later) had another child at the age of 40 or older. We focused on ten women's experiences of motherhood later in life, as well as on the way they managed social norms and expectations regarding family building and the appropriate life course. We identified two main themes. The first theme describes the participants' encounters with social norms that challenged their decision to reproduce and parent later in life, and how they managed and anticipated criticism, surprise, disbelief and incomprehension about their renewed motherhood in various ways. The second theme shows how these women talked about taking responsibility as a (renewed) mother of advanced age. For them, responsible motherhood involved making thoughtful reproductive choices, attending to the range of needs of their children, and making extra efforts to safeguard the social and emotional wellbeing of their youngest children, thereby seeking to reduce potential harm resulting from these reproductive choices. This study provides insight into these women's self-conception and their interactions with prejudiced social views of motherhood and family building.
Collapse
Affiliation(s)
- Kato Verghote
- Bioethics Institute Ghent; Department of Philosophy and Moral Sciences, Ghent University, Ghent, Belgium
| | - Nathalie Neeser
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Guido Pennings
- Bioethics Institute Ghent; Department of Philosophy and Moral Sciences, Ghent University, Ghent, Belgium
| | - Bernice Elger
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Veerle Provoost
- Bioethics Institute Ghent; Department of Philosophy and Moral Sciences, Ghent University, Ghent, Belgium
| |
Collapse
|
8
|
Slabá J, Kocourková J, Šťastná A. The fertility timing gap: the intended and real timing of childbirth. J Biosoc Sci 2024; 56:504-517. [PMID: 38356439 DOI: 10.1017/s002193202400004x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
The fertility gap, which indicates the difference between the planned and actual number of children born, can be explained by the shift in parenthood to older ages and is associated with the non-attainment of one's intended reproductive plans. This paper focuses on the gap in the timing of entry into parenthood, i.e. between the planned and actual age at the birth of the first child. The study is based on data from the Women 2016 survey which re-interviewed women of fertile age from the second wave of the Czech Generations & Gender Survey conducted in 2008. At the population level, the fertility timing gap differs across generations. While for Czech women born between 1966 and 1971 the planned age exceeded the actual observed age by one year, the realisation of fertility occurred two years later than planned for the youngest generation (1983-1990) included in the study. At the individual level, the later-than-planned realisation of fertility was found to be related primarily to partner-related factors.
Collapse
Affiliation(s)
- Jitka Slabá
- Faculty of Science, Charles University, Prague, Czech Republic
| | | | - Anna Šťastná
- Faculty of Science, Charles University, Prague, Czech Republic
| |
Collapse
|
9
|
Colleselli-Türtscher V, Hafenmayr M, Ciresa-König A, Trinker M, Maier S, Toth B, Seeber B. Retrospective cohort study comparing success of medical management of early pregnancy loss in pregnancies conceived with and without medical assistance. Fertil Steril 2024; 121:824-831. [PMID: 38211763 DOI: 10.1016/j.fertnstert.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 01/03/2024] [Accepted: 01/05/2024] [Indexed: 01/13/2024]
Abstract
OBJECTIVE To compare the success rates of medical management using a combined mifepristone and misoprostol protocol in cases of early pregnancy loss (EPL) between women who conceived without medical assistance and those who conceived through in vitro fertilization (IVF), after fresh or frozen embryo transfer, and evaluate for the predictive factors of success, time to first passage of tissue, and time to complete resolution of pregnancy. DESIGN Retrospective cohort study. SETTING University hospital. PATIENT(S) Women who presented with EPL below 13 weeks of gestation between June 2013 and July 2021 who were managed medically with mifepristone 200 mg orally and misoprostol 800 mcg vaginally were included in the study. INTERVENTION(S) Medical management with mifepristone and misoprostol; conception without medical assistance vs. post-IVF, after fresh or frozen embryo transfer. MAIN OUTCOME MEASURE(S) We evaluated overall success and performed subgroup analysis according to the mode of conception and compared fresh vs. frozen-thawed embryo transfers for IVF pregnancies. In all groups, we also calculated success according to gestational age and compared the time to first passage of tissue. The potential predictive factors of treatment success were analyzed. The side effects and complications of treatment were recorded. RESULT(S) A total of 930 women were included in the study, 99 (11%) of whom achieved pregnancy after IVF. The overall success of medical treatment was 89% with no statistically significant difference according to the mode of conception (89% vs. 89%) or type of transfer (fresh 89% vs. frozen 89%). Only lower gestational age by sonography was independently predictive of treatment success, showing a negative regression coefficient of β = -0.333 and an odds ratio of 0.717. The mean time to first passage of tissue was 5.0 ± 2.1 hours. Altogether, 666 women (72%) showed pregnancy resolution on the day of medication administration, an additional 110 women at 1-week follow-up, and a further 74 women after ≥4 weeks on ultrasound. CONCLUSION(S) Medical management of EPL with mifepristone and misoprostol is a highly successful treatment option that results in completed abortion in a timely fashion in both pregnancies conceived without medical assistance and those conceived after IVF.
Collapse
Affiliation(s)
| | - Marina Hafenmayr
- Department of Gynecological Endocrinology and Reproductive Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Alexandra Ciresa-König
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Trinker
- Department of Gynecological Endocrinology and Reproductive Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Sarah Maier
- Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Innsbruck, Austria
| | - Bettina Toth
- Department of Gynecological Endocrinology and Reproductive Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Beata Seeber
- Department of Gynecological Endocrinology and Reproductive Medicine, Medical University of Innsbruck, Innsbruck, Austria.
| |
Collapse
|
10
|
Grossini E, Aquino CI, Venkatesan S, Troìa L, Tizzoni E, Fumagalli F, Ferrante D, Vaschetto R, Remorgida V, Surico D. Plasma Redox Balance in Advanced-Maternal-Age Pregnant Women and Effects of Plasma on Umbilical Cord Mesenchymal Stem Cells. Int J Mol Sci 2024; 25:4869. [PMID: 38732088 PMCID: PMC11084157 DOI: 10.3390/ijms25094869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 04/24/2024] [Accepted: 04/28/2024] [Indexed: 05/13/2024] Open
Abstract
Pregnancy at advanced maternal age (AMA) is a condition of potential risk for the development of maternal-fetal complications with possible repercussions even in the long term. Here, we analyzed the changes in plasma redox balance and the effects of plasma on human umbilical cord mesenchymal cells (hUMSCs) in AMA pregnant women (patients) at various timings of pregnancy. One hundred patients and twenty pregnant women younger than 40 years (controls) were recruited and evaluated at various timings during pregnancy until after delivery. Plasma samples were used to measure the thiobarbituric acid reactive substances (TBARS), glutathione and nitric oxide (NO). In addition, plasma was used to stimulate the hUMSCs, which were tested for cell viability, reactive oxygen species (ROS) and NO release. The obtained results showed that, throughout pregnancy until after delivery in patients, the levels of plasma glutathione and NO were lower than those of controls, while those of TBARS were higher. Moreover, plasma of patients reduced cell viability and NO release, and increased ROS release in hUMSCs. Our results highlighted alterations in the redox balance and the presence of potentially harmful circulating factors in plasma of patients. They could have clinical relevance for the prevention of complications related to AMA pregnancy.
Collapse
Affiliation(s)
- Elena Grossini
- Laboratory of Physiology, Department of Translational Medicine, Università del Piemonte Orientale, Via Solaroli 17, 28100 Novara, Italy;
| | - Carmen Imma Aquino
- Gynecology and Obstetrics, Department of Translational Medicine, Università del Piemonte Orientale, “Maggiore della Carità” Hospital, 28100 Novara, Italy; (C.I.A.); (E.T.); (F.F.); (V.R.); (D.S.)
| | - Sakthipriyan Venkatesan
- Laboratory of Physiology, Department of Translational Medicine, Università del Piemonte Orientale, Via Solaroli 17, 28100 Novara, Italy;
| | - Libera Troìa
- Gynecology and Obstetrics, Department of Translational Medicine, Università del Piemonte Orientale, “Maggiore della Carità” Hospital, 28100 Novara, Italy; (C.I.A.); (E.T.); (F.F.); (V.R.); (D.S.)
| | - Eleonora Tizzoni
- Gynecology and Obstetrics, Department of Translational Medicine, Università del Piemonte Orientale, “Maggiore della Carità” Hospital, 28100 Novara, Italy; (C.I.A.); (E.T.); (F.F.); (V.R.); (D.S.)
| | - Federica Fumagalli
- Gynecology and Obstetrics, Department of Translational Medicine, Università del Piemonte Orientale, “Maggiore della Carità” Hospital, 28100 Novara, Italy; (C.I.A.); (E.T.); (F.F.); (V.R.); (D.S.)
| | - Daniela Ferrante
- Medical Statistics, Department of Translational Medicine, Università del Piemonte Orientale, 28100 Novara, Italy;
| | - Rosanna Vaschetto
- Anesthesia and Intensive Care, Department of Translational Medicine, Università del Piemonte Orientale, 28100 Novara, Italy;
| | - Valentino Remorgida
- Gynecology and Obstetrics, Department of Translational Medicine, Università del Piemonte Orientale, “Maggiore della Carità” Hospital, 28100 Novara, Italy; (C.I.A.); (E.T.); (F.F.); (V.R.); (D.S.)
| | - Daniela Surico
- Gynecology and Obstetrics, Department of Translational Medicine, Università del Piemonte Orientale, “Maggiore della Carità” Hospital, 28100 Novara, Italy; (C.I.A.); (E.T.); (F.F.); (V.R.); (D.S.)
| |
Collapse
|
11
|
Mashayekh-Amiri S, Asghari Jafarabadi M, Molaie B, Rashidi F, Hemati E, Aliasghari F, Mirghafourvand M. Validation and measurement properties of the Male and Female Fertility Knowledge Inventories (MFKI and FFKI) in Iranian couples. Reprod Health 2024; 21:57. [PMID: 38649965 DOI: 10.1186/s12978-024-01795-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 04/15/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND One of the most important population challenges during the last three decades has been the significant decrease in the fertility rate worldwide. Since the validity and reliability of the Male and Female Fertility Knowledge Inventories (MFKI and FFKI) have not been determined in Iran, we conducted this study to assess psychometric characteristics of the MFKI and FFKI in couples in Tabriz and Urmia, Iran. METHODS This was a cross-sectional study, as the first part (quantitative phase) of a sequential explanatory mixed-method study. The current study was done on 1200 participants (600 women with their husbands) living in the northwestern region of Iran, between January 2023 and September 2023. The psychometric properties of the Persian version of the tool (MFKI and FFKI) were performed in 5 stages, including translation process, content validity, face validity, construct validity and reliability assesment. RESULTS In this study, the CVI, CVR, and impact scores of the MFKI tool were equal to 0.90, 0.88, 3.26 and CVI, CVR, and Impact scores of the FFKI tool were respectively equal to 0.95, 0.91 and 3.59, that it indicated a satisfactory level of content and face validity. Then, to check the construct validity, the results of the exploratory factor analysis of the MFKI tool on 13 items led to the identification of 3 factors, including Environment and reproductive health (ERH), Lifestyle factors (LSF) and Sperm quality (SQ), which explained 66% of the cumulative variance. The results of the exploratory factor analysis of the FFKI tool on 15 items led to the identification of 4 factors, including Reproductive health (RH), Lifestyle factors (LSF), Chance of conception (CHC) and Ovarian reserve and preservation (ORP), which explained 68% of the cumulative variance. CONCLUSIONS The findings of this study indicated that the Persian version of MFKI and FFKI has acceptable psychometric properties to measure the awareness of Iranian couples regarding fertility, which can be used as a screening tool for fertility knowledge by health care professionals and also as a reliable tool in research.
Collapse
Affiliation(s)
- Sepideh Mashayekh-Amiri
- Student of Midwifery, Students Research Committee, Midwifery Department, Faculty of Nursing and Midwifery, Tabriz University of Medical sciences, Tabriz, Iran
| | - Mohammad Asghari Jafarabadi
- Cabrini Research, Cabrini Health, Malvern, VIC, 3144, Australia
- School of Public Health and Preventative Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, VIC, 3800, Australia
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Behnam Molaie
- Department of Psychiatry, Faculty of Medicine, Ardabil University of Medical Science, Ardabil, Iran
| | - Fatemeh Rashidi
- Students Research Committee, Midwifery Department, Faculty of Nursing and Midwifery, Tabriz University of Medical sciences, Tabriz, Iran
| | - Elnaz Hemati
- Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fatemeh Aliasghari
- Reproductive Health Research Center, Midwifery Department, Faculty of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran
| | - Mojgan Mirghafourvand
- Social Determinants of Health Research Center, Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran.
| |
Collapse
|
12
|
Li L, Jin G, Lai X, Jing R, Zhu H. A reassessment of trends and rural-urban/regional differences in the total fertility rate in China, 2000-2020: analyses of the 2020 national census data. Sci Rep 2024; 14:8601. [PMID: 38615138 PMCID: PMC11016060 DOI: 10.1038/s41598-024-59177-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 04/08/2024] [Indexed: 04/15/2024] Open
Abstract
The decline in the total fertility rate (TFR) is a key driver of population change and has important implications for population health and social development. However, China's TFR has been a considerable controversy due to a lack of high-quality data. Therefore, this study used the 2020 national population census of China (NPCC) data and reverse survival method to reassess temporal trends in the TFRs and to reexamine rural-urban differences and regional variations in TFRs from 2000 to 2020 in China. Overall, there were significant gaps between the estimated and reported TFRs before 2020, and the estimated TFRs based on the 2020 NPCC data remained higher than the reported TFRs from government statistics. Although TFRs rebounded shortly in the years after the two-child policy, they have shown a wavelike decline since 2010. Additionally, the estimated TFRs fluctuated below 1.5 children per woman in urban areas compared to above 1.8 in rural areas, but the rural-urban differences continued to decrease. Regarding geographic regional variations, the estimated TFRs in all regions displayed a declining trend during 2010-2020, especially in rural areas. Large decreases of over 25% in TFRs occurred in the north, east, central, and northwest regions. In addition to changing the birth policy, the government and society should adopt comprehensive strategies, including reducing the costs of marriage, childbearing, and child education, as well as promoting work-family balance, to encourage and increase fertility levels.
Collapse
Affiliation(s)
- Long Li
- Center for Population and Development Studies, Renmin University of China, Beijing, 100872, China
| | - Guangzhao Jin
- Center for Population and Development Studies, Renmin University of China, Beijing, 100872, China
| | - Xiaozhen Lai
- China Center for Health Development Studies, Peking University, Beijing, 100871, China
| | - Rize Jing
- School of Public Administration and Policy, Renmin University of China, No. 59, Zhongguancun Street, Haidian District, Beijing, 100872, China.
| | - He Zhu
- China Center for Health Development Studies, Peking University, Beijing, 100871, China.
- China Center for Health Development Studies, Peking University, No. 38, Xueyuan Road, Haidian District, Beijing, 100191, China.
| |
Collapse
|
13
|
Rakisheva A, Sliwa K, Bauersachs J, Van Linthout S, Chopra VK, Bayes-Genis A, Fruzzetti F, Cannatà A, Deniau B, Mebazaa A, Savarese G, Ray R, Vitale C, Metra M, Rosano GMC. Multidisciplinary care of peripartum heart failure: A scientific statement of the Heart Failure Association of the ESC. Eur J Heart Fail 2024; 26:742-753. [PMID: 38679896 DOI: 10.1002/ejhf.3246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 01/22/2024] [Accepted: 04/04/2024] [Indexed: 05/01/2024] Open
Abstract
Heart failure is the most common cardiovascular complication during pregnancy and the postpartum period. It is associated with increased risk of maternal morbidity and mortality as well as potentially life-threatening foetal pathology. Management of heart failure in pregnancy requires expert knowledge of cardiovascular disease as well as obstetrics which underscores the importance of multidisciplinary cardio-obstetrics teams in order to optimize diagnosis, treatment and outcome. This includes counselling of women at risk before and during the course of pregnancy in order to strengthen the relationship between medical specialists and patients, as well as to allow patient-centred delivery of care and improve quality of life.
Collapse
Affiliation(s)
- Amina Rakisheva
- Department of Cardiology, City Cardiology Center, Almaty, Kazakhstan
- Qonaev City Hospital, Almaty, Kazakhstan
| | - Karen Sliwa
- Cape Heart Institute, Department of Cardiology and Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Sophie Van Linthout
- Berlin Institute of Health (BIH) at Charité - Universitätmedizin Berlin, BIH Center for Regenerative Therapies (BCRT), Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner site Berlin, Berlin, Germany
| | | | - Antoni Bayes-Genis
- CIBERCV, Carlos III Institute of Health, Madrid, Spain
- Institut del Cor, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Franca Fruzzetti
- Department of Obstetrics and Gynecology, Pisa University Hospital, Pisa, Italy
| | - Antonio Cannatà
- King's College London, British Heart Foundation Centre of Research Excellence, School of Cardiovascular Medicine & Sciences, London, UK
| | - Benjamin Deniau
- Department of Anesthesiology, Critical Care and Burn Unit, University Hospital Saint-Louis - Lariboisière, AP-HP, Paris, France
- INSERM UMR-S 942, Cardiovascular Markers in Stress Condition (MASCOT), Université de Paris Cité, Paris, France
- Université de Paris Cité, Paris, France
- FHU PROMICE, DMU Parabol, Paris, France
| | - Alexandre Mebazaa
- Department of Anesthesiology, Critical Care and Burn Unit, University Hospital Saint-Louis - Lariboisière, AP-HP, Paris, France
- INSERM UMR-S 942, Cardiovascular Markers in Stress Condition (MASCOT), Université de Paris Cité, Paris, France
- Université de Paris Cité, Paris, France
- FHU PROMICE, DMU Parabol, Paris, France
| | - Gianluigi Savarese
- Department of Medicine, Karolinska Institutet, and Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Robin Ray
- Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St George's, University of London, St George's Hospital, London, UK
| | - Cristiana Vitale
- Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St George's, University of London, St George's Hospital, London, UK
| | - Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | | |
Collapse
|
14
|
Wierenga H, Målqvist M. Differences in Antenatal Care Policies in England, Finland, and the Netherlands: A Framing analysis. Matern Child Health J 2024; 28:738-745. [PMID: 38334865 DOI: 10.1007/s10995-023-03882-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2023] [Indexed: 02/10/2024]
Abstract
BACKGROUND AND PURPOSE The World Health Organization (WHO) states that good quality antenatal care should strive for both mother and child achieving their best possible health. On a policy level, in Europe these goals are reached with varying approaches. This research offers a fresh look on the underlying assumptions embedded in the ANC policies in three European countries. METHODS A framing analysis was conducted to publicly available ANC policies on uncomplicated pregnancies in Finland, England, and the Netherlands. Analysis was guided by van Hulst and Yanowa and included the following phases: a) Sense-making, b) Selecting, naming, and categorizing and c) Storytelling. MAIN FINDINGS Findings of this study demonstrate how ANC is organized with distinct frames. The Finnish ANC policies emphasized equity in care and instead of focusing on women, the ANC focused on the family. In England the pregnant woman was central, and it is seen as her responsibility to understand the ANC protocols. The ANC in the Netherlands focused on the pregnant woman's pregnancy experience and freedom. CONCLUSION The three studied countries had individual priorities and values guiding ANC provision. Despite each country being in line with the WHO ANC recommendations, areas requiring improvement should not be overlooked.
Collapse
Affiliation(s)
- Hanna Wierenga
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Mats Målqvist
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
| |
Collapse
|
15
|
Porto ME, Moura AL, Carvalho TR, Gonçalves CC, Freitas NP, Araujo Júnior E, Cavalcante MB. Fertility preservation: knowledge, awareness, and attitude of university students and professors. Minerva Obstet Gynecol 2024; 76:142-150. [PMID: 36222787 DOI: 10.23736/s2724-606x.22.05187-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Delayed pregnancy is a worldwide trend, especially in Western countries. University students and professors are at high risk of presenting age-related reproductive difficulties due to this new reproductive profile. Thus, through this study, we aimed at exploring the knowledge, awareness, and attitude of university students and professors related to fertility and fertility preservation (FP). METHODS We adopted a prospective cross-sectional study design and included students and professors from private university located in the Northeast of Brazil. Eligible participants (male and female) were invited through an online message. The participants accessed the online questionnaire through a link. RESULTS We performed 256 surveys (100 students and 156 professors). The overall mean age of participants was 35.8±13.1 years (from 18 to 67 years). Fertility was considered relevant by all participants, being very important among a greater number of students compared to professors, 61% versus 30.1%, P<0.001, respectively. The main reasons why participants could have postponed parenthood were reach financial stability (62.1%), career building (51.2%), health issues (37.9%), and not having a partner (33.9%). Students demonstrated a better understanding of FP and highlighted the importance of the age of females at the time of the oocyte cryopreservation. Very few students and professors already discussed reproductive planning with a health professional. CONCLUSIONS We observed a deficiency in the knowledge of Brazilian university students and professors about female fertility and FP options. Thus, exposing the population to information related to FP should be hyped in the university environment.
Collapse
Affiliation(s)
- Maria E Porto
- Department of Medicine, University of Fortaleza (UNIFOR), Fortaleza, Brazil
| | - Ana L Moura
- Department of Medicine, University of Fortaleza (UNIFOR), Fortaleza, Brazil
| | - Thiago R Carvalho
- Department of Medicine, University of Fortaleza (UNIFOR), Fortaleza, Brazil
| | | | - Natércia P Freitas
- Department of Medical Sciences, University of Fortaleza (UNIFOR), Fortaleza, Brazil
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil -
- Department of Medicine, Municipal University of São Caetano do Sul (USCS), Bela Vista Campus, São Paulo, Brazil
| | - Marcelo B Cavalcante
- Department of Medicine, University of Fortaleza (UNIFOR), Fortaleza, Brazil
- Department of Medical Sciences, University of Fortaleza (UNIFOR), Fortaleza, Brazil
- Human Reproduction Sector, CONCEPTUS - Reproductive Medicine, Fortaleza, Brazil
| |
Collapse
|
16
|
Neels K, Marynissen L, Wood J. Economic Cycles and Entry into Parenthood: Is the Association Changing and Does it Affect Macro-Level Trends? Micro-Level Hazard and Simulation Models of Belgian Fertility Trends, 1960-2010. EUROPEAN JOURNAL OF POPULATION = REVUE EUROPEENNE DE DEMOGRAPHIE 2024; 40:13. [PMID: 38551762 PMCID: PMC10980675 DOI: 10.1007/s10680-024-09695-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 01/18/2024] [Indexed: 04/01/2024]
Abstract
The association between economic cycles-typically measured in terms of GDP growth or swings in unemployment-and macro-level fertility trends has received ample attention in the literature. Compared to studies that consider macro-level fertility, individual-based models can address the association between economic cycles and specific stages of family formation (e.g. entry into parenthood) more precisely while allowing for structural factors that contribute to fertility postponement. Using population-wide longitudinal microdata from the Belgian censuses we combine discrete-time hazard models of entry into parenthood for the period 1960 to 2010 with microsimulation models to assess whether economic cycles in tandem with educational expansion can account for year-to-year variation in the proportion of women entering parenthood and variation in the pace of fertility postponement at the macro-level. Results indicate that educational expansion has been a structural driver of fertility postponement, whereas the procyclical effect of economic cycles accounts for accelerations and decelerations of fertility postponement throughout the period considered. Microsimulation of macro-level fertility trends indicates that individual-based models predict the annual proportion of women entering parenthood and the mean age at first birth with average errors of prediction below 1 per cent and 3 months, respectively, while also showing strong correlations between first differences of observed and simulated time-series. Because the extended observation window encompasses several severe recessions, we test whether the association between economic cycles and entry into parenthood has changed over time and how this affected macro-level trends, discussing several mechanisms that may account for such temporal variation.
Collapse
Affiliation(s)
- Karel Neels
- Centre for Population, Family & Health, University of Antwerp, Antwerp, Belgium.
| | - Leen Marynissen
- Centre for Population, Family & Health, University of Antwerp, Antwerp, Belgium
| | - Jonas Wood
- Centre for Population, Family & Health, University of Antwerp, Antwerp, Belgium
| |
Collapse
|
17
|
Armijo-Sánchez A, Benítez Castillo N, García-Vidal E, Luna Chadid M, Salvador Ballada C, Valls Ricart G, Torres Pellens V. Treatment With a Patented 3.6:1 Myo-Inositol to D-chiro-Inositol Ratio, Antioxidants, Vitamins and Minerals Food Supplement in Women With a History of Assisted Reproductive Technique (ART) Failures: A Series of Case Reports. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2024; 17:11795476241242265. [PMID: 38559382 PMCID: PMC10981332 DOI: 10.1177/11795476241242265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 03/11/2024] [Indexed: 04/04/2024]
Abstract
Infertility affects 15% of couples in reproductive age worldwide. In women in particular, infertility can be caused by various abnormalities, with polycystic ovary syndrome (PCOS) being the most common. Currently, there are many assisted reproductive techniques (ART) available to combat the burden of infertility. However, positive results are not guaranteed. The administration of inositol has been shown to increase positive reproductive outcomes in women undergoing ART. Here we present a series of clinical cases in which women with a history of infertility and previously failed ART, supplemented with a specific 3.6:1 MYO:DCI ratio, antioxidants, vitamins, and minerals for a period of 1 to 3 months before undergoing in vitro fertilization (IVF). In this series of case reports, we provide preliminary evidence that supplementation with a specific 3.6:1 MYO to DCI ratio, as well as antioxidants, vitamins, and minerals may contribute positively to female fertility in women undergoing IVF, with a history of primary or secondary infertility and previously failed ART.
Collapse
Affiliation(s)
| | - N. Benítez Castillo
- Hospital Universitario Materno Infantil de Canarias, Las Palmas de Gran Canaria, Spain
| | | | | | | | | | | |
Collapse
|
18
|
Carducci ME, Izbizky G. [Advanced maternal age as a risk factor for adverse maternal and perinatal outcomes]. REVISTA DE LA FACULTAD DE CIENCIAS MÉDICAS 2024; 81:24-39. [PMID: 38537099 PMCID: PMC11110671 DOI: 10.31053/1853.0605.v81.n1.41447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 10/23/2023] [Indexed: 04/05/2024] Open
Abstract
Introduction A progressive increase in the age of women at first pregnancy is observed, a situation that has been associated with a greater risk of adverse maternal and perinatal effects. Objective The aim of this study was to describe the characteristics and the maternal and perinatal outcomes of nulliparas of 40 years and older and compare them with those of nulliparas under 40. Study design This was a retrospective cohort analysis of a database of pregnancy population who had attended their deliveries in a private university hospital. Results An association was observed between maternal age ≥ 40 with the maternal compound adverse outcome (OR 1,3; 95% CI: 1,1-1,6), gestational diabetes (OR 3,6; 95% CI: 1,80-3,7), hypertensive disorders/preeclampsia (OR 2,2; 95% CI: 1,6-3,1) and postpartum hemorrhage (4,7; 95% CI: 1,2-16,3), with advanced maternal age persisting as an independent risk factor for the maternal compound adverse outcome (OR 1,3; 95% CI: 1,1 -1,6) and the perinatal compound adverse outcome (OR 1,40; 95% CI: 1,2-1,7) in the multivariate analysis. A higher rate of preterm birth was observed in the group of older nulliparas (OR 1,6; 95% CI: 1,3-2,0) with a higher requirement for admission to NICU for their newborns (OR 1,3; 95% CI: 1,0-1,8). Conclusions Women with advanced maternal age constitute a high-risk population, whose attention and follow-up would require a differential approach aiming to improve maternal and perinatal outcomes.
Collapse
Affiliation(s)
- Maria Eugenia Carducci
- Servicio de Obstetricia, Hospital Italiano de Buenos Aires. Instituto Universitario del Hospital Italiano de Buenos Aires..
| | - Gustavo Izbizky
- Servicio de Obstetricia, Hospital Italiano de Buenos Aires. Instituto Universitario del Hospital Italiano de Buenos Aires. .
| |
Collapse
|
19
|
Kan-Tor Y, Srebnik N, Gavish M, Shalit U, Buxboim A. Evaluating the heterogeneous effect of extended culture to blastocyst transfer on the implantation outcome via causal inference in fresh ICSI cycles. J Assist Reprod Genet 2024; 41:703-715. [PMID: 38321264 PMCID: PMC10957840 DOI: 10.1007/s10815-024-03023-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 01/04/2024] [Indexed: 02/08/2024] Open
Abstract
PURPOSE In IVF treatments, extended culture to single blastocyst transfer is the recommended protocol over cleavage-stage transfer. However, evidence-based criteria for assessing the heterogeneous implications on implantation outcomes are lacking. The purpose of this work is to estimate the causal effect of blastocyst transfer on implantation outcome. METHODS We fit a causal forest model using a multicenter observational dataset that includes an exogenous source of variability in treatment assignment and has a strong claim for satisfying the assumptions needed for valid causal inference from observational data. RESULTS We quantified the probability difference in embryo implantation if transferred as a blastocyst versus cleavage stage. Blastocyst transfer increased the average implantation rate; however, we revealed a subpopulation of embryos whose implantation potential is predicted to increase via cleavage-stage transfer. CONCLUSION Relative to the current policy, the proposed embryo transfer policy retrospectively improves implantation rate from 0.2 to 0.27. Our work demonstrates the efficacy of implementing causal inference in reproductive medicine and motivates its utilization in medical disciplines that are dominated by retrospective datasets.
Collapse
Affiliation(s)
- Yoav Kan-Tor
- Rachel and Selim Benin School for Computer Science and Engineering, Hebrew University of Jerusalem, The Edmond J. Safra Campus Givat Ram, 9190401, Jerusalem, Israel
- The Center for Interdisciplinary Data Science Research, The Hebrew University of Jerusalem, The Edmond J. Safra Campus, Givat Ram, 9190401, Jerusalem, Israel
| | - Naama Srebnik
- Department of Cell and Developmental Biology, Hebrew University of Jerusalem, The Edmond J. Safra Campus, Givat Ram, 9190401, Jerusalem, Israel
- Hebrew University School of Medicine, In Vitro Fertilization Unit, Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, 9103102, Jerusalem, Israel
| | - Matan Gavish
- Rachel and Selim Benin School for Computer Science and Engineering, Hebrew University of Jerusalem, The Edmond J. Safra Campus Givat Ram, 9190401, Jerusalem, Israel
- The Center for Interdisciplinary Data Science Research, The Hebrew University of Jerusalem, The Edmond J. Safra Campus, Givat Ram, 9190401, Jerusalem, Israel
| | - Uri Shalit
- Data and Decision Sciences, Technion - Israel Institute of Technology, 3200003, Haifa, Israel
| | - Amnon Buxboim
- Rachel and Selim Benin School for Computer Science and Engineering, Hebrew University of Jerusalem, The Edmond J. Safra Campus Givat Ram, 9190401, Jerusalem, Israel.
- The Center for Interdisciplinary Data Science Research, The Hebrew University of Jerusalem, The Edmond J. Safra Campus, Givat Ram, 9190401, Jerusalem, Israel.
- Alexander Grass Center for Bioengineering, Hebrew University of Jerusalem, The Edmond J. Safra Campus, Givat Ram, 9190401, Jerusalem, Israel.
| |
Collapse
|
20
|
Ribeiro S, Pedro J, Martins MV. Psychosocial experiences of involuntary definitive childless women: a comparative study based on reproductive status. Hum Reprod 2024; 39:559-568. [PMID: 38290160 DOI: 10.1093/humrep/deae001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 12/27/2023] [Indexed: 02/01/2024] Open
Abstract
STUDY QUESTION Do involuntary definitive childless women have lower psychosocial adjustment levels than women with infertility diagnoses actively trying to conceive and presumably fertile women? SUMMARY ANSWER Involuntary definitive childless women have lower levels of sexual functioning than infertile women actively trying to conceive and presumably fertile women, and higher levels of depression than presumably fertile women. WHAT IS KNOWN ALREADY Involuntary definitive childless defines those who wanted to become parents but were unable to do so. Studies have provided evidence about infertility and its psychosocial consequences, but there is a lack of knowledge about the impact of involuntary definitive childlessness, namely on sexual function, social support, marital satisfaction, and psychological adjustment. STUDY DESIGN, SIZE, DURATION This associative study was conducted between July 2021 and January 2022 for involuntary definitive childless women and between July 2016 and February 2018 for women with an infertility diagnosis actively trying to conceive as well as presumably fertile women. An online questionnaire announced in social media and gynaecology and fertility clinics was used. The inclusion criteria for all participants were being childless, in a heterosexual relationship and cohabiting for at least 2 years. Specific inclusion criteria for involuntary definitive childless women were: trying to conceive for at least 2 years; not achieving pregnancy because of biological and medical constraints; and not undergoing fertility treatment or being a candidate for adopting a child at time of the study. For women with an infertility diagnosis the inclusion criteria were: actively trying to conceive (naturally or through fertility treatments); having a primary fertility diagnosis; and aged between 22 and 42 years old. For presumably fertile women, the inclusion criteria were: having a parenthood wish in the future; and not knowing of any condition that could prevent them from conceiving. PARTICIPANTS/MATERIALS, SETTING, METHODS Out of 360 women completing the survey, only 203 were eligible for this study (60 involuntary definitive childless women, 78 women with an infertility diagnosis actively trying to conceive, and 65 presumably fertile women). All participants completed a questionnaire including sociodemographic and clinical data, the Female Sexual Function Index, the 2-Way Social Support Scale, the Relationship Assessment Scale, and Hospital Anxiety and Depression Scale. Binary logistic regression was performed to assess the relation between sexual function, social support, marital satisfaction, anxiety, depression, and reproductive status, adjusting for age, and cohabitation length. Presumably fertile women were used as a reference group. MAIN RESULTS AND THE ROLE OF CHANCE Women were 34.31 years old (SD = 5.89) and cohabited with their partners for 6.55 years (SD = 4.57). The odds ratio (OR) showed that involuntary definitive childless women had significantly lower sexual function than infertile women actively trying to conceive (OR = 0.88, 95% CI = 0.79-0.99) and presumably fertile women (OR = 34.89, 95% CI = 1.98-614.03), and higher depression levels than presumably fertile women (OR = 99.89, 95% CI = 3.29-3037.87). Women with an infertility diagnosis actively trying to conceive did not differ from presumably fertile women in sexual function, social support, marital satisfaction, anxiety, and depression. LIMITATIONS, REASONS FOR CAUTION The majority of childless women underwent fertility treatments, and childlessness for circumstantial reasons owing to lack of a partner was not included, therefore these results may not reflect the experiences of all women with an involuntary childless lifestyle. There was a time gap in the recruitment process, and only the definitive childlessness group filled out the questionnaire after the coronavirus disease 2019 pandemic. We did not ask participants if they self-identified themselves with the groups' terminology they were assigned to. WIDER IMPLICATIONS OF THE FINDINGS Our results emphasize the importance of future research to provide a more comprehensive understanding of the adjustment experiences of childless women and an awareness of the poor adjustment they might experience, highlighting the need to keep following women after unsuccessful treatments. Clinical practitioners must attend to these dimensions when consulting involuntary definitive childless women who might not have gone through treatments but also experience these adverse outcomes. STUDY FUNDING/COMPETING INTEREST(S) This study was partially supported by the Portuguese Foundation for Science and Technology. The authors declare that they have no conflict of interest. TRIAL REGISTRATION NUMBER N/A.
Collapse
Affiliation(s)
- Sara Ribeiro
- Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
| | - Juliana Pedro
- Centre for Reproductive Genetics A.Barros, Porto, Portugal
- Center for Psychology at University of Porto, Porto, Portugal
| | - Mariana Veloso Martins
- Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
- Center for Psychology at University of Porto, Porto, Portugal
| |
Collapse
|
21
|
Yuan Y, Yang L, Hu J, Deng Y, Zhang H. Knowledge, attitude and practice on ovarian reserve function among women of childbearing age: a prospective cross-sectional study in Chongqing and surrounding regions. BMJ Open 2024; 14:e080890. [PMID: 38431304 PMCID: PMC10910424 DOI: 10.1136/bmjopen-2023-080890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 02/20/2024] [Indexed: 03/05/2024] Open
Abstract
OBJECTIVES To evaluate the knowledge, attitudes and practice (KAP) on ovarian reserve function among women of childbearing age in Chongqing and surrounding regions, China. DESIGN Cross-sectional study. SETTING Chongqing and surrounding regions, China. PARTICIPANTS Women of childbearing age (18-48 years) by convenience sampling. PRIMARY AND SECONDARY OUTCOME MEASURES The demographic characteristics of the respondents and their KAP on ovarian reserve function were collected by administering 38-item questionnaires. RESULTS A total of 510 valid questionnaires were collected. The mean knowledge score of all respondents was 7.56±2.03 (possible range: 0-10), the mean attitude score was 29.12±3.98 (possible range: 8-40) and the mean practice score was 23.45±3.58 (possible range: 6-30). The multivariable analysis showed knowledge level (OR 1.175, 95% CI 1.049 to 1.317, p=0.002), attitude level (OR 1.249, 95% CI 1.167 to 1.337, p<0.001) and eating habits (self-cooked vs eating out, OR 1.958, 95% CI 1.201 to 3.190, p=0.007) were independently associated with better practice level. The structural equation modelling analysis showed that knowledge had a direct influence on attitude (β=0.487, p=0.030) and practice (β=0.312, p=0.012) and an indirect influence on practice (β=0.213, p=0.016). Attitude had a direct influence on practice (β=0.438, p=0.007). The total influence of knowledge on practice was significant (β=0.525, p=0.012). CONCLUSIONS The women living in Chongqing and surrounding regions had good knowledge, moderate attitude and good practice towards ovarian reserve function. The knowledge aspect can be further improved by education, which in turn might also improve practice among women of childbearing age.
Collapse
Affiliation(s)
- Youfang Yuan
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Li Yang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jun Hu
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yu Deng
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hongying Zhang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| |
Collapse
|
22
|
Ji JS, Liu L, Huang H, Chen HW, Xiao L, Lu XY, Ni YY, Jia WJ, Huang L. The body mass index and the risk of ectopic pregnancy: a 5-year retrospective case-control study. BMC Pregnancy Childbirth 2024; 24:143. [PMID: 38368325 PMCID: PMC10873945 DOI: 10.1186/s12884-024-06319-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 02/04/2024] [Indexed: 02/19/2024] Open
Abstract
PURPOSE Acknowledging the associated risk factors may have a positive impact on reducing the incidence of ectopic pregnancy (EP). In recent years, body mass index (BMI) has been mentioned in research. However, few studies are available and controversial on the relationship between EP and BMI. METHODS We retrospectively studied the EP women as a case group and the deliveries as a control group in the central hospital of Wuhan during 2017 ~ 2021. χ2 test of variables associated with ectopic pregnancy was performed to find differences. Univariate and multivariate binary logistic regression analysis was conducted to analyze the association of the variables of age, parity, history of induced abortion, history of ectopic pregnancy, history of spontaneous abortion, history of appendectomy surgery and BMI (< 18.5 kg/m2, 18.5 ~ 24.9 kg/m2, 25 kg/m2 ~ 29.9 kg/m2, ≥ 30 kg /m2) with EP. RESULTS They were 659 EP and 1460 deliveries. The variables of age, parity, history of induced abortion, history of ectopic pregnancy and BMI were different significantly(P < 0.05). Multivariate analysis showed that the variables of age > 35 years old [(OR (Odds Ratio), 5.415; 95%CI (Confidence Interval), 4.006 ~ 7.320, P < 0.001], history of ectopic pregnancy (OR, 3.944; 95%CI, 2.405 ~ 6.467; P < 0.001), history of induced abortion(OR, 3.365; 95%CI, 2.724 ~ 4.158, P < 0.001) and low BMI (< 18.5 kg/m2) (OR, 1.929; 95%CI, 1.416 ~ 2.628, P < 0.001])increased the risk of EP. CONCLUSION The history of ectopic pregnancy, history of induced abortion and age > 35 years old were the risk factors with EP. In addition to these traditional factors, we found low BMI (< 18.5 kg/m2) with women may increase the risk to EP.
Collapse
Affiliation(s)
- Jin-Shuang Ji
- Department of Gynecology & Obstetrics, Tongji Medical College, The Central Hospital of Wuhan, Huazhong University of Science and Technology, Wuhan, 430014, Hubei, China
| | - Ling Liu
- The Diagnosis and Therapy Center of Pelvic Floor Rehabilitation and Electrophysiology, Tongji Medical College, The Central Hospital of Wuhan, Huazhong University of Science and Technology, Wuhan, 430014, Hubei, China
| | - Huan Huang
- Department of Gynecology & Obstetrics, Tongji Medical College, The Central Hospital of Wuhan, Huazhong University of Science and Technology, Wuhan, 430014, Hubei, China
| | - Hong-Wei Chen
- Department of Gynecology & Obstetrics, Tongji Medical College, The Central Hospital of Wuhan, Huazhong University of Science and Technology, Wuhan, 430014, Hubei, China
| | - Li Xiao
- Department of Gynecology & Obstetrics, Tongji Medical College, The Central Hospital of Wuhan, Huazhong University of Science and Technology, Wuhan, 430014, Hubei, China
- The Diagnosis and Therapy Center of Pelvic Floor Rehabilitation and Electrophysiology, Tongji Medical College, The Central Hospital of Wuhan, Huazhong University of Science and Technology, Wuhan, 430014, Hubei, China
| | - Xiang-Yi Lu
- Department of Gynecology & Obstetrics, Tongji Medical College, The Central Hospital of Wuhan, Huazhong University of Science and Technology, Wuhan, 430014, Hubei, China
| | - Yang-Yang Ni
- Department of Gynecology & Obstetrics, Tongji Medical College, The Central Hospital of Wuhan, Huazhong University of Science and Technology, Wuhan, 430014, Hubei, China
| | - Wen-Juan Jia
- Department of Gynecology & Obstetrics, Tongji Medical College, The Central Hospital of Wuhan, Huazhong University of Science and Technology, Wuhan, 430014, Hubei, China
| | - Lei Huang
- Department of Gynecology & Obstetrics, Tongji Medical College, The Central Hospital of Wuhan, Huazhong University of Science and Technology, Wuhan, 430014, Hubei, China.
- The Diagnosis and Therapy Center of Pelvic Floor Rehabilitation and Electrophysiology, Tongji Medical College, The Central Hospital of Wuhan, Huazhong University of Science and Technology, Wuhan, 430014, Hubei, China.
| |
Collapse
|
23
|
Greil AL, Wallace DD, Passet-Wittig J, McQuillan J, Bujard M, Lowry MH. Self-Perceived Infertility is Not Always Associated with Having Fewer Children: Evidence from German Panel Data. EUROPEAN JOURNAL OF POPULATION = REVUE EUROPEENNE DE DEMOGRAPHIE 2024; 40:8. [PMID: 38347334 PMCID: PMC10861411 DOI: 10.1007/s10680-023-09692-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 12/18/2023] [Indexed: 02/15/2024]
Abstract
Proximate determinants theory considers infertility rates a risk factor for lower fertility rates, but the assumption that people who perceive infertility will have fewer children has not been tested. This study investigates the association of self-perceived infertility with the number of children people have had after 11 years. Infertility implies reduced chances of conception (rather than sterility), but people do not always consistently perceive infertility over time. If people who think they are infertile at one time can later report no infertility, then does self-perceived infertility necessarily lead to having fewer children? We answer this question by analyzing 11 waves of the German family panel (pairfam) data using negative binomial growth curve models for eight core demographic subgroups created by combinations of gender (men/women), parity (0/1+children), and initial age groups (25-27 and 35-37). Those who repeatedly perceived themselves to be infertile (three times or more) had fewer children than those who perceived themselves to be infertile once or twice in only four of eight gender by initial parity by age groups. Only in four groups did people who perceived themselves to be infertile once or twice have fewer children than those who never perceived themselves to be infertile in both the unadjusted and adjusted models. Thus, self-perceived infertility does not necessarily result in fewer children. Rather, the association depends upon life course context and gender.
Collapse
Affiliation(s)
- Arthur L Greil
- Division of Social Sciences, Alfred University, Alfred, NY, USA
| | | | - Jasmin Passet-Wittig
- Family and Fertility Research Area, Federal Institute for Population Research, Wiesbaden, Germany
| | - Julia McQuillan
- Department of Sociology, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Martin Bujard
- Family and Fertility Research Area, Federal Institute for Population Research, Wiesbaden, Germany.
| | - Michele H Lowry
- Division of Social Sciences, Alfred University, Alfred, NY, USA
| |
Collapse
|
24
|
Wang SH, Lin MC, Wu CS, Chen PC, Thompson WK, Fan CC. Familial factors rather than paternal age contribute to the aetiology of epilepsy. Int J Epidemiol 2024; 53:dyad191. [PMID: 38199793 DOI: 10.1093/ije/dyad191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Whether paternal age associated with offspring's epilepsy risk is a cause of de novo mutation as men age, or just an association due to confounding factors, is still unclear. METHODS We performed a population-based, multi-generation and sibling comparison study in Taiwan, which included 2 751 232 singletons born in 2001-17 who were followed until 2020. Of these, 819 371/826 087 with information on paternal/maternal grandparents were selected for multi-generation analyses and 1 748 382 with sibling(s) were selected for sibling comparison. Cox proportional hazard regression was used to estimate the hazard ratio (HR) and 95% confidence interval (CI). RESULTS In the total cohort, there was an increased risk of epilepsy in individuals with advanced paternal age, e.g. the HR for paternal age ≥50 was1.36 (95% CI: 1.15-1.61) compared with paternal age 25-29, and fathers older than mothers, e.g. the HR for parental age difference ≥15 years was 1.29 (95% CI: 1.16-1.43). When accounting for parental age difference, the association between paternal age and epilepsy in offspring was attenuated (HR for paternal age ≥50 was 1.11, 95% CI: 0.93-1.34). Multi-generation analyses did not support the association of advanced grand-paternal age at childbirth of the parent with offspring's risk of epilepsy. Sibling comparison analyses did not support the association of older paternal age with increased risk of epilepsy (HR was 0.96 for per year increase in paternal age, 95% CI: 0.96-0.97). CONCLUSIONS These results do not support the hypothesis that advanced paternal age is associated with epilepsy in offspring. Instead, familial factors may explain the observed paternal age association with the offspring's risk of epilepsy.
Collapse
Affiliation(s)
- Shi-Heng Wang
- National Center for Geriatrics and Welfare Research, National Health Research Institutes, Zhunan, Taiwan
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Mei-Chen Lin
- National Center for Geriatrics and Welfare Research, National Health Research Institutes, Zhunan, Taiwan
| | - Chi-Shin Wu
- National Center for Geriatrics and Welfare Research, National Health Research Institutes, Zhunan, Taiwan
- Department of Psychiatry, National Taiwan University Hospital, Yunlin Branch, Douliu, Taiwan
| | - Pei-Chun Chen
- National Center for Geriatrics and Welfare Research, National Health Research Institutes, Zhunan, Taiwan
| | - Wesley K Thompson
- Center for Population Neuroscience and Genetics, Laureate Institute for Brain Research, Tulsa, OK, USA
| | - Chun-Chieh Fan
- Center for Population Neuroscience and Genetics, Laureate Institute for Brain Research, Tulsa, OK, USA
- Department of Radiology, School of Medicine, University of California San Diego, La Jolla, CA, USA
| |
Collapse
|
25
|
Liu A, Akimova ET, Ding X, Jukarainen S, Vartiainen P, Kiiskinen T, Koskelainen S, Havulinna AS, Gissler M, Lombardi S, Fall T, Mills MC, Ganna A. Evidence from Finland and Sweden on the relationship between early-life diseases and lifetime childlessness in men and women. Nat Hum Behav 2024; 8:276-287. [PMID: 38110509 PMCID: PMC10896715 DOI: 10.1038/s41562-023-01763-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 10/18/2023] [Indexed: 12/20/2023]
Abstract
The percentage of people without children over their lifetime is approximately 25% in men and 20% in women. Individual diseases have been linked to childlessness, mostly in women, yet we lack a comprehensive picture of the effect of early-life diseases on lifetime childlessness. We examined all individuals born in 1956-1968 (men) and 1956-1973 (women) in Finland (n = 1,035,928) and Sweden (n = 1,509,092) to the completion of their reproductive lifespan in 2018. Leveraging nationwide registers, we associated sociodemographic and reproductive information with 414 diseases across 16 categories, using a population and matched-pair case-control design of siblings discordant for childlessness (71,524 full sisters and 77,622 full brothers). The strongest associations were mental-behavioural disorders (particularly among men), congenital anomalies and endocrine-nutritional-metabolic disorders (strongest among women). We identified new associations for inflammatory and autoimmune diseases. Associations were dependent on age at onset and mediated by singlehood and education. This evidence can be used to understand how disease contributes to involuntary childlessness.
Collapse
Affiliation(s)
- Aoxing Liu
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland.
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA.
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, USA.
| | - Evelina T Akimova
- Leverhulme Centre for Demographic Science, Nuffield Department of Population Health, and Nuffield College, University of Oxford, Oxford, UK
| | - Xuejie Ding
- Leverhulme Centre for Demographic Science, Nuffield Department of Population Health, and Nuffield College, University of Oxford, Oxford, UK
| | - Sakari Jukarainen
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
| | - Pekka Vartiainen
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
| | - Tuomo Kiiskinen
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Sara Koskelainen
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
| | - Aki S Havulinna
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Mika Gissler
- Finnish Institute for Health and Welfare, Helsinki, Finland
- Research Centre for Child Psychiatry and Invest Research Flagship, University of Turku, Turku, Finland
- Academic Primary Health Care Centre, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | | | - Tove Fall
- Molecular Epidemiology, Department of Medical Sciences, and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Melinda C Mills
- Leverhulme Centre for Demographic Science, Nuffield Department of Population Health, and Nuffield College, University of Oxford, Oxford, UK.
- Department of Economics, Econometrics and Finance, Faculty of Economics and Business, University of Groningen, Groningen, the Netherlands.
- Department of Genetics, University Medical Centre Groningen, Groningen, the Netherlands.
| | - Andrea Ganna
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland.
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA.
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, USA.
| |
Collapse
|
26
|
Riederer B, Beaujouan É. Explaining the urban-rural gradient in later fertility in Europe. POPULATION, SPACE AND PLACE 2024; 30:psp.2720. [PMID: 38213311 PMCID: PMC7615507 DOI: 10.1002/psp.2720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 10/06/2023] [Indexed: 01/13/2024]
Abstract
Demographic research shows that, in Europe, fertility takes place later and is lower in cities than in rural areas. One might expect fertility to be delayed in urban areas because of longer periods in education and enhanced career opportunities. We, therefore, examine how prevalent later fertility (35+ and 40+) is along the urban-rural axis, and whether differences can be explained by economic, cultural and compositional factors. We estimate multilevel random coefficient models, employing aggregated Eurostat data of 1328 Nomenclature des unités territoriales statistiques (NUTS) 3 and 270 NUTS 2 regions from 28 European countries. The urban-rural gradient in later fertility considerably diminishes once factors describing the economic environment, family and gender norms as well as population composition are accounted for. The higher prevalence of later fertility in cities is particularly associated with higher female education, greater wealth and a higher share of employment in high-technology sectors.
Collapse
Affiliation(s)
- Bernhard Riederer
- Vienna Institute of Demography, Austrian Academy of Sciences, Vienna, Austria
- Department of Demography, University of Vienna, Vienna, Austria
- Department of Sociology, University of Vienna, Vienna, Austria
- Wittgenstein Centre for Demography and Global Human Capital (IIASA, OeAW, University of Vienna), Vienna, Austria
| | - Éva Beaujouan
- Department of Demography, University of Vienna, Vienna, Austria
- Wittgenstein Centre for Demography and Global Human Capital (IIASA, OeAW, University of Vienna), Vienna, Austria
| |
Collapse
|
27
|
de Kermadec E, Zheng Y, Rosenberg S, Ruddy KJ, Ligibel JA, Emmons KM, Partridge AH. Fertility concerns and treatment decision-making among national sample of young women with breast cancer. Cancer Med 2023; 13:e6838. [PMID: 38131887 PMCID: PMC10807590 DOI: 10.1002/cam4.6838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/03/2023] [Accepted: 11/27/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Diagnosis of breast cancer in young women has been shown to affect their decision-making with regard to fertility and family planning. Limited data are available from populations across the U.S. regarding this issue; thus, we sought to describe fertility concerns and efforts to preserve fertility in a national clinical trial population of young breast cancer patients. METHODS The young and strong study was a cluster-randomized controlled trial testing an intervention program for young women with breast cancer. Patients were surveyed within 3 months after diagnosis and at 3, 6, and 12 months after. Surveys asked about sociodemographics, psychosocial domains, fertility concerns, and fertility preservation strategies. Univariable and multivariable models were used to investigate sociodemographic, clinical, and psychosocial predictors of fertility concerns. RESULTS Of 467 women from 54 clinical sites across the U.S. (14 academic, 40 community), 419 were evaluable regarding fertility concerns. Median age was 40 years (range 22-45), 11% were Black, 6% Hispanic, and 75% had children. Tumor stage was I (35%), II (51%), or III (14%); 82% received chemotherapy. At time of the treatment decision, 133 (32%) participants had fertility concerns, among whom 47% indicated this affected their treatment decisions. Sixty percent of participants reported having discussed fertility with their physician. Twenty percent of those with fertility concerns used fertility preservation strategies. History of difficulty becoming pregnant and younger age were associated with higher odds of fertility concerns in multivariable modeling. CONCLUSION Many young women with newly diagnosed breast cancer are concerned about fertility in a way that impacts their treatment decisions. Concerns were discussed, but few used fertility preservation strategies. These findings have implications for counseling young patients.
Collapse
Affiliation(s)
- Elisabeth de Kermadec
- Medical OncologyDana‐Farber Cancer InstituteBostonMassachusettsUSA
- Breast Oncology ProgramDana‐Farber Brigham Cancer CenterBostonMassachusettsUSA
- Present address:
SanofiCambridgeMassachusettsUSA
| | - Yue Zheng
- Data ScienceDana‐Farber Cancer InstituteBostonMassachusettsUSA
| | - Shoshana Rosenberg
- Medical OncologyDana‐Farber Cancer InstituteBostonMassachusettsUSA
- Breast Oncology ProgramDana‐Farber Brigham Cancer CenterBostonMassachusettsUSA
- Harvard Medical SchoolBostonMassachusettsUSA
- Present address:
Weill Cornell MedicineNew YorkNew YorkUSA
| | | | - Jennifer A. Ligibel
- Medical OncologyDana‐Farber Cancer InstituteBostonMassachusettsUSA
- Breast Oncology ProgramDana‐Farber Brigham Cancer CenterBostonMassachusettsUSA
- Harvard Medical SchoolBostonMassachusettsUSA
| | - Karen M. Emmons
- Harvard T. H. Chan School of Public HealthBostonMassachusettsUSA
| | - Ann H. Partridge
- Medical OncologyDana‐Farber Cancer InstituteBostonMassachusettsUSA
- Breast Oncology ProgramDana‐Farber Brigham Cancer CenterBostonMassachusettsUSA
- Harvard Medical SchoolBostonMassachusettsUSA
| |
Collapse
|
28
|
Fioroni Ribeiro da Silva C, Greco ALR, Castilho Cabrera Santos D, Sgandurra G, Tudella E. Association between Contextual Factors and Affordances in the Home Environment of Infants Exposed to Poverty. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1932. [PMID: 38136134 PMCID: PMC10742190 DOI: 10.3390/children10121932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/08/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023]
Abstract
Home environments of infants exposed to poverty exhibit fewer affordances for child development. This study aimed to investigate the association between contextual factors and affordances in the home environments of infants facing poverty. Term infants (n = 128) were divided into two groups: (1) exposed group (EG), comprising term infants exposed to poverty, and (2) comparison group (CG), consisting of term infants classified with medium and high socio-economic status. The main dependent variables were physical space, variety of stimulation, gross and fine motor toys, and the total score; measured using the Brazilian version of the Affordances in the Home Environment for Motor Development-Infant Scale (AHEMD-IS) questionnaire, named Affordances no Ambiente Domiciliar para o Desenvolvimento Motor-Escala Bebê. Statistical analysis employed independent sample t-tests or Mann-Whitney tests, chi-square tests, and stepwise multiple linear regression models to evaluate predictors of less adequate home environments. The EG presented significantly fewer affordances in gross motor toys (Cohen's r = 0.353; p < 0.01); fine motor toys (Cohen's r = 0.327; p < 0.01); and total score (Cohen's r = 0.377; p < 0.01). Binary logistic regression analysis showed a significant association (r2 = 0.828, p < 0.01) between the less than adequate home environment category and maternal age (p = 0.043, OR: 0.829 (0.692-0.994)), revealing that maternal age was associated with better quantity and quality of affordances for child development.
Collapse
Affiliation(s)
| | | | - Denise Castilho Cabrera Santos
- Human Movement Sciences Graduate Program, Methodist University of Piracicaba, Piracicaba 13423-170, Brazil;
- Department of Human Development and Rehabilitation, School of Medical Science, University of Campinas (UNICAMP), Campinas 13083-970, Brazil
| | - Giuseppina Sgandurra
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56126 Pisa, Italy;
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Viale del Tirreno 331, 56128 Pisa, Italy
| | - Eloisa Tudella
- Neuropediatrics and Motricity Studies Center (NENEM), Federal University of São Carlos, São Carlos 13565-905, Brazil;
| |
Collapse
|
29
|
Wang L, Han C, Lv X, Zeng S, Mu R, Deng Y, Xie W, Huang J, Wu S, Zhang Y, Zhang H, He Y, Peng Z, Wang Y, Shen H, Wang Q, Zhang Y, Yan D, Yang Y, Ma X. Structural transition of parenthood among Chinese nulliparous couples with planned pregnancies, 2013-2019. BMC Public Health 2023; 23:2412. [PMID: 38049775 PMCID: PMC10696718 DOI: 10.1186/s12889-023-17380-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 11/30/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND The postponement of parenthood is a global public health issue that has received attention of many public health experts. However, few studies have investigated the postponement in marriage age, marriage and conception interval, and pregnancy age in terms of demographic and regional heterogenicities. METHODS This is a cross-sectional, registry-based study, and a total of 13 894 601 nulliparous couples who participated in the National Free Pre-Pregnancy Check-ups Project and became pregnant during 2013-2019 were included. We calculated annual percentage change and forest plots for marriage age, marriage and conception interval, and pregnancy age. RESULTS Late marriage (marriage age ≥ 35 years), long marriage and conception interval (marriage and conception interval ≥ 2 years), and advanced pregnancy (pregnancy age ≥ 35 years) increased from 1.20%, 22.01%, and 1.88% in 2013 to 1.69%, 32.75%, and 2.79% in 2019, respectively. The corresponding annual percentage changes were 6.55%, 8.44%, and 8.17%. Participants without higher education had a higher annual percentage change, but comparable prevalence for long marriage and conception interval with participants with higher education. Participants residing in second- or new first-tier cities, and the northeast of China who had a higher prevalence of parenthood postponement also had higher corresponding annual percentage changes. CONCLUSIONS Structural postponement of parenthood with demographic and regional heterogenicities was observed among Chinese nulliparous couples with planned pregnancies during 2013-2019. Inclusive and comprehensive parenting support should be developed and implemented in mainland China to minimize the negative health effects arising from the postponement, especially for couples without higher education and living in new first/second-tier cities or the northeast China.
Collapse
Affiliation(s)
- Long Wang
- Institute of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, China
| | - Chunying Han
- Institute of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, China
| | - Xinyi Lv
- National Research Institute for Family Planning, Beijing, China
- Graduate School of Peking Union Medical College, Beijing, China
| | - Shuai Zeng
- Institute of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, China
| | - Rongwei Mu
- Institute of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, China
| | - Yuzhi Deng
- National Research Institute for Family Planning, Beijing, China
- Graduate School of Peking Union Medical College, Beijing, China
| | - Wenlu Xie
- Institute of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, China
| | - Jiaxin Huang
- Institute of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, China
| | - Siyu Wu
- Institute of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, China
| | - Ya Zhang
- National Research Institute for Family Planning, Beijing, China
| | - Hongguang Zhang
- National Research Institute for Family Planning, Beijing, China
| | - Yuan He
- National Research Institute for Family Planning, Beijing, China
| | - Zuoqi Peng
- National Research Institute for Family Planning, Beijing, China
| | - Yuanyuan Wang
- National Research Institute for Family Planning, Beijing, China
| | - Haiping Shen
- Department of Maternal and Child Health, National Health Commission of the PRC, Beijing, China
| | - Qiaomei Wang
- Department of Maternal and Child Health, National Health Commission of the PRC, Beijing, China
| | - Yiping Zhang
- Department of Maternal and Child Health, National Health Commission of the PRC, Beijing, China
| | - Donghai Yan
- Department of Maternal and Child Health, National Health Commission of the PRC, Beijing, China
| | - Ying Yang
- National Research Institute for Family Planning, Beijing, China.
- National Human Genetic Resources Centre, Beijing, China.
- Graduate School of Peking Union Medical College, Beijing, China.
| | - Xu Ma
- National Research Institute for Family Planning, Beijing, China.
- National Human Genetic Resources Centre, Beijing, China.
- Graduate School of Peking Union Medical College, Beijing, China.
| |
Collapse
|
30
|
Treskina NA, Postoev VA, Usynina AA, Grjibovski AM, Odland JØ. Secular trends of socio-demographic and lifestyle characteristics among delivering women in Arctic Russia, 1973-2017. Int J Circumpolar Health 2023; 82:2161131. [PMID: 36547385 PMCID: PMC9793942 DOI: 10.1080/22423982.2022.2161131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The aim of this study was to describe temporal trends in socio-demographic and lifestyle characteristics among delivering women in two Northern provinces of Russia from 1973 to 2017. Totally 161,730 births were registered in three birth registries. Changes in the distribution of maternal age, education, marital status, smoking during pregnancy were studied using Pearson's chi-squared tests and one-way ANOVA. The logistic regression models were used to assess factors, contributing to the variations in the prevalence of maternal smoking. The mean age of primiparous mothers increased from 22.1 years in 1973-1980 to 25.4 years in 2012-2017 (p < 0.001). The proportion of primiparous mothers with higher education increased from 26.2% in 2006 to 38.3% in 2017 (p < 0.001). The proportion of cohabiting primiparous women increased from 5.0% to 15.2% over the study period (p < 0.001). The proportion of mothers smoking during pregnancy decreased from 18.9% in 2006-2011 to 14.8% in 2012-2017 (p < 0.001). Downward in the prevalence of smoking was revealed in 2012-2017 compared to 2006-2011 (OR = 137.76; 95%CI:71.62-264.96, OR = 183.74; 95%CI:95.52-353.41, respectively). Over the past decades, women postpone childbearing until receiving higher education, continue living in cohabitation during pregnancy and smoke less.
Collapse
Affiliation(s)
- Natalia A. Treskina
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway,CONTACT Natalia A. Treskina Norwegian University of Science and Technology, 8900, NO-7491Trondheim, Norway
| | - Vitaly A. Postoev
- Department of Public Health, Health Care and Social Work, Northern State Medical University, Arkhangelsk, Russia
| | - Anna A. Usynina
- Department of Neonatology and Perinatology, Northern State Medical University, Arkhangelsk, Russia
| | - Andrej M. Grjibovski
- Central Scientific Research Laboratory, Northern State Medical University, Arkhangelsk, Russia,Department of Health Policy and Management, Al Farabi Kazakh National University, Almaty, The Republic of Kazakhstan,Department of Epidemiology and Modern Vaccination Technologies, I.M. Sechenov First Moscow State Medical University, Moscow, Russia,Department of Biology, Ecology and Biotechnology, Northern (Arctic) Federal University, Arkhangelsk, Russia
| | - Jon Øyvind Odland
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway,Department of General Hygiene, I.M. Sechenov First Moscow State Medical University, Moscow, Russia,Institute of Ecology, National Research University Higher School of Economics, Moscow, Russia
| |
Collapse
|
31
|
Cai H, Mol B, Gordts S, Wang H, Shi J. Elective single versus double blastocyst-stage embryo transfer in women aged 36 years or older: a retrospective cohort study. HUM FERTIL 2023; 26:1185-1194. [PMID: 36719262 DOI: 10.1080/14647273.2022.2153348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 08/29/2022] [Indexed: 02/01/2023]
Abstract
We evaluated if elective single-blastocyst transfer (eSBT) could be adopted in women aged 36 or older. In this retrospective cohort, women aged ≥36 years received IVF ovarian stimulation cycles and had ≥ two blastocysts. A total of 240 women underwent eSBT and 189 double-blastocyst transfer (DBT) in the first transfer cycle. The subsequent frozen-thawed embryo transfer cycles were a combination of single- and double- blastocyst transfers. Analysis was stratified for patients in age groups 36-37, 38-39 and ≥40, considering the quality of the blastocyst transferred. The cumulative live birth rates (cLBR) were 74.2% (178/240) versus 63.0% (119/189) after eSBT versus DBT, respectively (aOR: 1.09 (0.68, 1.75)). Time to live birth did not vary significantly between the two groups (HR: 0.85 (0.68, 1.08)). The total number of children born was 194 after eSBT (162 singletons and 16 pairs of twins) versus 154 (84 singletons and 35 twins) after DBT. The odds ratios for preterm birth (0.37 (0.21-0.64)), and low birth weight (0.31 (0.16, 0.60)) were all lower in eSBT. In women aged ≥36 years, cLBR following single- versus double- blastocyst transfer was comparable while the odds of multiple live births and adverse perinatal outcomes were reduced.
Collapse
Affiliation(s)
- He Cai
- Assisted Reproduction Center, Northwest Women's and Children's Hospital, Xi'an, People's Republic of China
| | - Ben Mol
- Medicine Department, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Parkville, Victoria, Australia
- Pregnancy Research Centre, Department of Maternal-Fetal Medicine, Royal Women's Hospital, Parkville, Victoria, Australia
| | - Stephan Gordts
- Leuven Institute for Fertility & Embryology, Leuven, Belgium
| | - Hui Wang
- Assisted Reproduction Center, Northwest Women's and Children's Hospital, Xi'an, People's Republic of China
| | - Juanzi Shi
- Assisted Reproduction Center, Northwest Women's and Children's Hospital, Xi'an, People's Republic of China
| |
Collapse
|
32
|
Trohl J, Schindler M, Buske M, de Nivelle J, Toto Nienguesso A, Navarrete Santos A. Advanced maternal age leads to changes within the insulin/IGF system and lipid metabolism in the reproductive tract and preimplantation embryo: insights from the rabbit model. Mol Hum Reprod 2023; 29:gaad040. [PMID: 38001038 DOI: 10.1093/molehr/gaad040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 10/16/2023] [Indexed: 11/26/2023] Open
Abstract
Reproductive potential in women declines with age. The impact of ageing on embryo-maternal interactions is still unclear. Rabbits were used as a reproductive model to investigate maternal age-related alterations in reproductive organs and embryos on Day 6 of pregnancy. Blood, ovaries, endometrium, and blastocysts from young (16-20 weeks) and advanced maternal age phase (>108 weeks, old) rabbits were analysed at the mRNA and protein levels to investigate the insulin-like growth factor (IGF) system, lipid metabolism, and stress defence system. Older rabbits had lower numbers of embryos at Day 6 of pregnancy. Plasma insulin and IGF levels were reduced, which was accompanied by paracrine regulation of IGFs and their receptors in ovaries and endometrium. Embryos adapted to hormonal changes as indicated by reduced embryonic IGF1 and 2 levels. Aged reproductive organs increased energy generation from the degradation of fatty acids, leading to higher oxidative stress. Stress markers, including catalase, superoxide dismutase 2, and receptor for advanced glycation end products were elevated in ovaries and endometrium from aged rabbits. Embryonic fatty acid uptake and β-oxidation were increased in both embryonic compartments (embryoblast and trophoblast) in old rabbits, associated with minor changes in the oxidative and glycative stress defence systems. In summary, the insulin/IGF system, lipid metabolism, and stress defence were dysregulated in reproductive tissues of older rabbits, which is consistent with changes in embryonic metabolism and stress defence. These data highlight the crucial influence of maternal age on uterine adaptability and embryo development.
Collapse
Affiliation(s)
- Juliane Trohl
- Department of Anatomy and Cell Biology, Martin Luther University Faculty of Medicine, Halle (Saale), Germany
| | - Maria Schindler
- Department of Anatomy and Cell Biology, Martin Luther University Faculty of Medicine, Halle (Saale), Germany
| | - Maximilian Buske
- Department of Anatomy and Cell Biology, Martin Luther University Faculty of Medicine, Halle (Saale), Germany
| | - Johanna de Nivelle
- Department of Anatomy and Cell Biology, Martin Luther University Faculty of Medicine, Halle (Saale), Germany
| | - Alicia Toto Nienguesso
- Department of Anatomy and Cell Biology, Martin Luther University Faculty of Medicine, Halle (Saale), Germany
| | - Anne Navarrete Santos
- Department of Anatomy and Cell Biology, Martin Luther University Faculty of Medicine, Halle (Saale), Germany
| |
Collapse
|
33
|
Potabattula R, Prell A, Dittrich M, Nava C, Depienne C, Bejaoui Y, El Hajj N, Hahn T, Schorsch M, Haaf T. Effects of paternal and chronological age on BEGAIN methylation and its possible role in autism. Aging (Albany NY) 2023; 15:12763-12779. [PMID: 38019471 DOI: 10.18632/aging.205275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 10/23/2023] [Indexed: 11/30/2023]
Abstract
Children from old fathers carry an increased risk for autism spectrum (ASD) and other neurodevelopmental disorders, which may at least partially be mediated by paternal age effects on the sperm epigenome. The brain enriched guanylate kinase associated (BEGAIN) protein is involved in protein-protein interactions at and transmission across synapses. Since several epigenome-wide methylation screens reported a paternal age effect on sperm BEGAIN methylation, here we confirmed a significant negative correlation between BEGAIN promoter methylation and paternal age, using more sensitive bisulfite pyrosequencing and a larger number of sperm samples. Paternal age-associated BEGAIN hypomethylation was also observed in fetal cord blood (FCB) of male but not of female offspring. There was no comparable maternal age effect on FCB methylation. In addition, we found a significant negative correlation between BEGAIN methylation and chronological age (ranging from 1 to 70 years) in peripheral blood samples of male but not of female donors. BEGAIN hypomethylation was more pronounced in male children, adolescents and adults suffering from ASD compared to controls. Both genetic variation (CC genotype of SNP rs7141087) and epigenetic factors may contribute to BEGAIN promoter hypomethylation. The age- and sex-specific BEGAIN methylation trajectories in the male germ line and somatic tissues, in particular the brain, support a role of this gene in ASD development.
Collapse
Affiliation(s)
- Ramya Potabattula
- Institute of Human Genetics, Julius Maximilians University, Würzburg, Germany
| | - Andreas Prell
- Institute of Human Genetics, Julius Maximilians University, Würzburg, Germany
| | - Marcus Dittrich
- Institute of Human Genetics, Julius Maximilians University, Würzburg, Germany
- Department of Bioinformatics, Julius Maximilians University, Würzburg, Germany
| | - Caroline Nava
- U.F. de Neurogénétique Moléculaire et Cellulaire, Dpt. de Génétique et Cytogénétique, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Christel Depienne
- Institute of Human Genetics, University Hospital Essen, Essen, Germany
| | - Yosra Bejaoui
- College of Health and Life Sciences and College of Science and Engineering, Hamad Bin Khalifa University, Doha, Qatar
| | - Nady El Hajj
- College of Health and Life Sciences and College of Science and Engineering, Hamad Bin Khalifa University, Doha, Qatar
| | | | | | - Thomas Haaf
- Institute of Human Genetics, Julius Maximilians University, Würzburg, Germany
| |
Collapse
|
34
|
Pathare ADS, Loid M, Saare M, Gidlöf SB, Zamani Esteki M, Acharya G, Peters M, Salumets A. Endometrial receptivity in women of advanced age: an underrated factor in infertility. Hum Reprod Update 2023; 29:773-793. [PMID: 37468438 PMCID: PMC10628506 DOI: 10.1093/humupd/dmad019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/24/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Modern lifestyle has led to an increase in the age at conception. Advanced age is one of the critical risk factors for female-related infertility. It is well known that maternal age positively correlates with the deterioration of oocyte quality and chromosomal abnormalities in oocytes and embryos. The effect of age on endometrial function may be an equally important factor influencing implantation rate, pregnancy rate, and overall female fertility. However, there are only a few published studies on this topic, suggesting that this area has been under-explored. Improving our knowledge of endometrial aging from the biological (cellular, molecular, histological) and clinical perspectives would broaden our understanding of the risks of age-related female infertility. OBJECTIVE AND RATIONALE The objective of this narrative review is to critically evaluate the existing literature on endometrial aging with a focus on synthesizing the evidence for the impact of endometrial aging on conception and pregnancy success. This would provide insights into existing gaps in the clinical application of research findings and promote the development of treatment options in this field. SEARCH METHODS The review was prepared using PubMed (Medline) until February 2023 with the keywords such as 'endometrial aging', 'receptivity', 'decidualization', 'hormone', 'senescence', 'cellular', 'molecular', 'methylation', 'biological age', 'epigenetic', 'oocyte recipient', 'oocyte donation', 'embryo transfer', and 'pregnancy rate'. Articles in a language other than English were excluded. OUTCOMES In the aging endometrium, alterations occur at the molecular, cellular, and histological levels suggesting that aging has a negative effect on endometrial biology and may impair endometrial receptivity. Additionally, advanced age influences cellular senescence, which plays an important role during the initial phase of implantation and is a major obstacle in the development of suitable senolytic agents for endometrial aging. Aging is also accountable for chronic conditions associated with inflammaging, which eventually can lead to increased pro-inflammation and tissue fibrosis. Furthermore, advanced age influences epigenetic regulation in the endometrium, thus altering the relation between its epigenetic and chronological age. The studies in oocyte donation cycles to determine the effect of age on endometrial receptivity with respect to the rates of implantation, clinical pregnancy, miscarriage, and live birth have revealed contradictory inferences indicating the need for future research on the mechanisms and corresponding causal effects of women's age on endometrial receptivity. WIDER IMPLICATIONS Increasing age can be accountable for female infertility and IVF failures. Based on the complied observations and synthesized conclusions in this review, advanced age has been shown to have a negative impact on endometrial functioning. This information can provide recommendations for future research focusing on molecular mechanisms of age-related cellular senescence, cellular composition, and transcriptomic changes in relation to endometrial aging. Additionally, further prospective research is needed to explore newly emerging therapeutic options, such as the senolytic agents that can target endometrial aging without affecting decidualization. Moreover, clinical trial protocols, focusing on oocyte donation cycles, would be beneficial in understanding the direct clinical implications of endometrial aging on pregnancy outcomes.
Collapse
Affiliation(s)
- Amruta D S Pathare
- Department of Obstetrics and Gynaecology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - Marina Loid
- Department of Obstetrics and Gynaecology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
- Competence Centre on Health Technologies, Tartu, Estonia
| | - Merli Saare
- Department of Obstetrics and Gynaecology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
- Competence Centre on Health Technologies, Tartu, Estonia
| | - Sebastian Brusell Gidlöf
- Division of Obstetrics and Gynaecology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
- Department of Gynecology and Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Masoud Zamani Esteki
- Division of Obstetrics and Gynaecology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Genetics, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Department of Genetics and Cell Biology, GROW School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Ganesh Acharya
- Division of Obstetrics and Gynaecology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Medicine, Women’s Health and Perinatology Research Group, UiT The Arctic University of Norway, Tromsø, Norway
| | - Maire Peters
- Department of Obstetrics and Gynaecology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
- Competence Centre on Health Technologies, Tartu, Estonia
| | - Andres Salumets
- Department of Obstetrics and Gynaecology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
- Competence Centre on Health Technologies, Tartu, Estonia
- Division of Obstetrics and Gynaecology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
35
|
Tan PL, Pan J, Xia X. Does information on age-related fertility decline and fertility policies affect university students' family and career expectations? Evidence from a randomized controlled trial. PLoS One 2023; 18:e0287526. [PMID: 37910460 PMCID: PMC10619829 DOI: 10.1371/journal.pone.0287526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 06/06/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Past research shows that young adults have poor knowledge of age-related fertility decline and that the provision of information can improve fertility knowledge. We provide university students with information on age-related fertility and fertility-related policies and investigate whether the provision of such information affects their family formation and career expectations. METHODS A three-armed randomized controlled trial was conducted online in Singapore between September and October 2021. A total of 1000 undergraduate students were recruited through campus advertisements to complete a 30- to 45-minute online survey, which randomly exposed participants to one of three informational brochures on age-related fertility decline, fertility policies, or diabetes (control group). Participants answered questions on family formation and career expectations both before and after the information intervention. Analysis of covariance was used to assess the effects of the information intervention. RESULTS Exposure to age-related fertility information resulted in significant reductions in the ideal age at first childbirth, significant increases in the expected probability of marriage before age 30, and (among female participants) significant increases in the expected likelihood of undergoing social egg-freezing. No difference existed in child-number ideals, educational aspirations, and income expectations between groups after exposure. No difference existed between the fertility policy information group and the control group after exposure in any of the outcomes of interest. CONCLUSIONS Information on age-related fertility decline brought forward university students' expected timing of childbearing and marriage without reducing their educational and career expectations. The provision of fertility information at early ages, such as during university, can help correct widespread inaccurate beliefs about fertility and promote realistic family formation planning without adversely affecting educational and career goals. TRIAL REGISTRATION ClinicalTrials.gov.
Collapse
Affiliation(s)
- Poh Lin Tan
- Lee Kuan Yew School of Public Policy, National University of Singapore, Singapore, Singapore
| | - Jessica Pan
- Department of Economics, National University of Singapore, Singapore, Singapore
| | - Xing Xia
- Division of Social Sciences, Yale-NUS College, Singapore, Singapore
| |
Collapse
|
36
|
Zhang Z, Zhao N, Liao W, Chen H. Educational Mismatch and Workers' Fertility Intentions: Evidence from China. Behav Sci (Basel) 2023; 13:837. [PMID: 37887487 PMCID: PMC10603843 DOI: 10.3390/bs13100837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 10/05/2023] [Accepted: 10/11/2023] [Indexed: 10/28/2023] Open
Abstract
This paper focuses on the impact of the educational mismatch on workers' fertility intentions and explores the underlying mechanisms. Empirical research based on the China Family Panel Survey (CFPS) data shows that undereducation has a negative effect on the fertility intentions of women aged 18-35, whereas overeducation reports no effect, a finding that remains stable in the robustness test and the IV model. An explanation for this phenomenon is that undereducated female workers have a wage premium and higher expectations of career development, which implies a greater opportunity cost of fertility. The heterogeneity analysis shows that women with low socio-economic status, especially those who are less educated, from low-income households, and who are employed in the private sector, are more affected. It is therefore necessary to reduce the substitution risk in the labor market for this group and to lighten the fertility burden and pressure on women.
Collapse
Affiliation(s)
| | | | | | - Hounan Chen
- School of Statistics, Beijing Normal University, Beijing 100875, China; (Z.Z.); (N.Z.); (W.L.)
| |
Collapse
|
37
|
Plaikner A, Siegler K, Hertel H, Jacob A, Petzel A, Schubert M, Blohmer JU, Böhmer G, Marnitz S, Ragosch V, Domröse C, Oppelt P, Jülicher A, Schneider A, Willems A, Favero G, Köhler C. Fertility sparing therapy in women with lymph node negative cervical cancer >2cm - oncologic and fertility outcomes of neoadjuvant chemotherapy followed by radical vaginal trachelectomy. Int J Gynecol Cancer 2023; 33:1542-1547. [PMID: 37696645 DOI: 10.1136/ijgc-2023-004669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023] Open
Abstract
OBJECTIVE Simple or radical trachelectomy are accepted fertility sparing therapies for patients diagnosed with cervical cancer ≤2 cm. In patients with larger tumors a fertility sparing concept is considered experimental. The aim of our study is to present oncological and fertility outcomes of laparoscopic pelvic lymphadenectomy followed by neoadjuvant chemotherapy and subsequent radical vaginal trachelectomy. These procedures were performed in two centers in patients diagnosed with cervical cancer of diameter >2 cm. METHOD We retrospectively analyzed the demographic, histological, fertility and follow-up data of all patients with cervical cancer assessed as stage IB2, IB3 or IIA1 under the International Federation of Gynecology and Obstetrics (FIGO) 2018 system. These patients had undergone pelvic lymphadenectomy, followed by neoadjuvant chemotherapy and radical vaginal trachelectomy between February 2006 and June 2020 at Charité University Berlin and Asklepios Hospital, Hamburg. RESULTS A total of 31 patients (mean age 29.5 years, range; 26-40) underwent neoadjuvant chemotherapy followed by radical vaginal trachelectomy in case of proven tumor-free lymph nodes. Twenty-six (84%) of these patients were nulliparous. Across all 31 patients, the initial tumor stages were FIGO 2018 stage IB2 (n=27), IB3 (n=3) and IIA1 (n=1).Lymphadenectomy was completed in all but one patient (sentinel) with a median of 33 (range; 11-47) pelvic lymph nodes. The neoadjuvant chemotherapy regimen was two cycles of paclitaxel, ifosfamide and cisplatin in 17 patients; three cycles of paclitaxel, ifosfamide and cisplatin in eight patients; two cycles of paclitaxel and cisplatin in four patients; two cylces cisplatin monoagent in one patient; and two cycles of paclitaxel and cisplatin followed by two cycles of paclitaxel, ifosfamide and cisplatin in one patient. Residual tumor was histologically confirmed in 17 specimens (55%). The median residual tumor size following neoadjuvant chemotherapy was 12 mm (range; 1-60). Fertility could be preserved in 27 patients (87%); two patients underwent adjuvant chemoradiation after radical vaginal trachelectomy due to high-risk histological features; two other patients underwent radical hysterectomy with adjuvant chemoradiation therapy following neoadjuvant chemotherapy. Of 18 (67%) patients seeking motherhood, 13 became pregnant (72%). There were 12 live births in 10 women, with a median fetal weight of 2490 grams (range; 1640-3560) and five miscarriages. After a median follow-up of 94.5 months (range; 6-183) three recurrences (11.1%) were detected, one patient (3.7%) died of the disease. CONCLUSION Neoadjuvant chemotherapy followed by radical vaginal trachelectomy may be offered to patients seeking motherhood with cervical cancer >2 cm and histopathologically tumor-free lymph nodes, the rate of healthy baby pregnancy on discharge was 10/18 women (55%). This fertility-preserving strategy is associated with higher recurrence and death compared with what was published in the literature for women undergoing radical vaginal trachelectomy for tumors up to 2 cm.
Collapse
Affiliation(s)
- Andrea Plaikner
- Department of Special Operative and Oncologic Gynecology, Asklepios Klinik Altona, Hamburg, Hamburg, Germany
| | - Kathrin Siegler
- Department of Special Operative and Oncologic Gynecology, Asklepios Klinik Altona, Hamburg, Hamburg, Germany
| | - Hermann Hertel
- Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Niedersachsen, Germany
| | - Anna Jacob
- Department of Gynecology, Asklepios Clinic Wandsbek, Hamburg, Germany
| | - Anja Petzel
- Institute for Dysplasia and Cytology, MVZ Kreuzberg, Berlin, Germany
| | - Melanie Schubert
- Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Jens-Uwe Blohmer
- Charité University Medicine, Department of Gynecology, Charité, Campus Mitte, Berlin, Germany
| | - Gerd Böhmer
- Institute for Dysplasia and Cytology, IZD Hannover, Hannover, Germany
| | - Simone Marnitz
- Department of Radiooncology, Radiation Oncology Vosspalais, Private Clinic, Berlin, Germany, Berlin, Berlin, Germany
| | - Volker Ragosch
- Department of Obstetrics, Asklepios Clinic Altona, Hamburg, Germany
| | - Christian Domröse
- Department of Obstetrics and Gynecology, Medical Faculty of the University of Cologne, Köln, Nordrhein-Westfalen, Germany
| | - Peter Oppelt
- Department for Gynecology, Obstetrics and Gynecological Endocrinology, Johannes Kepler University Linz, Linz, Austria
| | - Anne Jülicher
- Institute for Dysplasia and Cytology, MVZ Fürstenbergkarree, Berlin, Germany
| | - Achim Schneider
- Institute for Dysplasia and Cytology, MVZ Fürstenbergkarree, Berlin, Germany
| | - Anne Willems
- Institute for Dysplasia and Cytology, MVZ Köpenick, Germany
| | - Giovanni Favero
- Department of Gynecology and Obstetrics, Asklepios Hospital Lich, Lich, Germany
| | - Christhardt Köhler
- Department of Special Operative and Oncologic Gynecology, Asklepios Klinik Altona, Hamburg, Hamburg, Germany
- Institute for Dysplasia and Cytology, MVZ Fürstenbergkarree, Berlin, Germany
- Department of Gynecology, German Red Cross Clinic Berlin Westend, Berlin, Germany
| |
Collapse
|
38
|
Ontiveros J, Gunnarsdóttir J, Guðnadóttir SA, Aspelund T, Einarsdóttir K. Twin birth rates and obstetric interventions in Iceland: A nationwide study from 1997 to 2018. Int J Gynaecol Obstet 2023; 163:226-233. [PMID: 37128945 DOI: 10.1002/ijgo.14817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 03/29/2023] [Accepted: 04/12/2023] [Indexed: 05/03/2023]
Abstract
OBJECTIVE Twin pregnancies are associated with increased antepartum and intrapartum risks. Limited multiple embryo transfers are associated with decreased twin birth rates. We aimed to study the effect of 2009 Icelandic regulations on twin birth rates and examine obstetric intervention rates for twin births during the study period. METHODS The study included all births (N = 94 028) in Iceland during 1997-2018. Twin birth rates and obstetric intervention rates were compared over birth year periods using modified Poisson regression adjusted for confounders. RESULTS An observed decrease in the twin birth rate trend was most notable from 2006 until 2009. Twin birth decreased in 2009-2013 (prevalence ratio [PR] 0.74, 95% confidence interval [CI] 0.64-0.86) and in 2014-2018 (PR 0.74, 95% CI 0.64-0.86) compared with 1997-2002. This decrease was only evident for women aged 30+ years in stratified analysis. Induction of labor rates increased from 26% in 1997-2002 to 44% in 2014-2018 (adjusted rate ratio [ARR] 2.10, 95% CI 1.72-2.57) whereas elective cesarean section (ARR 0.80, 95% CI 0.59-1.07) and urgent cesarean section (ARR 0.79, 95% CI 0.63-1.00) rates appeared to decline. CONCLUSION Twin births decreased during the study period. International guidelines published before the Icelandic regulations may have affected twin birth rates in Iceland. Induction of labor rates for twins increased while cesarean section rates decreased.
Collapse
Affiliation(s)
- Jamie Ontiveros
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Jóhanna Gunnarsdóttir
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
- Department of Obstetrics and Gynecology, Landspítali The National University Hospital of Iceland, Reykjavík, Iceland
| | | | - Thor Aspelund
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Kristjana Einarsdóttir
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| |
Collapse
|
39
|
Ernst A, Brix N, Gaml-Sørensen A, Arendt LH, Toft G, Tøttenborg SS, Hougaard KS, Bonde JPE, Ramlau-Hansen CH. Parental age at birth and biomarkers of fecundity in young Danish men. Andrology 2023. [PMID: 37750236 DOI: 10.1111/andr.13536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 08/16/2023] [Accepted: 09/12/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND High parental age is associated with adverse birth and genetic outcomes, but little is known about fecundity in male offspring. OBJECTIVES We investigated if high parental age at birth was associated with biomarkers of male fecundity in a large population-based sample of young men. MATERIALS AND METHODS We conducted a study of 1057 men from the Fetal Programming of Semen Quality (FEPOS) cohort, a sub-cohort of sons born 1998-2000 into the Danish National Birth Cohort. Semen characteristics and reproductive hormone concentrations were measured in samples provided by the men 2017-2019. Testis volume was determined by self-measurement. Data on the parental age was drawn from registers. Adjusted relative difference in percentage with 95% confidence intervals were estimated for each outcome according to pre-specified maternal and paternal age groups (< 30 (reference), 30-34 and ≥ 35) as well as for combinations of parental age groups, using multivariable negative binomial regression models. RESULTS We did not observe consistent associations between parental age and biomarkers of fecundity, although sons of mothers ≥ 35 years had lower sperm concentration (-15% (95% CI: -30, 3)) and total sperm count (-10% (95% CI: -25, 9)). The analysis with parental age combinations showed lower sperm concentration with high age of the parents (both ≥ 35 years: -27%, 95% CI: -40, -19) when compared to the reference where both parents were below 30 years. DISCUSSION AND CONCLUSION We found no strong association between higher parental age and biomarkers of fecundity in young men. However, we cannot exclude poorer semen characteristics in sons born by older mothers or with high age of both parents.
Collapse
Affiliation(s)
- Andreas Ernst
- Research Unit for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
- Department of Urology, Aarhus University Hospital, Aarhus, Denmark
| | - Nis Brix
- Research Unit for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
- Department of Clinical Genetics, Aarhus University Hospital, Aarhus, Denmark
| | - Anne Gaml-Sørensen
- Research Unit for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Linn Håkonsen Arendt
- Research Unit for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Gunnar Toft
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Sandra Søgaard Tøttenborg
- Department of Occupational and Environmental Medicine, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Karin Søring Hougaard
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Jens Peter Ellekilde Bonde
- Department of Occupational and Environmental Medicine, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | |
Collapse
|
40
|
Salazar A, Diaz-García C, García-Velasco JA. Third-party reproduction: a treatment that grows with societal changes. Fertil Steril 2023; 120:494-505. [PMID: 36681263 DOI: 10.1016/j.fertnstert.2023.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 01/12/2023] [Accepted: 01/12/2023] [Indexed: 01/20/2023]
Abstract
Third-party reproduction refers to the use of eggs, sperm, or embryos that have been donated by a third person (the donor) to enable individuals or couples (the intended parents) with infertility to have a child. This differs from the traditional father-mother family model with no third parties involved. Third-party reproduction is also used by couples that are unable to reproduce by traditional means, same-sex couples, and men and women without a partner. This has emerged as a treatment option with great success rates in a scene of changing family constellations. Consequently, this therapeutic alternative has become a realistic solution which has brought great satisfaction and happiness to people who otherwise would have not been able to achieve parenthood if these options were not medically and legally available.
Collapse
|
41
|
Paternostro C, Joura EA, Ranftl C, Langthaler EM, Ristl R, Dorittke T, Pils S. Rate of Involved Endocervical Margins According to High-Risk Human Papillomavirus Subtype and Transformation Zone Type in Specimens with Cone Length ≤ 10 mm versus > 10 mm-A Retrospective Analysis. Life (Basel) 2023; 13:1775. [PMID: 37629632 PMCID: PMC10455508 DOI: 10.3390/life13081775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 08/16/2023] [Accepted: 08/18/2023] [Indexed: 08/27/2023] Open
Abstract
The aim of this study was to evaluate the endocervical margin status according to transformation zone (TZ) and high-risk HPV (hr-HPV) subtype in specimens with cone length ≤ 10 mm versus > 10 mm to provide data for informed decision making and patients counseling especially for women wishing to conceive. In this retrospective cohort study, 854 patients who underwent large loop excision of the transformation zone during a nine-year period (2013-2021) for cervical disease were analyzed. The main outcome parameters were excision length, histological result, TZ type, HPV subtype and endocervical margin status. A subgroup analysis was performed according to excision length, with a cut-off value of 10 mm. A two-step surgical procedure was performed in case of an excision length of > 10 mm. The overall rate of positive endocervical margins irrespective of excision length was 17.2%, with 19.3% in specimens with ≤ 10 mm and 15.0% with > 10 mm excision length. Overall, 41.2% of women with a visible TZ and HPV 16/hr infection and 27.0% of women with HPV 18 received an excisional treatment of > 10 mm length without further oncological benefit, respectively. In contrast, assuming that only an excision of ≤ 10 mm length had been performed in women with visible TZ, the rate of clear endocervical margins would have been 63.7% for HPV 16/hr infections and 49.3% for HPV 18 infections. In conclusion, the decision about excision length should be discussed with the patient in terms of oncological safety and the risk of adverse pregnancy events. An excision length > 10 mm increases the number of cases with cervical tissue removed without further oncological benefit, which needs to be taken into account in order to provide an individual therapeutic approach. Furthermore, HPV 18 positivity is related to a higher rate of positive endocervical margins irrespective of TZ.
Collapse
Affiliation(s)
- Chiara Paternostro
- Department of Obstetrics and Gynecology, Medical University of Vienna, 1090 Vienna, Austria; (C.P.); (C.R.); (T.D.); (S.P.)
| | - Elmar A. Joura
- Department of Obstetrics and Gynecology, Medical University of Vienna, 1090 Vienna, Austria; (C.P.); (C.R.); (T.D.); (S.P.)
| | - Christina Ranftl
- Department of Obstetrics and Gynecology, Medical University of Vienna, 1090 Vienna, Austria; (C.P.); (C.R.); (T.D.); (S.P.)
| | | | - Robin Ristl
- Center of Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, 1090 Vienna, Austria;
| | - Tim Dorittke
- Department of Obstetrics and Gynecology, Medical University of Vienna, 1090 Vienna, Austria; (C.P.); (C.R.); (T.D.); (S.P.)
| | - Sophie Pils
- Department of Obstetrics and Gynecology, Medical University of Vienna, 1090 Vienna, Austria; (C.P.); (C.R.); (T.D.); (S.P.)
| |
Collapse
|
42
|
Johnson A, Thompson R, Nickel B, Shih P, Hammarberg K, Copp T. Websites Selling Direct-to-Consumer Anti-Mullerian Hormone Tests. JAMA Netw Open 2023; 6:e2330192. [PMID: 37603332 PMCID: PMC10442712 DOI: 10.1001/jamanetworkopen.2023.30192] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 07/14/2023] [Indexed: 08/22/2023] Open
Abstract
Importance The recent provision of direct-to-consumer (DTC) Anti-Mullerian Hormone (AMH) testing in several countries has been contentious, particularly due to concerns about judicious testing and informed consent. Objective To describe and analyze information on websites that sell DTC AMH tests. Design, Setting, and Participants Qualitative study including content analysis of text information from websites in multiple countries that sell AMH tests DTC. The top 50 search results from 4 different internet search strings were captured and reviewed for eligibility. Data were extracted in March 2022 and analyzed from April 2022 to July 2023. Main outcomes and measures Themes and categories were derived from the website content using a conventional inductive approach, with a particular focus on information content, quality and accuracy, as well as the tone and language used. Results Twenty-seven websites across 7 different countries formed the sample for analysis. Information varied considerably across websites and was organized into 6 overarching categories: (1) whether a test description was included (25 websites [93%]); (2) statements about what the test can do, which included indicating ovarian reserve (26 websites [96%]) and indicating likelihood of conceiving (20 websites [74%]); (3) statements about the usefulness of the test result, which included enabling women to adjust their reproductive timeline (11 websites [41%]) and determining whether egg freezing was a viable option (8 websites [30%]); (4) blood collection method (ie, through a laboratory or an at-home sample); (5) promotion tactics, such as stating the convenience of testing (24 websites [89%]) and using language promoting empowerment and control (7 websites [26%]); and (6) statements about limitations of the test, which included polycystic ovary syndrome falsely inflating AMH levels (13 websites [48%]) and that it cannot accurately predict chances of conceiving (9 websites [33%]). Conclusion and relevance In this qualitative study including content analysis, most websites selling DTC AMH tests included false and misleading claims which might lead consumers to purchase an AMH test in the belief that it can reliably predict fertility potential and age of menopause. Depending on the test result, this may in turn lead to misplaced anxiety or reassurance about one's fertility and modifications to subsequent conception or contraceptive plans and behavior.
Collapse
Affiliation(s)
- Alexis Johnson
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Rachel Thompson
- Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Brooke Nickel
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Patti Shih
- Faculty of Arts, Social Sciences and Humanities, School of Health and Society, Australian Centre for Health Engagement, Evidence and Values, University of Wollongong, Wollongong, New South Wales, Australia
| | - Karin Hammarberg
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Tessa Copp
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
43
|
Neo DT, Desrosiers TA, Martin CL, Carmichael SL, Gucsavas-Calikoglu M, Conway KM, Evans SP, Feldkamp ML, Gilboa SM, Insaf TZ, Musfee FI, Shaw GM, Shumate CJ, Werler MM, Olshan AF. Neighborhood-level Socioeconomic Position During Early Pregnancy and Risk of Gastroschisis. Epidemiology 2023; 34:576-588. [PMID: 36976718 PMCID: PMC10291502 DOI: 10.1097/ede.0000000000001621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
BACKGROUND Neighborhood-level socioeconomic position has been shown to influence birth outcomes, including selected birth defects. This study examines the un derstudied association between neighborhood-level socioeconomic position during early pregnancy and the risk of gastroschisis, an abdominal birth defect of increasing prevalence. METHODS We conducted a case-control study of 1,269 gastroschisis cases and 10,217 controls using data from the National Birth Defects Prevention Study (1997-2011). To characterize neighborhood-level socioeconomic position, we conducted a principal component analysis to construct two indices-Neighborhood Deprivation Index (NDI) and Neighborhood Socioeconomic Position Index (nSEPI). We created neighborhood-level indices using census socioeconomic indicators corresponding to census tracts associated with addresses where mothers lived the longest during the periconceptional period. We used generalized estimating equations to estimate odds ratios (ORs) and 95% confidence intervals (CIs), with multiple imputations for missing data and adjustment for maternal race-ethnicity, household income, education, birth year, and duration of residence. RESULTS Mothers residing in moderate (NDI Tertile 2 aOR = 1.23; 95% CI = 1.03, 1.48 and nSEPI Tertile 2 aOR = 1.24; 95% CI = 1.04, 1.49) or low socioeconomic neighborhoods (NDI Tertile 3 aOR = 1.28; 95% CI = 1.05, 1.55 and nSEPI Tertile 3 aOR = 1.32, 95% CI = 1.09, 1.61) were more likely to deliver an infant with gastroschisis compared with mothers residing in high socioeconomic neighborhoods. CONCLUSIONS Our findings suggest that lower neighborhood-level socioeconomic position during early pregnancy is associated with elevated odds of gastroschisis. Additional epidemiologic studies may aid in confirming this finding and evaluating potential mechanisms linking neighborhood-level socioeconomic factors and gastroschisis.
Collapse
Affiliation(s)
- Dayna T. Neo
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Tania A. Desrosiers
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Chantel L. Martin
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Suzan L. Carmichael
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA
| | - Muge Gucsavas-Calikoglu
- Department of Pediatrics, Division of Genetics and Metabolism, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Kristin M. Conway
- Department of Epidemiology, College of Public Health, The University of Iowa, Iowa City, IA
| | - Shannon Pruitt Evans
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
- Eagle Global Scientific LLC, San Antonio, TX, USA
| | - Marcia L. Feldkamp
- Division of Medical Genetics, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT
| | - Suzanne M. Gilboa
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - Tabassum Z. Insaf
- Bureau of Environmental and Occupational Epidemiology, Center for Environmental Health, New York State Department of Health, Albany, NY
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, Rensselaer, NY
| | - Fadi I. Musfee
- Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR
- Arkansas Center for Birth Defects Research and Prevention, Fay W. Boozman College of Public Helath, University of Arkansas for Medical Sciences, Little Risk, AR
| | - Gary M. Shaw
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Charles J. Shumate
- Birth Defects Epidemiology and Surveillance Branch, Texas Department of State Health Services, Austin, TX
| | - Martha M. Werler
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Andrew F. Olshan
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | |
Collapse
|
44
|
Xavier P, Dantas S, Almeida-Santos T, Soares SR, Imhoff RJ, Genovez V, Modesto C, Gens H, Correia I, Catalão C. Screening for diminished ovarian reserve in Portugal: a cost-saving answer to shorten the fertility journey. J Comp Eff Res 2023; 12:e230003. [PMID: 37345566 PMCID: PMC10508297 DOI: 10.57264/cer-2023-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 05/29/2023] [Indexed: 06/23/2023] Open
Abstract
Aim: Assess the budget impact of nationwide screening for diminished ovarian reserve (OR), via anti-Müllerian hormone (AMH) levels, to the Portugal National Health System (NHS). Patients & methods: The clinical journey was determined using literature and the family planning decision-making process/response using survey results. A panel of four local clinicians validated all assumptions/inputs. Results: Screening for OR led to an expected savings of € 9.4 million for the NHS, driven by a 24% reduction in medically assisted reproduction (MAR) use. When needed, referral for MAR was earlier and more women used first-line versus second-line techniques. The model estimated a 12% decrease in failure. Conclusion: This model shows AMH screening may allow more informed decisions, leading to a shorter fertility journey, more efficient use of treatments, and substantial cost-savings for the NHS.
Collapse
Affiliation(s)
- Pedro Xavier
- President of the Portuguese Society of Reproductive Medicine (SPMR); Gynaecology-Obstetrics specialist, sub-speciality in Reproductive Medicine, Centre for Reproduction Genetics Prof. Alberto Barros, 4100-021, Portugal
| | - Sofia Dantas
- Gynaecology-Obstetrics specialist, sub-speciality in Reproductive Medicine, Hospital Senhora da Oliveira, Guimarães, 4835-044, Portugal
| | - Teresa Almeida-Santos
- Gynaecology-Obstetrics specialist, sub-speciality in Reproductive Medicine, Centro Hospitalar Universitário de Coimbra (CHUC), Coimbra, 3004-561, Portugal
| | - Sérgio Reis Soares
- Gynaecology-Obstetrics specialist, sub-speciality in Reproductive Medicine, IVI (Instituto Valenciano de Infertilidade), Lisbon, 1800-282, Portugal
| | - Ryan J Imhoff
- Research Scientist II, CTI Clinical Trial & Consulting Services, Covington, KY 41011, USA
| | - Victória Genovez
- Market Access Associate II, CTI Clinical Trial & Consulting Services Portugal, Lisbon, 1072-274, Portugal
| | - Cátia Modesto
- HTA & Market Access Associate II, CTI Clinical Trial & Consulting Services Portugal, Lisbon, 1070-274, Portugal
| | - Helena Gens
- Medical Affairs Lead, Roche Sistemas de Diagnósticos, Amadora, 2720-413, Portugal
| | - Inês Correia
- Medical Science Liaison, Roche Sistemas de Diagnósticos, Amadora, 2720-413, Portugal
| | - Carlos Catalão
- Access & Innovation Director, Roche Sistemas de Diagnósticos, Amadora, 2720-413, Portugal
| |
Collapse
|
45
|
Maslowski K, Reiss MJ, Biswakarma R, Harper J. Reproductive health education in the schools of the four UK nations: is it falling through the gap? HUM FERTIL 2023; 26:527-539. [PMID: 37356204 DOI: 10.1080/14647273.2023.2216395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 05/08/2023] [Indexed: 06/27/2023]
Abstract
Reproductive health education is crucial to ensure young people understand their reproductive system and can make informed decisions about their sexual lives and fertility, including whether they want to have children or not. This study involved an investigation of the intended UK school curricula for 14-18 year-olds as they relate to reproductive health. Analysis revealed substantial differences. Most, but not all, specifications include sexually transmitted infections, hormonal aspects of reproduction, contraception, the menstrual cycle and assisted reproductive technology (ART). Important topics, such as endometriosis, fertility, preconception health, pregnancy, miscarriage, menopause and infertility (except in the context of ART) are missing from examination specifications and/or the RSE/RSHP curricula. We conclude that many young people in the UK are at risk of leaving school with inadequate understanding of concepts that have important implications for their reproductive health. There are differences between nations, with Scotland having the most comprehensive coverage of topics in its curriculum. High-quality reproductive health education should be an entitlement for all young people. It should give young people accurate and up-to-date information and enable them to discuss issues and develop their own thinking. Ideally, sex and reproductive health education would be taught comprehensively across the RSE/RSHP and science curricula.
Collapse
Affiliation(s)
| | - Michael J Reiss
- UCL's Faculty of Education and Society, IOE, University College London, London, UK
| | - Rina Biswakarma
- UCL's Faculty of Education and Society, IOE, University College London, London, UK
| | - Joyce Harper
- EGA Institute for Women's Health, University College London, London, UK
| |
Collapse
|
46
|
Łada-Maśko AB, Kaźmierczak M. Dyadic approach to maturity to parenthood: multilevel study on attachment in expectant and non-expectant couples. J Reprod Infant Psychol 2023:1-17. [PMID: 37366347 DOI: 10.1080/02646838.2023.2230592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 06/22/2023] [Indexed: 06/28/2023]
Abstract
OBJECTIVE This study examined links between attachment styles and maturity to parenthood and its dimensions across different age groups of childless young adult couples. The role of developmental factors (age, assuming parental role) for maturity to parenthood was also investigated. BACKGROUND Relational and individual factors have both been confirmed to be crucial for the transition to parenthood. The concept of maturity to parenthood has been linked to individual values, personality traits, and close relationships. However, the question arises whether maturity to parenthood is related to one of the most crucial concepts in family psychology - attachment. METHOD Three hundred heterosexual young adult couples aged 20-35 years (Mage = 26.20; SD = 3.63) took part. Couples were divided into three groups: 1) 110 couples aged 20-25 (emerging adulthood); 2) 90 couples aged 26-35 (young adulthood); and 3) 100 couples aged 20-35 expecting their first child (third trimester of pregnancy). The main questionnaires used were the Maturity to Parenthood Scale and Close Relationship Experience Scale. RESULTS The results indicated that the more avoidant couples had lower maturity to parenthood. A moderation effect of group (pregnancy) was also observed - the effect of attachment-related avoidance was weaker in expectant couples. Women presented higher overall and behavioural maturity to parenthood than men. Furthermore, higher life satisfaction were associated with greater maturity to parenthood. CONCLUSION Maturity to parenthood is also created in the dyadic context. When related to lower attachment avoidance, it might greatly facilitate transition to parenthood and future parent - child relations.
Collapse
|
47
|
Ren Y, Xie Y, Xu Q, Long M, Zheng Y, Li L, Niu C. University students' fertility awareness and its influencing factors: a systematic review. Reprod Health 2023; 20:85. [PMID: 37280685 DOI: 10.1186/s12978-023-01628-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/25/2023] [Indexed: 06/08/2023] Open
Abstract
INTRODUCTION In recent years, a growing number of researchers have begun to study fertility awareness (FA). Evidence suggests that college students in their reproductive years have a common understanding of fertility, risk factors for infertility, and assisted reproductive technologies. Therefore, this systematic review summarizes these studies and explores the factors affecting college students' fertility awareness. METHODS A systematic literature search of databases (PUBMED/MEDLINE, Cochrane, Web of Science, Embase, and EBSCO) was conducted from inception to September 2022. Studies that assessed the levels of fertility awareness and factors influencing college students were considered for the review. The qualities of the included studies were evaluated using the Strengthening the Reporting of Observational Studies in Epidemiology guidelines. This systematic review is reported according to the preferred reporting items for systematic review (PRISMA) guidelines. RESULTS Twenty-one articles met the eligibility criteria and were included. The preliminary results showed that participants reported low to moderate FA. Female medical students demonstrated higher levels of fertility awareness. The association between age, years of education, and FA was insufficient. CONCLUSION The results of the current study suggest that increased FA interventions are warranted, especially for the male, non-medical student population. Governments and educational institutions should strengthen education programs for young students on reproductive health to help them raise awareness about childbirth, and society should provide family support for young people.
Collapse
Affiliation(s)
- Yue Ren
- School of Nursing School of Public, Health Yangzhou University, Mid Jiangyang Road 136, Yangzhou, Jiangsu, People's Republic of China
| | - Yue Xie
- School of Nursing School of Public, Health Yangzhou University, Mid Jiangyang Road 136, Yangzhou, Jiangsu, People's Republic of China
| | - Qulian Xu
- School of Nursing School of Public, Health Yangzhou University, Mid Jiangyang Road 136, Yangzhou, Jiangsu, People's Republic of China
| | - Miaochen Long
- School of Nursing School of Public, Health Yangzhou University, Mid Jiangyang Road 136, Yangzhou, Jiangsu, People's Republic of China
| | - Ying Zheng
- School of Nursing School of Public, Health Yangzhou University, Mid Jiangyang Road 136, Yangzhou, Jiangsu, People's Republic of China
| | - Lin Li
- Department of Obstetrics and Gynecology, Yangzhou University Affiliated Hospital, Yangzhou, China
| | - Changmin Niu
- School of Nursing School of Public, Health Yangzhou University, Mid Jiangyang Road 136, Yangzhou, Jiangsu, People's Republic of China.
| |
Collapse
|
48
|
Alijanzadeh M, Bahrami N, Jafari E, Noori M, Miri F, Joftyar M, Griffiths MD, Alimoradi Z. Iranian women's attitude toward childbearing and its' association with generalized trust, social support, marital satisfaction and governmental childbearing incentives. Heliyon 2023; 9:e16162. [PMID: 37215895 PMCID: PMC10199260 DOI: 10.1016/j.heliyon.2023.e16162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 04/27/2023] [Accepted: 05/09/2023] [Indexed: 05/24/2023] Open
Abstract
Background Having a child is important event for families worldwide. Attitudes toward childbearing are influenced by many factors. The aim of the present study was to investigate Iranian women's attitude toward childbearing and its association with generalized trust, social support, marital satisfaction, mental health, and socio-economic characteristics in Qazvin province. Methods A cross-sectional survey study was conducted between April and July 2022. Using convenience sampling, 347 women with no children or one child in Qazvin province (Iran) participated in the study. Data were collected via the Iranian online platform Porsline. The survey included a demographic and fertility characteristics questionnaire, Attitudes Toward the Government's Childbearing Incentives Scale (ATGCIS), Attitudes Toward Fertility and Childbearing Scale (ATFCS), ENRICH Marital Satisfaction Scale (ENRICH MSS), Patient Health Questionnaire (PHQ-4), Multidimensional Scale of Perceived Social Support (MSPSS), and Generalized Trust Scale (GTS). Findings The average age of participants was 35.66 years (SD = 6.89). The score of attitudes toward fertility and childbearing was 84.66 out of 134 (SD = 19.17). The average number of expected children by the couple was 2.36 (SD = 1.35). Multivariable linear regression found a positive and significant relationship between participants' attitudes toward fertility and childbearing (ATFC) and (i) governmental childbearing incentives (β = 0.365, p < 0.001, with 1.37 increase in ATFC with each unit increase in this scale) (ii) generalized trust (i.e., individual's expectation of others' trustworthiness), (β = 0.155, p < 0.003, with 0.60 increase in ATFC with each unit increase in generalized trust) and (iii) marital satisfaction (β = 0.146, p < 0.005, with 0.26 increase in ATFC with each unit increase marital satisfaction). The multivariable linear regression model also showed that attitudes toward fertility and childbearing was the only predictor of couples' expected number of children in the future (β = 0.214, p < 0.001, with 0.38 increase in couples' expected number of children with each unit increase in ATFC). Conclusion Government incentives were the strongest independent predictor of participants' attitudes toward childbearing which can indirectly influence couples' expected number of children in the future. Consequently, governments may be able to influence couples' childbearing decisions by providing appropriate incentives. Generalized trust and marital satisfaction were other significant predictors of attitudes toward childbearing. Therefore, implementing programs to improve generalized trust, and increasing marital satisfaction might be other influential measures in couples' childbearing decisions.
Collapse
Affiliation(s)
- Mehran Alijanzadeh
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Nasim Bahrami
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Elahe Jafari
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Mohsen Noori
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Fatemeh Miri
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Mahsa Joftyar
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Mark D. Griffiths
- International Gaming Research Unit, Psychology Department, Nottingham Trent University, Nottingham, UK
| | - Zainab Alimoradi
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
| |
Collapse
|
49
|
Mathieson I, Day FR, Barban N, Tropf FC, Brazel DM, Vaez A, van Zuydam N, Bitarello BD, Gardner EJ, Akimova ET, Azad A, Bergmann S, Bielak LF, Boomsma DI, Bosak K, Brumat M, Buring JE, Cesarini D, Chasman DI, Chavarro JE, Cocca M, Concas MP, Davey Smith G, Davies G, Deary IJ, Esko T, Faul JD, Franco O, Ganna A, Gaskins AJ, Gelemanovic A, de Geus EJC, Gieger C, Girotto G, Gopinath B, Grabe HJ, Gunderson EP, Hayward C, He C, van Heemst D, Hill WD, Hoffmann ER, Homuth G, Hottenga JJ, Huang H, Hyppӧnen E, Ikram MA, Jansen R, Johannesson M, Kamali Z, Kardia SLR, Kavousi M, Kifley A, Kiiskinen T, Kraft P, Kühnel B, Langenberg C, Liew G, Lind PA, Luan J, Mägi R, Magnusson PKE, Mahajan A, Martin NG, Mbarek H, McCarthy MI, McMahon G, Medland SE, Meitinger T, Metspalu A, Mihailov E, Milani L, Missmer SA, Mitchell P, Møllegaard S, Mook-Kanamori DO, Morgan A, van der Most PJ, de Mutsert R, Nauck M, Nolte IM, Noordam R, Penninx BWJH, Peters A, Peyser PA, Polašek O, Power C, Pribisalic A, Redmond P, Rich-Edwards JW, Ridker PM, Rietveld CA, Ring SM, Rose LM, Rueedi R, Shukla V, Smith JA, Stankovic S, Stefánsson K, Stöckl D, Strauch K, Swertz MA, Teumer A, Thorleifsson G, Thorsteinsdottir U, Thurik AR, Timpson NJ, Turman C, Uitterlinden AG, Waldenberger M, Wareham NJ, Weir DR, Willemsen G, Zhao JH, Zhao W, Zhao Y, Snieder H, den Hoed M, Ong KK, Mills MC, Perry JRB. Genome-wide analysis identifies genetic effects on reproductive success and ongoing natural selection at the FADS locus. Nat Hum Behav 2023; 7:790-801. [PMID: 36864135 DOI: 10.1038/s41562-023-01528-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 01/12/2023] [Indexed: 03/04/2023]
Abstract
Identifying genetic determinants of reproductive success may highlight mechanisms underlying fertility and identify alleles under present-day selection. Using data in 785,604 individuals of European ancestry, we identified 43 genomic loci associated with either number of children ever born (NEB) or childlessness. These loci span diverse aspects of reproductive biology, including puberty timing, age at first birth, sex hormone regulation, endometriosis and age at menopause. Missense variants in ARHGAP27 were associated with higher NEB but shorter reproductive lifespan, suggesting a trade-off at this locus between reproductive ageing and intensity. Other genes implicated by coding variants include PIK3IP1, ZFP82 and LRP4, and our results suggest a new role for the melanocortin 1 receptor (MC1R) in reproductive biology. As NEB is one component of evolutionary fitness, our identified associations indicate loci under present-day natural selection. Integration with data from historical selection scans highlighted an allele in the FADS1/2 gene locus that has been under selection for thousands of years and remains so today. Collectively, our findings demonstrate that a broad range of biological mechanisms contribute to reproductive success.
Collapse
Affiliation(s)
- Iain Mathieson
- Department of Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Felix R Day
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Nicola Barban
- Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Felix C Tropf
- Nuffield College, University of Oxford, Oxford, UK
- École Nationale de la Statistique et de L'administration Économique (ENSAE), Paris, France
- Center for Research in Economics and Statistics (CREST), Paris, France
| | - David M Brazel
- Nuffield College, University of Oxford, Oxford, UK
- Leverhulme Centre for Demographic Science, University of Oxford, Oxford, UK
| | - Ahmad Vaez
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Bioinformatics, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Natalie van Zuydam
- Beijer Laboratory and Department of Immunology, Genetics and Pathology, Uppsala University and SciLifeLab, Uppsala, Sweden
| | - Bárbara D Bitarello
- Department of Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Eugene J Gardner
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Evelina T Akimova
- Nuffield College, University of Oxford, Oxford, UK
- Leverhulme Centre for Demographic Science, University of Oxford, Oxford, UK
| | - Ajuna Azad
- DNRF Center for Chromosome Stability, Department of Cellular and Molecular Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Sven Bergmann
- Department of Computational Biology, University of Lausanne, Lausanne, Switzerland
- Swiss Institute of Bioinformatics, Lausanne, Switzerland
- Department of Integrative Biomedical Sciences, University of Cape Town, Cape Town, South Africa
| | - Lawrence F Bielak
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - Dorret I Boomsma
- Department of Biological Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Reproduction and Development (AR&D) Research Institute, Amsterdam, the Netherlands
| | | | - Marco Brumat
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Julie E Buring
- Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - David Cesarini
- Department of Economics, New York University, New York, NY, USA
- Research Institute for Industrial Economics, Stockholm, Sweden
- National Bureau of Economic Research, Cambridge, MA, USA
| | - Daniel I Chasman
- Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Jorge E Chavarro
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Massimiliano Cocca
- Institute for Maternal and Child Health, IRCCS 'Burlo Garofolo', Trieste, Italy
| | - Maria Pina Concas
- Institute for Maternal and Child Health, IRCCS 'Burlo Garofolo', Trieste, Italy
| | | | - Gail Davies
- Lothian Birth Cohorts, Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Ian J Deary
- Lothian Birth Cohorts, Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Tõnu Esko
- Estonian Genome Center, University of Tartu, Tartu, Estonia
- Broad Institute of the Massachusetts Institute of Technology and Harvard University, Cambridge, MA, USA
| | - Jessica D Faul
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Oscar Franco
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Andrea Ganna
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland
- Analytic and Translational Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Audrey J Gaskins
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | - Eco J C de Geus
- Department of Biological Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Christian Gieger
- Research Unit of Molecular Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Giorgia Girotto
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
- Institute for Maternal and Child Health, IRCCS 'Burlo Garofolo', Trieste, Italy
| | - Bamini Gopinath
- Centre for Vision Research, Westmead Institute for Medical Research and Department of Ophthalmology, University of Sydney, Sydney, New South Wales, Australia
| | - Hans Jörgen Grabe
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - Erica P Gunderson
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Caroline Hayward
- Medical Research Council Human Genetics Unit, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - Chunyan He
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA
- Department of Internal Medicine, Division of Medical Oncology, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Diana van Heemst
- Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - W David Hill
- Lothian Birth Cohorts, Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Eva R Hoffmann
- DNRF Center for Chromosome Stability, Department of Cellular and Molecular Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Georg Homuth
- Interfaculty Institute for Genetics and Functional Genomics, University of Greifswald, Greifswald, Germany
| | - Jouke Jan Hottenga
- Department of Biological Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Hongyang Huang
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Elina Hyppӧnen
- Australian Centre for Precision Health, University of South Australia Cancer Research Institute, Adelaide, South Australia, Australia
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Rick Jansen
- Department of Psychiatry, Amsterdam Public Health and Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
| | - Magnus Johannesson
- Department of Economics, Stockholm School of Economics, Stockholm, Sweden
| | - Zoha Kamali
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Bioinformatics, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sharon L R Kardia
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Annette Kifley
- Centre for Vision Research, Westmead Institute for Medical Research and Department of Ophthalmology, University of Sydney, Sydney, New South Wales, Australia
| | - Tuomo Kiiskinen
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland
- National Institute for Health and Welfare, Helsinki, Finland
| | - Peter Kraft
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Brigitte Kühnel
- Research Unit of Molecular Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Claudia Langenberg
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Gerald Liew
- Centre for Vision Research, Westmead Institute for Medical Research and Department of Ophthalmology, University of Sydney, Sydney, New South Wales, Australia
| | - Penelope A Lind
- Psychiatric Genetics, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Jian'an Luan
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Reedik Mägi
- Estonian Genome Center, University of Tartu, Tartu, Estonia
| | - Patrik K E Magnusson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Anubha Mahajan
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Nicholas G Martin
- Genetic Epidemiology, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Hamdi Mbarek
- Department of Biological Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Qatar Genome Programme, Qatar Foundation Research, Development and Innovation, Qatar Foundation, Doha, Qatar
| | - Mark I McCarthy
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - George McMahon
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Sarah E Medland
- Psychiatric Genetics, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Thomas Meitinger
- Institute of Human Genetics, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Andres Metspalu
- Estonian Genome Center, University of Tartu, Tartu, Estonia
- Institute of Molecular and Cell Biology, University of Tartu, Tartu, Estonia
| | | | - Lili Milani
- Estonian Genome Center, University of Tartu, Tartu, Estonia
| | - Stacey A Missmer
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Division of Adolescent and Young Adult Medicine, Department of Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
- Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
| | - Paul Mitchell
- Centre for Vision Research, Westmead Institute for Medical Research and Department of Ophthalmology, University of Sydney, Sydney, New South Wales, Australia
| | - Stine Møllegaard
- Department of Sociology, University of Copenhagen, Copenhagen, Denmark
| | - Dennis O Mook-Kanamori
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Anna Morgan
- Institute for Maternal and Child Health, IRCCS 'Burlo Garofolo', Trieste, Italy
| | - Peter J van der Most
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Renée de Mutsert
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Matthias Nauck
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Ilja M Nolte
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Raymond Noordam
- Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Brenda W J H Penninx
- Department of Psychiatry, EMGO Institute for Health and Care Research and Neuroscience Campus Amsterdam, VU University Medical Center/GGZ inGeest, Amsterdam, the Netherlands
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Patricia A Peyser
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - Ozren Polašek
- University of Split School of Medicine, Split, Croatia
- Algebra University College, Zagreb, Croatia
| | - Chris Power
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | | | - Paul Redmond
- Lothian Birth Cohorts, Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Janet W Rich-Edwards
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Division of Women's Health, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Paul M Ridker
- Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Cornelius A Rietveld
- Erasmus University Rotterdam Institute for Behavior and Biology, Rotterdam, the Netherlands
- Department of Applied Economics, Erasmus School of Economics, Rotterdam, the Netherlands
| | - Susan M Ring
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | | | - Rico Rueedi
- Department of Computational Biology, University of Lausanne, Lausanne, Switzerland
- Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | - Vallari Shukla
- DNRF Center for Chromosome Stability, Department of Cellular and Molecular Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jennifer A Smith
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Stasa Stankovic
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | | | - Doris Stöckl
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Konstantin Strauch
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center, Johannes Gutenberg University, Mainz, Germany
- Institute of Genetic Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- Chair of Genetic Epidemiology, IBE, Faculty of Medicine, LMU, Munich, Germany
| | - Morris A Swertz
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Alexander Teumer
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | | | | | - A Roy Thurik
- Erasmus University Rotterdam Institute for Behavior and Biology, Rotterdam, the Netherlands
- Department of Applied Economics, Erasmus School of Economics, Rotterdam, the Netherlands
- Montpellier Business School, Montpellier, France
| | | | - Constance Turman
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - André G Uitterlinden
- Erasmus University Rotterdam Institute for Behavior and Biology, Rotterdam, the Netherlands
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Melanie Waldenberger
- Research Unit of Molecular Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Nicholas J Wareham
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - David R Weir
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Gonneke Willemsen
- Department of Biological Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Jing Hau Zhao
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Wei Zhao
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - Yajie Zhao
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Harold Snieder
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Marcel den Hoed
- Beijer Laboratory and Department of Immunology, Genetics and Pathology, Uppsala University and SciLifeLab, Uppsala, Sweden
| | - Ken K Ong
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Melinda C Mills
- Nuffield College, University of Oxford, Oxford, UK.
- Leverhulme Centre for Demographic Science, University of Oxford, Oxford, UK.
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
- Department of Economics, Econometrics and Finance, University of Groningen, Groningen, the Netherlands.
| | - John R B Perry
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK.
| |
Collapse
|
50
|
Somigliana E, Parazzini F, Goisis A, Esposito G, Li Piani L, Filippi F, Vigano' P. ART and the forgotten siblings: a call for research. Hum Reprod 2023:7147080. [PMID: 37119532 DOI: 10.1093/humrep/dead082] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 02/19/2023] [Indexed: 05/01/2023] Open
Abstract
A broader definition of infertility is the incapacity to have the intended number of children. However, most literature on ART exclusively focuses on live birth as an outcome, rather than on the capacity to fully realize the reproductive wishes of the couples. This issue has probably received scant attention because the total fertility rate is below replacement levels in affluent countries, and one may simplistically assume that only a minority of couples may be interested in more than one child. This assumption, however, is unproven and presumably erroneous. Unfortunately, evidence on the rate of return in couples who conceived their first child with ART is scant and information on the intended number of children in infertile couples is lacking. In general, we plea for more research on this subject. The documentation of an intended number of children above two and a high return rate in infertile couples may lead to changes in clinical practice, such as the storage of oocytes or embryos prior to initiating embryo transfers. This could improve the chance of conceiving the second child when the couple comes back some years later. In addition, the identification of the determinants for non-return as well as those explaining the gap between the intended and the realized number of children may reveal specific barriers and possibly how to tackle them. However, at present, available evidence is insufficient to advocate any intervention. Thorough research is warranted.
Collapse
Affiliation(s)
- Edgardo Somigliana
- Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Fabio Parazzini
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Alice Goisis
- Social Research Institute, University College London, London, UK
| | - Giovanna Esposito
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Letizia Li Piani
- Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Francesca Filippi
- Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paola Vigano'
- Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| |
Collapse
|