Search

Objective: To evaluate if in pregnancies conceived with the transfer of single genetically tested embryos, maternal race and ethnicity relate to pregnancy outcome., Design: Retrospective cohort., Setting: Data available in the Clinical Outcome Reporting System of the Society for Assisted Reproductive Technology (SART-CORS) for years 2016-2018., Patient(s): Autologous frozen-thaw embryo transfer (FET) cycles with transfer of single genetically tested embryo in SART-CORS for years 2016-2018; cycles associated with diagnoses of recurrent pregnancy loss, gestational carrier, donor egg and donor embryo were excluded., Intervention(s): Information on race and ethnicity linked with in vitro fertilization and FET cycles available in SART-CORS., Main Outcome Measure(s): Multivariable analyses using generalized estimating equation examined the relationship between categories of race and ethnicity with the following outcomes: Pregnancy positive β hCG (human chorionic gonadotropin), clinical pregnancy, pregnancy loss (early [at gestation <13 weeks] and late [loss between ≥13 and <20 weeks]), preterm (<37 weeks), term (≥37 weeks) and live birth. Covariates adjusted for included age, body mass index, anti-Mullerian hormone, infertility diagnosis and smoking history., Result(s): Seventy-nine thousand four hundred and sixteen FET cycles met the eligibility criteria. Information on race and ethnicity was specified for 50,820 (64.0%) and was not known in 28,723 (36%) of the cycles. The population was predominantly non-Hispanic White (44%); non-Hispanic Black comprised 2.7%, Asian 12.3%, Hispanic 3.4%, and American Indian, Pacific Islander, Hawaiian, and Alaskan comprised 0.2% of the population. Nearly 1.0 % self-identified with more than one race. On multivariable analyses, pregnancies in non-Hispanic Black and in Hispanic women (compared with non-Hispanic Whites') were significantly more likely to result in in preterm birth. Compared with non-Hispanic White women, the likelihood of live birth was significantly lower in non-Hispanic Blacks, Asian, Hispanic, American Indian, Pacific Islander, Hawaiian, and Alaskan women. The likelihood for delivery by Cesarean was also disproportionately higher in the non Hispanic Black and, Hispanic women and in those identifying with more than one race (0.023) compared with non-Hispanic White women., Conclusion(s): Racial and ethnic differentials are apparent in the outcomes of FET conceived pregnancies resulting from the transfer of single genetically tested embryos., Competing Interests: Declaration of Interests X.B. has nothing to disclose. S.K. has nothing to disclose. M.A. has nothing to disclose. L.P. is an advisory board member for Flo Health, outside the submitted work., (Copyright © 2024 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: To evaluate donor gamete utilization, patient satisfaction, and fertility treatment outcomes of patients pursuing treatment with donor gametes stratified by the desired race as well as ethnicity of the gamete donor., Design: Survey study., Setting: Clinic., Patient(s): Patients planning to undergo treatment using donor sperm and/or donor oocytes at a single academic fertility clinic in the Southeastern United States between 2015 and 2020., Intervention(s): None., Main Outcome Measure(s): Utilization rates of donor gametes, satisfaction with donor gamete selection, and fertility treatment outcomes stratified by race and ethnicity of patient, as well as that of their gamete donor., Result(s): Four hundred fifty patients were eligible for inclusion and 170 (38%) responded to the survey. Among the respondents, 59% desired a non-Hispanic White gamete donor and 20% desired a non-Hispanic Black gamete donor. Patients seeking a non-Hispanic Black gamete donor had lower odds of using donor gametes (Odds ratio [OR], 0.13; 95% confidence interval [CI], 0.04-0.40) compared with individuals seeking a non-Hispanic White gamete donor. When evaluating satisfaction with donor gamete selection, patients seeking a non-Hispanic Black gamete donor reported lower satisfaction compared with individuals seeking a non-Hispanic White gamete donor (OR, 0.19; 95% CI, 0.09-0.43). When evaluating fertility outcomes, Non-Hispanic Black patients and those using non-Hispaninc Black gamete donors were found to have lower odds of successful conception compared with non-Hispanic White patients (OR, 0.18; 95% CI, 0.07-0.46) and individuals seeking non-Hispanic White gamete donors (OR, 0.26; 95% CI, 0.09-0.75), respectively., Conclusion(s): Patients seeking non-Hispanic Black donor gametes have lower utilization rates, less satisfaction with gamete donor selection, and lower odds of conception when compared with those seeking non-Hispanic White gamete donors. These findings highlight the need for more racial diversity within donor gamete banks, as well as within the donor pools available through agencies and fertility clinics., Competing Interests: Declaration of Interests S.M. reports funding from Hammond Research Grant – Duke Obstetrics and Gynecology used to fund participant gift cards for the submitted work. B.S.H. has nothing to disclose. J.W. has nothing to disclose. A.B. has nothing to disclose. A.E. has nothing to disclose. C.N. has nothing to disclose. D.S. has nothing to disclose. S.N. reports funding from Hammond Research Grant – Duke Obstetrics and Gynecology used to fund participant gift cards for the submitted work., (Copyright © 2024 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Background: In the United States, infertility and treatment for infertility are marked by racial/ethnic and socioeconomic inequalities. Simultaneously, biomedical advances and increased public health attention toward preventing and addressing infertility have grown. It is not known, however, whether the racial/ethnic and socioeconomic inequalities observed in infertility prevalence, help-seeking, or help received have changed over time., Methods: Using National Survey of Family Growth data (1995 through 2017-2019 cycles), this study applied multivariable logistic regression with interaction terms to investigate whether and how racial/ethnic and socioeconomic inequalities in 1) the prevalence of infertility, 2) ever seeking help to become pregnant, and 3) use of common types of medical help (advice, testing, medication for ovulation, surgery for blocked tubes, and artificial insemination) have changed over time., Results: The results showed persisting, rather than narrowing or increasing, inequalities in the prevalence of infertility and help-seeking overall. The results showed persisting racial/ethnic inequalities in testing, ovulation medication use, and surgery for blocked tubes. By contrast, the results showed widening socioeconomic inequalities in testing and narrowing inequalities in the use of ovulation medications., Conclusions: There is little evidence to suggest policy interventions, biomedical advances, or increased public health awareness has narrowed inequalities in infertility prevalence, treatment seeking, or use of specific treatments., (Copyright © 2024 Jacobs Institute of Women's Health, George Washington University. Published by Elsevier Inc. All rights reserved.)

Objective: To evaluate if racial/ethnic differences in pregnancy outcomes persisted in frozen-thawed embryo transfer (FET) cycles on a national level., Design: Retrospective cohort study., Setting: Clinic-based data., Patient(s): A total of 189,000 Society for Assisted Reproductive Technology FET cycles from 2014-2016 were screened, of which 12,000 cycles had available fresh cycle linkage information and ultimately, because of missing data, 7,002 FET cycles were included. Cycles were stratified by race (White, Black, Asian, and Hispanic)., Intervention(s): None., Main Outcome Measure(s): The primary outcome was live birth rate. Secondary outcomes were implantation rate, clinical pregnancy rate, multiple pregnancy rate, and clinical loss rate (CLR)., Result(s): Live birth rate was significantly lower in the Black vs. White and Asian, but not Hispanic group. Implantation rate was also significantly lower and CLR higher in the Black group compared with all other groups (all P<.01). Black women had a lower risk of live birth (adjusted risk ratio, 0.82; 95% confidence interval [CI], 0.73-0.92) and a higher risk of clinical loss (adjusted risk ratio, 1.59; 95% CI, 1.28-1.99) compared with White women. There was no significant difference between groups in clinical pregnancy rate or multiple pregnancy rate. When the analysis was limited to preimplantation genetic testing FET cycles, there remained a significantly lower implantation rate in the Black group compared with all other groups (all P<.01)., Conclusion(s): Black race remains an independent predictor of reduced live birth rate in FET cycles, likely because of higher CLR., (Copyright © 2021. Published by Elsevier Inc.)

Hispanic women have lower rates of use of infertility services than non-Hispanic White women. There are many barriers that impede access to infertility care including economic, geographic, cultural, and societal factors and there are disparities in treatment outcomes. Hispanic women are less likely to seek infertility care than non-Hispanic White women and even after infertility evaluation, Hispanic women are less likely to receive treatment for their infertility. Lower use of infertility treatments among Hispanic women is unlikely to be driven solely by economic factors. There is disappointingly little data on in-vitro fertilization treatment outcomes including the population of Hispanic women, and existing data has yielded conflicting results. Incomplete and variable reporting of race data across clinics raises the potential for misclassification bias and invalid study conclusions. Addressing disparities in access to reproductive medicine in the Hispanic population will required a multifaceted approach including expanded insurance coverage, improved education for both patients and providers, and additional research on barriers to care., (© 2021. The Author(s).)

The goal of this Views and Reviews is to let colleagues and leaders well versed in the African American experience in reproductive medicine address the problems of racism affecting our trainees and patients and, more significantly, propose solutions. The areas in reproductive medicine that will be explored from the African American perspective include the pipeline of providers, health disparities, and access to infertility treatment., (Copyright © 2021 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

The first paper describing an association between African American race, infertility prevalence, and outcomes of fertility treatments was published more than 20 years ago, calling initial attention to differences in how infertility is experienced, diagnosed, and managed in African Americans. Since that initial publication, multiple other studies have explored African American race and its association with elements of the fertility spectrum-disparities that have been durable over time. The goal of this review is to provide an overview of the evolution of aspects of this research focusing on the outcomes of infertility treatments and barriers to access. A consideration of the system-based practice issues that interface with timely fertility evaluation and treatment in ways that challenge reproductive health equity will be presented., (Copyright © 2021. Published by Elsevier Inc.)

Background: Although infertility affects an estimated 6.1 million individuals in the United States, only half of those individuals seek fertility treatment and the majority of those patients are White and of high socioeconomic status. Research has shown that insurance mandates are not enough to ensure equal access. Many workplaces, schools, and medical education programs have made efforts in recent years to improve the cultural humility of providers in efforts to engage more racially and economically underrepresented groups in medical care. However, these efforts have not been assessed on a population of patients receiving fertility care, an experience that is uniquely shaped by individual social, cultural, and economic factors., Objective: This study aimed to better understand the racial, cultural, economic, and religious factors that impact patient experiences obtaining fertility care., Study Design: A cross-sectional self-administered survey was administered at an academic fertility center in Chicago, Illinois. Of 5000 consecutive fertility care patients, 1460 completed the survey and were included in the study sample. No interventions were used. Descriptive univariate frequencies and percentages were calculated to summarize sociodemographic and other relevant patient characteristics (eg, race or ethnicity, age, household income, religious affiliation, insurance coverage). Rates of endorsing perceived physician cultural competency were compared among demographic subgroups using Pearson chi-squared tests with 2-sided P<.05 indicative of statistical significance. To identify the key determinants of patient-reported worry regarding 9 different fertility treatment outcomes and related concerns, a series of multiple logistic regression models were fit to examine factors associated with patient report of being "very worried" or "extremely worried.", Results: Members of our sample (N=1460) were between 20 and 58 years of age (mean adjusted , 36.2; standard deviation, 4.4). Among Black participants, 42.3% reported that their physician does not understand their cultural background compared with 16.5% of White participants (P<.0001). Participants who identified as Latinx were significantly more likely than White participants to report being very/extremely worried about side effects of treatment, a miscarriage, ectopic pregnancies, and birth defects (P<.05, P=.02, P=.002, P=.001, respectively). Individuals who identify as Hindu were nearly 4 times more likely to report being very/extremely worried about experiencing an ectopic pregnancy than nonreligious participants (P<.0002). Respondents most strongly identified the biology or physiology of the couple (mean adjusted , 21.6; confidence interval, 20.4-22.7) and timing or age (mean adjusted , 27.8; confidence interval, 26.5-29.1) as being associated with fertility. Overall, respondents most strongly disagreed that the ability to bear children rests upon God's will (mean adjusted , 65.4; confidence interval, 63.7-67.1), which differed most significantly by race (P<.0001) and religion (P<.0001)., Conclusion: Of the patient characteristics investigated, racial and ethnic subgroups showed the greatest degree of variation in regard to worries and concerns surrounding the experience of fertility treatment. Our findings emphasize a need for improved cultural humility on behalf of physicians, in addition to affordable psychological support for all patients seeking fertility care., (Copyright © 2021 Elsevier Inc. All rights reserved.)

In the United States, economic, racial, ethnic, geographic, and other disparities prevent access to fertility treatment and affect treatment outcomes. This opinion examines the factors that contribute to these disparities, proposes actions to address them, and replaces the document of the same name, last published in 2015., (Copyright © 2021 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Self-identified race/ethnicity and socioeconomic status (SES) contribute to disparities in several health domains, although research on their effects on women's reproductive function has largely focused on links between SES and age of menarche. Here, we assessed whether race/ethnicity, SES, and downstream correlates of SES such as food security and health-insurance security are associated with age of menarche, infertility, and live birth ratios (ratios of recognized pregnancies resulting in live births) in the USA. We used cross-sectional data from 1694 women aged 12-18 years for menarche (2007-2016), 974 women aged 23-45 for infertility (2013-2016), and 1714 women aged 23-45 for live birth ratios (2007-2016) from the National Health and Nutrition Examination Survey. We estimated multiple linear and logistic regressions with survey weights to test these associations. When controlling for lifestyle (activity levels, smoking, alcohol consumption) and physiological factors (diabetes, weight status), non-Hispanic (NH) black and Hispanic girls reported a significantly lower age of menarche by about 4.3 (standard error [SE] = 0.08, p < 0.001), and 3.2 months (SE = 0.09, p < 0.001), respectively, relative to NH white girls. NH black women reported live birth ratios 9% (SE = 0.02, p < 0.001) lower than NH white women. Women with unstable health insurance reported live birth ratios 6% (SE = 0.02, p = 0.02) lower than women with stable health insurance. Race/ethnicity, SES, and its downstream correlates were not associated with infertility. One hypothesized explanation for observed disparities in age of menarche and live birth ratios is the embodiment of discrimination faced by NH black women within the USA. Our findings also underscore the importance of health insurance access for favorable reproductive health outcomes. Future work should elucidate the role of embodied discrimination and other downstream correlates of SES in modulating women's reproductive health outcomes to inform strategies to mitigate health disparities.

Introduction: The aim of this study was to investigate the sexual intercourse frequency (SIF) of infertile couples without sexual dysfunction and analyze its related influencing factors., Materials and Methods: We retrospectively analyzed the data of a total number of 4,923 infertile couples without sexual dysfunction who received treatment in our assisted reproductive center from October 2016 to October 2018. Both partners of couples were inquired about their information of demographic statistics, occupations, lifestyles, education backgrounds, psychological characteristics, and testostrone levels of male patients. The multivariable linear regression analysis was applied to evaluate the influence of various variables on SIF., Results: The median (interquartile range) SIF of infertile couples without sexual dysfunction was 7 (6.5-8) times per month. Lower academic qualification and younger age were predictive of increased SIF in both partners. The SIF of Chinese Han women and Chinese Zang women is higher than that of other ethnic groups. Men with lower testosterone (<10 nmol/L) were associated with lower SIF. The BMI, occupation, alcohol consumption, races of both partners of couples, and smoking status of males were not associated with SIF. Multivariable linear regression analysis indicated that only the age and the education level of men played an important role in SIF, and educational level of men had the greatest impact, followed by men's age., Conclusion: In our study, we analyzed demographics data, occupational characteristics, and lifestyle behaviors of both partners, as well as men's testosterone levels; we also reported the related SIF. According to our research, men's education level was the most important factor in predicting SIF, followed by men's age. Testosterone levels of men do not appear to play a substantial role in predicting SIF in infertile couples., (© 2021 S. Karger AG, Basel.)

Current knowledge about infertility and access to infertility treatment among Aboriginal and Torres Strait Islander peoples is extremely limited. We conducted an online survey of Medical Directors of registered ART providers in Australia (n = 59) to obtain preliminary information on this topic. Six (10%) Directors responded; only two reported routinely collecting the Aboriginal and Torres Strait Islander status of clients. While the low response rate prevents generalising the findings, the poor engagement may indicate gaps in awareness of fertility issues for this group. This warrants further investigation, to understand whether Aboriginal and Torres Strait Islander people are appropriately accessing infertility care., (© 2020 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.)

Background: Numerous studies have demonstrated substantial differences in assisted reproductive technology outcomes between black non-Hispanic and white non-Hispanic women. We sought to determine if disparities in assisted reproductive technology outcomes between cycles from black non-Hispanic and white non-Hispanic women have changed and to identify factors that may have influenced change and determine racial differences in cumulative live birth rates., Methods: This is a retrospective cohort study of the SARTCORS database outcomes for 2014-2016 compared with those previously reported in 2004-2006 and 1999/2000. Patient demographics, etiology of infertility, and cycle outcomes were compared between black non-hispanic and white non-hispanic patients. Categorical values were compared using Chi-squared testing. Continuous variables were compared using t-test. Multiple logistic regression was used to assess confounders., Results: We analyzed 122,721 autologous, fresh, non-donor embryo cycles from 2014 to 2016 of which 13,717 cycles from black and 109,004 cycles from white women. The proportion of cycles from black women increased from 6.5 to 8.4%. Cycles from black women were almost 3 times more likely to have tubal and/or uterine factor and body mass index ≥30 kg/m 2 . Multivariate logistic regression demonstrated that black women had a lower live birth rate (OR 0.71;P < 0.001) and a lower cumulative live birth rate for their initial cycle (OR 0.64; P < 0.001) independent of age, parity, body mass index, etiology of infertility, ovarian reserve, cycle cancellation, past spontaneous abortions, use of intra-cytoplasmic sperm injection or number of embryos transferred. A lower proportion of cycles in black women were represented among non-mandated states (P < 0.001) and cycles in black women were associated with higher clinical live birth rates in mandated states (P = 0.006)., Conclusions: Disparities in assisted reproductive technology outcomes in the US have persisted for black women over the last 15 years. Limited access to state mandated insurance may be contributory. Race has continued to be an independent prognostic factor for live birth and cumulative live birth rate from assisted reproductive technology in the US.

Objectives: The aims of the study were to reviews the history of China's population policy since 2011, and draw lessons from the Chinese experience in response to infertility., Methods: Data from the Chinese infertility status survey report (2009) and national statistical yearbooks (2009-2019) are used to assess the severity of infertility and reproductive centers shortage in China. Lessons from China was informed by a review of existing literature., Results: The proportion of couples suffering from infertility in China increased to 12.5% (166.8 million in 2009) from just 6.89% (86.6 million in 1988) two decades earlier, while the number of reproductive centers was one for every 3.1 million citizens. The total costs per live birth for medically assisted reproduction in Chinese public fertility clinics was 30,000 yuan in 2012. Among infertile couples, unemployed patients accounted for the largest proportion (21.9% in 2014). Currently in China, health regulations permit oocyte donation only from infertility patients who have 20 or more mature oocytes, of which at least 15 must be kept for their own treatment., Conclusion: It is necessary to integrate the reproductive health care of infertile people into the national public health service. In addition to relieving their economic burden, national policies should guide and support enterprises to guarantee employee medical leave for infertility. Growing numbers of bereaved older women who have lost their only child make it imperative to reconsider liberalizing the regulation of oocyte donation in China.

Identifying the process of making the decision to use a surrogate mother can create a broad knowledge of this concept. In this grounded theory study, participants were selected through snowball sampling method and obtaining an informed consent, in-depth interviews were conducted face to face and recorded. Then, all the interviews, field notes, and memos were analyzed using Strauss-Corbin 1998 method. Analysis of the statements of the participants boiled down to 487 initial codes, 311 codes, 14 subcategories, and six categories. In the conceptual model of this process, "the hope to have a child" was an influential concept that interacted with other concepts.

Israel is known as a highly pronatalist society. We conceptualize the pro-natalist state as the employer of in vitro fertilization (IVF) patients in the labor of procreation. We characterize the unique Israeli religio-cultural environment regarding infertility using the concepts of emotional labor, surface acting, deep acting, emotional dissonance, and burnout. One hundred and forty-two women and 62 men undergoing IVF in eight public IVF units were asked to describe their emotions on the Positive and Negative Affect Schedule (PANAS). We discuss the patients' emotional responses in light of the religio-cultural and the emotional labor context. Evidence was found for gender differences whereby women suffer more negative emotional outcomes than male partners of IVF patients. The pro-natalist state poses greater emotional stress for female IVF patients in comparison with that experienced by the male spouses of IVF patients. Consulting professionals should offer psycho-social care if necessary, focusing on strategies taken from emotional labor theory.

Objective: To study social and demographic differentiation of assisted reproduction technology (ART) use at the population level in the United States., Design: Population-based study., Setting: Not applicable., Patient(s): Women 15-49 years old in the American Community Survey and National Vital Statistics Birth Certificate data from 2010-2017., Interventions: Not applicable., Main Outcome Measure(s): Birth rate after ART by major sociodemographic categories and likelihood of having an ART birth., Result(s): Net of education, age, period, and marital status, the incidence rates of ART births are lower for black women (0.57 times; 95% CI, 0.52-0.62) and Hispanic women (0.67 times; 95% CI, 0.57-0.62) relative to white women's rates; for Asian women, the incidence rates are 1.21 times that of white women's rates. Further, the incidence rates of ART births are higher for women with more than a 4-year degree (2.08 times; 95% CI, 1.90-2.27) relative to women with a 4-year degree, and are lower for women with less education. Women who are married have an incidence rate of ART that is 5.72 times (95% CI, 5.37-6.09) that of unmarried women. The incidence rates for 2013-2016 are statistically significantly higher than for 2010 by a factor of 1.16 (95% CI, 1.02-1.31), 1.16 (95% CI, 1.03-1.31), 1.27 (95% CI, 1.12-1.43), and 1.51 (95% CI, 1.43-1.82), respectively. The educational differences in ART exist across all age groups from 20 to 49, but are the largest among the 35-39 and 40-44 age groups., Conclusion(s): Large differences in the risk of an ART birth and the proportion of births and the total fertility rate due to ART exist across period, age, race, education, and marital status groups in the United States. Current measures of ART births may disguise an unmet need for ART., (Copyright © 2019 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Research Question: Does a woman's ethnicity affect her fresh and frozen embryo transfer outcomes differently?, Design: A retrospective cohort study of the first fresh and first frozen embryo transfer per woman carried out at a single tertiary level fertility unit between 2010 and 2016 using data retrieved from an electronic database. Biochemical pregnancy, biochemical pregnancy loss, clinical pregnancy, miscarriage and live birth rates per embryo transfer were compared between 5876 white Caucasian, 1071 South Asian and 114 Black Afro-Caribbean women undergoing their first fresh embryo transfer and for 1418 Caucasian, 273 South Asian and 31 Afro-Caribbean women undergoing their first frozen embryo transfer. Logistic regression was used to adjust for age, number of oocytes retrieved, and number and stage of embryos transferred., Results: South Asian (26% versus 32%, adjusted OR 0.622, 95% CI 0.533 to 0.725) and Black Afro-Caribbean women (21% versus 32%, adjusted OR 0.528, 95% CI 0.332 to 0.839) had a lower live birth rate per fresh embryo transfer compared with white Caucasian women. In contrast, the live birth rates per frozen embryo transfer were not significantly different between South Asian and Caucasian women (26% versus 28%, adjusted OR 0.890, 95% CI 0.661 to 1.200) and between Afro-Caribbean and Caucasian women (29% versus 28%, adjusted OR 0.983, 95% CI 0.447 to 2.162)., Conclusion: South Asian and Black Afro-Caribbean women have a significantly lower live birth rate than white Caucasian women after fresh embryo transfer, but their frozen embryo transfer live birth rates are not significantly different., (Copyright © 2019 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.)

Objective: To investigate factors associated with early IVF treatment discontinuation., Design: Retrospective cohort study., Setting: Academic medical center., Patient(s): Six hundred sixty-nine first-attempt IVF patients who did not have a live birth., Intervention(s): None., Main Outcome Measure(s): Treatment discontinuation and time to return for a second IVF cycle., Result(s): Women without IVF insurance coverage were more likely to discontinue treatment than women with insurance coverage (adjusted odds ratio [aOR] = 3.12; 95% confidence interval [CI], 2.22-4.40). African-American women were more likely to discontinue treatment (aOR = 2.95; 95% CI, 1.54-5.66) and returned for treatment more slowly (adjusted hazard ratio [aHR] = 0.44; 95% CI, 0.28-0.71) than non-Hispanic white women, regardless of IVF insurance coverage or income. Women with a poor prognosis were more likely to discontinue treatment than women with a good prognosis. Older women with IVF insurance coverage or a good prognosis had a shorter time to return for a second IVF cycle than older women without IVF insurance coverage or with a poor prognosis. Estimated income, distance to clinic, fertility diagnosis, number of oocytes retrieved, and history of previous live birth were not associated with treatment discontinuation or time to return for a second IVF cycle after adjustment for covariates., Conclusion(s): IVF insurance coverage, race, age, and future treatment prognosis are associated with IVF treatment discontinuation and time to return., (Copyright © 2019 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Background: The prevalence of infertility in American Indian/Alaska Native (AI/AN) populations is unknown. The objective of our study was to estimate the prevalence of infertility and impaired fecundity in the AI/AN population and other racial and ethnic groups., Methods: We analyzed female respondent data from the pooled National Survey of Family Growth (NSFG) cycles 2002, 2006-2010, and 2011-2013. We used modified Poisson regression with robust error variance accounting for survey weighting to estimate prevalence proportion ratios (PPR) and 95% confidence intervals (CI) for NSFG definitions of infertility and impaired fecundity by race and Hispanic ethnicity., Results: The prevalence of infertility and impaired fecundity in the pooled NSFG was 6.4% (95% CI 5.7, 7.0) and 11.0% (95% CI 11.0, 12.2), respectively. Compared to whites, blacks had a 1.45 times greater adjusted prevalence of infertility (95% CI 1.15, 1.83) and AI/ANs had a 1.37 times greater prevalence of infertility (95% CI 0.91, 2.06) compared to whites. We observed a 1.30 times greater prevalence of impaired fecundity among AI/AN (95% CI 1.04, 1.62) compared to whites. We observed no differences in impaired fecundity for black or Asian/Pacific Islander women compared to whites or for Hispanic compared to non-Hispanic women., Conclusions: Inequalities in the burden of reproductive impairments among blacks and AI/AN women warrant further evaluation to identify opportunities for prevention and disparity reduction., (© 2019 John Wiley & Sons Ltd.)

Objective: To assess public attitudes toward placing age limits on men and women seeking fertility treatment., Design: Cross-sectional web-based survey., Setting: Not applicable., Patient(s): A nationally representative sample of 1,427 adults in the United States., Intervention(s): Not applicable., Main Outcome Measure(s): Support for placing age limits on people seeking fertility treatment., Result(s): Sixty-seven percent of respondents supported placing age limits on women, whereas 57% supported placing age limits on men seeking fertility treatments. Sixty-four percent agreed with current American Society for Reproductive Medicine guidelines that ET should not be undertaken beyond age 55 years. Whereas 55% of respondents supported placing age limits on both men and women, 12% supported age limits on women but not men, and 3% supported age limits on men but not women. Men were more likely to answer discordantly when compared with female respondents. Individuals older than 50 years, who lived in the western United States, or with a personal knowledge of someone who used assisted reproductive technology were more likely to support age limits on both women and men seeking fertility treatments. Sexual minorities, people without biological children, and single, long-term partnered or divorced/widowed respondents were less likely to support age limits on men or women seeking fertility treatments., Conclusion(s): Fifty-five percent of respondents in a nationally representative sample support upper age limits on both men and women seeking fertility treatments. Support was associated with various demographic characteristics. Men were more likely than women to support age limits only on women., (Copyright © 2018 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Drawing from interviews and life histories, I consider the singular reproductive trajectories of women who fought infertility during the enforced pronatalist policies of the late communist era in Romania. I aim to explore the role of fine-grained ethnography in revealing both the localized mechanisms of reproductive governance and the diverse subjectivities produced by citizens' encounters with biopower. I argue that, through an analysis of these ethnographic cases, we can further conceptualize reproductive vulnerability as an intersubjective notion. In addition, women's atypical stories give us a glimpse into the typical workings of the recording and reporting practices of the pronatalist regime.

Objectives Previous studies have identified racial/ethnic disparities in infertility care, but patterns among American Indian/Alaska Natives (AI/AN) have not been reported. Our objective was to evaluate infertility services use in the US by race/ethnicity using data from the National Survey of Family Growth (NSFG). Methods We analyzed female respondent data from the pooled NSFG cycles 2002, 2006-2010 and 2011-2013. Respondents reported use of infertility services and types of services. We calculated weighted crude and adjusted prevalence proportion ratios (PPR) and 95% confidence intervals (95% CI) using modified Poisson regression with robust error variances accounting for the complex survey design to compare infertility services use across race/ethnicities. Results Overall, 8.7% of women reported using medical services to get pregnant. The prevalence of using any medical service to help get pregnant was lower for American Indian/Alaska Native (AI/AN) (PPR: 0.60, 95% CI 0.43-0.83) and black (PPR: 0.53, 95% CI 0.44-0.63) compared to white women and in Hispanic compared to non-Hispanic women (PPR: 0.57, 95% CI 0.48-0.67). The prevalence of accessing treatment, testing, and advice also differed by race and ethnicity. Conclusions for Practice We observed disparities in accessing services to get pregnant among AI/AN and black women and reduced use of advice among Asian/Pacific Islanders compared to whites. We also observed reduced service utilization for Hispanic compared to non-Hispanic women. Differential utilization of specific services suggests barriers to infertility care may contribute to reproductive health disparities among underserved populations.

Introduction: There is a 6.4 percent incidence of rubella exposure during pregnancy in the U.S. Given the severe effects rubella can have on a developing fetus, vaccination of women prior to pregnancy is important. Women seeking fertility treatment therefore present a population of patients primed for the vaccination. This study collected and analyzed rubella-specific immunoglobulin G (RV-IgG) titer statuses and corresponding demographics of infertility patients to identify patients at risk of rubella nonimmunity., Methods: The study consisted of a retrospective review of electronic medial records (EMR) of female patients, ages 18 to 50, who were new patients receiving an infertility workup at a Midwestern reproductive endocrinology clinic from Jan. 1, 2010 through Dec. 31, 2014. Of those patients who had RV-IgG titers noted in their EMR, the following demographics were collected: age, race, gravidity and parity, state of residence, and community size., Results: There were 750 patients included in the study. Rubella titers were drawn on 72.7 percent of the patients. Of those drawn, 90.8 percent had a positive rubella titer. Most of the participants (92.3 percent) were identified as Caucasian/White. Caucasians/Whites, Asians, and African Americans/Blacks had the highest rates of rubella immunity, while American Indians/Alaskan Natives had the lowest rates of immunity (p=0.0006). Nulligravida participants had a positive rubella titer rate of 94.1 percent, while primigravida participants had a rate of 89.8 percent (p=0.04). Participants living in the largest sampled communities had the lowest rates of positive rubella titers, while those living in the smallest communities had the highest rates of positive rubella titers, although these findings were not statistically significant., Conclusions: Of the infertility patients, 27.3 percent did not have an RV-IgG titer drawn as part of their fertility workup. Of the 72.7 percent of patients for whom titers were checked, nearly 10 percent were not immune to rubella. While there are a couple reasons why a patient may not have a positive titer, lack of immunization is the most common reason. Data analysis identified significance in the difference in titer status only with respect to race and gravidity, and those findings, particularly race, must be viewed critically in light of the study population. While the statistical significance of the study may be limited, there is clinical significance in identifying infertility patients at highest risk of rubella nonimmunity so vaccination education and efforts can be focused accordingly., (Copyright© South Dakota State Medical Association.)

Background: Chlamydia trachomatis is the most common reportable infection in the United States and can cause pelvic inflammatory disease (PID) and tubal factor infertility (TFI)., Methods: We created life tables to estimate the "lifetime" risk of chlamydia diagnosis among women aged 15-34 years in King County, Washington, between 1992 and 2014. We estimated the lifetime risk of chlamydia-associated PID and TFI incorporating published estimates of the risk of sequelae., Results: There were 51464 first chlamydia diagnoses in 1992-2014. For women born between 1980 and 1984, the lifetime risk of chlamydia diagnosis was 19.8% overall and 14.0% for non-Hispanic white, 64.9% for non-Hispanic black, and 32.6% for Hispanic women. The cumulative risk of chlamydia by age 24 increased overall from 13.9% to 17.3% among women born between 1975 and 1994 but declined among non-Hispanic black women, among whom risk by age 24 declined from 57.3% among women born between 1980 and 1984 to 38.6% among women born between 1990 and 1994. The lifetime risk of chlamydia-associated PID among women born between 1980 and 1984 ranged from 0.33% to 1.14%. Among non-Hispanic white, non-Hispanic black, and Hispanic women, the lifetime risk of chlamydia-associated TFI was 0.04%, 0.20%, and 0.10%, respectively., Conclusions: Over 60% of non-Hispanic black women had at least 1 chlamydia diagnosis by age 34 in the birth cohorts most affected, a risk almost 5 times that in non-Hispanic whites. An estimated 1 in 500 non-Hispanic black women develops chlamydia-associated TFI. More effective control measures are needed.

South Asians (SA) develop cardiometabolic disease at elevated rates. We investigate whether reproductive-aged SA women are at higher risk for a precursor condition, polycystic ovary syndrome (PCOS), as compared to Caucasian controls. 52 SA and 52 Caucasian infertility patients from a single institution were included in a cross-sectional analysis. Outcomes were compared using Student's t, Mann-Whitney U, Pearson's Chi-squared and Fisher's exact tests. SA women were younger, with six-fold greater odds of PCOS. SA women were not obese, with similar body mass indices to controls. However, when screened, they demonstrated abundant metabolic disease, including insulin resistance, diabetes and dyslipidemia, and endometrial disease, including hyperplasia and polyps. The SA population was younger with more PCOS and high rates of metabolic and endometrial pathology. These findings, in the context of ethnicity-specific elevations in cardiometabolic risk, highlight the need for comprehensive screening and counseling in this patient population.

The dominant approach to studying historical race-related fertility differences has been to limit samples to first-married and younger women. We argue that studying historical race-related fertility differences in the context of remarriage is also important: remarriage and fertility patterns are both rooted in the biosocial conditions that produce racial disparities in health. We employ a multiple causes framework that attributes variation in fertility patterns to voluntary limitation and involuntary factors (infecundity/subfecundity). We use data from the 1910 Integrated Public Use Microdata Series and estimate zero-inflated negative binomial models that simultaneously distinguish those who are infecund (vs. fecund) and estimate the number of remarital births among the fecund. Our approach allows us to evaluate historical remarital (in)fertility differences, accounting for marital, socioeconomic, and geographic influences on fecundity and fertility, while empirically accounting for the influence of children "missing" from the household due to mortality and fostering/aging out. Consistent with past studies that emphasized poorer African American health as a major influence on involuntary infertility, we find that African American women were more likely than white women to be in the always-zero (infecund) group and to have fewer remarital births. Supplemental analyses nuance these findings but indicate that these results are robust. Overall, we find support for a multiple-causes perspective: while the findings are consistent with the adoption of deliberate fertility control among urban and higher-status women at higher parities, remarital fertility differences in 1910 also reflected greater infecundity/subfecundity among subgroups of women, especially African American women.

Disparities in infertility and access to infertility treatments, such as assisted reproductive technology (ART), by race/ethnicity, have been reported. However, identifying disparities in ART usage may have been hampered by missing race/ethnicity information in ART surveillance. We review infertility prevalence and treatment disparities, use recent data to examine ART use in the United States by race/ethnicity and residency in states with mandated insurance coverage for in vitro fertilization (IVF), and discuss approaches for reducing disparities. We used 2014 National ART Surveillance System (NASS) data to calculate rates of ART procedures per million women 15-44 years of age, a proxy measure of ART utilization, for Census-defined racial/ethnic groups in the United States; rates were further stratified by the presence of insurance mandates for IVF treatment. Missing race/ethnicity data (35.6% of cycles) were imputed. Asian/Pacific Islander (A/PI) women had the highest rates of ART utilization at 5883 ART procedures per million women 15-44 years of age in 2014, whereas American Indian/Alaska Native non-Hispanic women had the lowest rates at 807 per million, compared with other racial/ethnic groups. In each racial/ethnic category, ART utilization rates were higher for women in states with an insurance mandate for IVF treatment versus those without. In 2014, A/PI women had the highest rates of ART utilization. ART utilization for all racial/ethnic groups was higher in states with insurance mandates for IVF than those without, although disparities were still evident. Although mandates may increase access to infertility treatments, they are not sufficient to eliminate these disparities.

Objective: To investigate the association of non-cavity-distorting uterine fibroids and pregnancy outcomes after ovarian stimulation-intrauterine insemination (OS-IUI) in couples with unexplained infertility., Design: Secondary analysis from a prospective, randomized, multicenter clinical trial investigating fertility outcomes after OS-IUI., Setting: Reproductive Medicine Network clinical sites., Patient(s): Nine hundred couples with unexplained infertility who participated in the Assessment of Multiple Intrauterine Gestations from Ovarian Stimulation (AMIGOS) clinical trial., Intervention(s): Participants were randomized to one of three arms (clomiphene citrate, letrozole, or gonadotropins), and treatment was continued for up to four cycles or until pregnancy was achieved., Main Outcomes Measure(s): Conception (serum hCG increase), clinical pregnancy (fetal cardiac activity), and live birth rates., Result(s): A total of 102/900 participants (11.3%) had at least one documented fibroid and a normal uterine cavity. Women with fibroids were older, more likely to be African American, had a greater uterine volume, lower serum antimüllerian hormone levels, and fewer antral follicles than women without fibroids. In conception cycles, clinical pregnancy rates were significantly lower in participants with fibroids than in those without uterine fibroids. Pregnancy loss before 12 weeks was more likely in African American women with fibroids compared with non-African American women with fibroids. There was no difference in conception and live birth rates in subjects with and without fibroids., Conclusion(s): No differences were observed in conception and live birth rates in women with non-cavity-distorting fibroids and those without fibroids. These findings provide reassurance that pregnancy success is not impacted in couples with non-cavity-distorting fibroids undergoing OS-IUI for unexplained infertility., Clinical Trial Registration Number: NCT01044862., (Copyright © 2016 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

The aim of this retrospective cohort study was to assess differences in infertility-related baseline characteristics and IVF outcome between European and Middle Eastern/North African (MENA) patients. Of 2703 patients undergoing their first IVF cycle, 2485 were Caucasian of European descent and 218 originated from the MENA region. MENA patients were significantly younger (30.6 versus 34.0 years, P < 0.001), less likely smokers, with higher body mass indexes. Infertility duration was longer in MENA patients (P < 0.001), their male partners were younger (P < 0.001) and smoked more often than European male patients (P = 0.005). Male factor infertility (P = 0.017) and polycystic ovary syndrome (PCOS; P = 0.032) was more prevalent in MENA patients, showed significantly higher basal FSH concentrations (P = 0.012) and significantly fewer oocytes retrieved (RR 0.83, 95% CI 0.74-0.93, P = 0.001). Clinical pregnancy rates were comparable (22.4% [European] versus 22.9% [MENA]). Fewer MENA patients had surplus embryos cryopreserved (OR 0.41, 95% CI 0.22-0.76, P = 0.004). Despite younger age and higher prevalence of PCOS, MENA patients had significantly lower oocyte yields than their European counterparts (P = 0.001). These findings suggest a more rapid decline in ovarian function in women of MENA descent., (Copyright © 2016 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.)

Objective: To evaluate the reliability, validity, and responsiveness of the Chinese version of the polycystic ovary syndrome questionnaire (PCOSQ)., Design: Translation and validation study., Setting: Gynaecology clinic and paediatric adolescent gynaecology clinic at the study institute., Population: Chinese women, 16 years of age or older, with polycystic ovary syndrome (PCOS)., Methods: Women completed the Chinese version of the PCOSQ and the Short-Form Health Survey (SF-36). Their sociodemographic details, clinical parameters, and biochemical results were recorded. A subset of 50 women repeated the PCOSQ 1 week later to evaluate test-retest reliability. Women subsequently received treatment for the symptoms of PCOS. Six months later, 100 women completed the PCOSQ and clinical parameters were assessed to evaluate the responsiveness of the PCOSQ., Main Outcome Measures: Internal reliability, test-retest reliability, convergent validity, criterion validity, and responsiveness., Results: A total of 262 Chinese women completed the study. Values of Cronbach's alpha coefficient were all above 0.7, demonstrating a good standard of internal consistency in all subscales. For the test-retest reliability, intraclass correlation coefficients showed excellent stability among the subscales (range 0.82-0.92, P < 0.001). Convergent validity was demonstrated by positive correlations with the subscales of SF-36 and clinical parameters like body mass index (BMI), waist-hip ratio (WHR), hirsutism score, menstrual regularity, and infertility, and the respective subscales. Improvement in PCOSQ scores was seen in women with improvements in BMI and menstrual patterns; however, these findings did not reach statistical significance., Conclusions: The Chinese version of PCOSQ is reliable and valid for use in women with PCOS., Tweetable Abstract: The Chinese version of the PCOSQ is reliable and valid for use., (© 2016 Royal College of Obstetricians and Gynaecologists.)

Objective: To evaluate the relationship between genetic ethnicity using ancestry informative markers (AIMs) and ovarian reserve and response parameters as evidenced by FSH, antimüllerian hormone (AMH), basal antral follicle count (BAFC), and total oocyte yield in IVF., Design: Retrospective., Setting: Academic medical center., Patients(s): A total of 2,508 infertile patients undergoing IVF at a single center., Intervention(s): Patients were genotyped for 32 AIMs and analyzed for differences in allele frequencies. A validated Bayesian clustering algorithm was then used to assign individuals into one of four ethnic populations: European, African, Central/South Asian, or East Asian., Main Outcome Measure(s): FSH, AMH, BAFC, and oocyte yield variation., Result(s): After controlling for age and body mass index, genetic ethnicity had no impact on AMH, BAFC, and oocyte yield. FSH was found to be lower in patients of Central/South Asian ancestry (6.46 ng/mL vs. 6.97 ng/mL); however, the absolute difference is of little clinical significance. Subgroup analyses of 1,327 patients restricted to those with limited genetic admixture as determined by AIMs indicated that FSH, AMH, BAFC, and oocyte yield were equivalent., Conclusion(s): When determining ethnicity using AIMs, ethnic background does not have an impact on markers of ovarian reserve or ovarian response. Specifically, no differences were found in AMH, BAFC, or oocyte yield relative to genotypic ethnicity. Using AIMs rather than self-reported ethnicity allows for elimination of reporting biases and nonreporting of ethnicity, which can confound data. Based upon these data, specific recommendations for ovarian reserve testing should thus be made based on other factors besides ethnic background., (Copyright © 2016 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Published studies on the association between the C677T and A1298C polymorphisms of the methylenetetrahydrofolate reductase (MTHFR) gene and male infertility risk are controversial. To obtain a more precise evaluation, we performed a meta-analysis based on published case-control studies. We conducted an electronic search of PubMed, EMBASE, the Cochrane Library, the Web of Science, and the China Knowledge Resource Integrated Database for papers on MTHFR gene C677T and A1298C polymorphisms and male infertility risk. Pooled odds ratios (ORs) with 95% confidence intervals (95%CIs) were used to assess the strength of association in homozygote, heterozygote, dominant, recessive, and additive models. Statistical heterogeneity, test of publication bias, and sensitivity analysis were carried out using the STATA software (Version 13.0). Overall, 21 studies of C677T (4505 cases and 4024 controls) and 13 studies of A1298C (2785 cases and 3094 controls) were included in this meta-analysis. For C677T, the homozygote comparison results were OR = 1.629, 95%CI (1.215- 2.184), and the recessive model results were OR = 1.462 (1.155- 1.850). For A1298C, the homozygote comparison results were OR = 1.289 (1.029-1.616), and the recessive model results were OR = 1.288 (1.034-1.604). In conclusion, the current meta-analysis showed that the MTHFR C677T polymorphism was associated with a significantly increased male infertility risk in the Asian and overall populations, but not in the Caucasian population, and there was a significant association between the A1298C polymorphism and male infertility risk in the Asian, Caucasian, and overall groups.

Aims and Objectives: To describe and understand the experiences and perceptions of women who undergo hysterosalpingography as part of the infertility process., Background: Nurses and midwives should conduct research into the emotional aspects of caring for patients undergoing infertility treatment. The hysterosalpingography is considered to be the most feared test in the infertility process and the one about which very little is known., Design: A phenomenological qualitative study., Methods: Ten Spanish women who had undergone hysterosalpingography participated in this study. In-depth interviews were carried out between October 2012-May 2013. Data analysis was performed with the help of atlas.ti software to identify emerging themes., Results: The experience of the participants who underwent hysterosalpingography during the infertility process is represented by the following three themes: (1) becoming a mother to feel complete as a person and as a woman, with the subthemes 'maternity as a life objective' and 'maternity in terms of gender identity'; (2) infertility--an intimate experience which provokes negative feelings, with the subthemes 'negative feelings regarding own infertility' and 'infertility as an experience that is little shared with others'; (3) Undergoing hysterosalpingography, with the subthemes 'feelings regarding hysterosalpingography', 'treatment by medical providers' and 'areas for improvement regarding the service given by the providers'., Conclusion: For women who undergo hysterosalpingography, maternity may be seen as a life objective that could identify them as women. Results suggest that although infertility is experienced with negative feelings such as anxiety, frustration and sadness, hysterosalpingography seems to be related with both hope and fear when facing the test., Relevance to Clinical Practice: Knowing the experiences of these women could help nurses, midwives and physicians to provide better patient-centred care., (© 2016 John Wiley & Sons Ltd.)

This study explored whether fertility-specific distress varied by race/ethnicity among a nationally representative sample of US women. Participants were 2363 White (n = 1266), Black (n = 569), Hispanic (n = 453), and Asian (n = 51) women who participated in the National Survey of Fertility Barriers. Participants were given the Fertility-Specific Distress Scale and assessed for strength of pregnancy intent, primary versus secondary infertility, and socioeconomic hardship. Black women reported lower levels of fertility-specific distress than White women, but these were fully mediated by the strength of pregnancy intentions. Primary versus secondary infertility and economic hardship were not associated with fertility-specific distress., (© The Author(s) 2014.)

Objective: To investigate the prevalence of infertility and related factors in Uygur and Kazak women in Xinjiang Uygur autonomous region (Xinjiang)., Methods: Questionnaire survey and pelvic examination were conducted among 535 Uygur women and 322 Kazak women at reproductive age who were selected through stratified cluster random sampling in Sansan and Fuhai counties in Xinjiang. The data were analyzed with software SPSS 17.0., Results: The prevalence of infertility among the Uygur and Kazak women were 26.5% and 21.7% respectively, the difference was not statistically significant (P>0.05). The prevalence of primary infertility among the Uygur and Kazak women were 14.7%, and 8.7%, respectively, the difference was statistically significant (P<0.05). The prevalence of secondary infertility among the Uygur and Kazak women were 11.8% and 13.0%, respectively, the difference was not statistically significant (P>0.05). The prevalence of infertility in the Uygur women was correlated with household income, pelvic inflammation, endometriosis and BMI, while the prevalence of infertility in the Kazak women was correlated with age of marriage, endometriosis and the history of ectopic pregnancy., Conclusion: The prevalence of infertility was high among the Uygur and Kazak women at reproductive age in Xinjiang. The influencing factors varied with ethnic group. It is necessary to conduct targeted health education and provide early diagnosis and effective treatment.

The present study examined whether public funding for in vitro fertilization (IVF) in Quebec, Canada was associated with differential access among Canadian-born infertility patients and those born outside of Canada. Anonymous demographic questionnaires were completed at 3 time points: 2 weeks before the implementation of public funding, 2 weeks after, and 8 months later. Almost half the patients were not born in Canada and of these, 35 % were recent immigrants to Canada. While patients born outside Canada were generally better educated than Canadian-born patients, they were more likely to be unemployed and have lower incomes. Following public funding, there was an overall increase in patients with lower incomes and lower levels of education. Canadian-born patients were more likely than immigrant patients to consult for secondary infertility. Patients born outside Canada tended to be older and nulliparous, suggesting that they may have delayed treatment seeking due to financial and other barriers. The results indicate that public funding reduces health disparities in access to IVF.

This study seeks to explore and explain the socio-cultural factors responsible for the incidence of infant malnutrition in Cameroon with particular emphasis on northern Cameroon where it is most accentuated. It combines quantitative data drawn from the 1991, 1998, 2004 and 2011 Cameroon Demographic and Health Surveys, as well as a literature review of publications by the WHO and UNICEF. This is further complemented with qualitative data from various regions of Cameroon, partly from a national ethnographic study on the ethno-medical causes of infertility in Cameroon conducted between 1999 and 2000. Whereas socio-cultural factors related to child feeding and maternal health (breast-feeding, food taboos and representations of the colostrum as dangerous for infants) are widespread throughout Cameroon, poverty-related factors (lack of education for mothers, natural disaster, unprecedented influx of refugees, inaccessibility and inequity in the distribution of health care services) are pervasive in northern Cameroon. This conjunction of factors accounts for the higher incidence of infant malnutrition and mortality in northern Cameroon. The study suggests the need for women's empowerment and for health care personnel in transcultural situations to understand local cultural beliefs, practices and sentiments before initiating change efforts in infant feeding practices and maternal health. Biomedical services should be tailored to the social and cultural needs of the target population--particularly women--since beliefs and practices underpin therapeutic recourse. Whereas infant diarrhoea might be believed to be the result of sexual contact, in reality, it is caused by unhygienic conditions. Similarly, weaning foods aimed at transmitting ethnic identity might not meet a child's age-specific food needs and might instead give rise to malnutrition.

Objectives: To explore the use of complementary and alternative medicine (CAM) for infertility in a multicultural healthcare setting and to compare Western and non-Western infertility patients' reasons for using CAM and the meanings they attribute to CAM use., Design: Qualitative semi-structured interviews using thematic analysis., Settings/location: Two infertility clinics in Montreal, Quebec, Canada., Participants: An ethnoculturally varied sample of 32 heterosexual infertile couples., Results: CAM used included lifestyle changes (e.g., changing diet, exercise), alternative medicine (e.g., acupuncture, herbal medicines), and religious methods (e.g., prayers, religious talismans). Patients expressed three attitudes toward CAM: desperate hope, casual optimism, and amused skepticism. PARTICIPANTS' CAM use was consistent with cultural traditions of health and fertility: Westerners relied primarily on biomedicine and used CAM mainly for relaxation, whereas non-Westerners' CAM use was often influenced by culture-specific knowledge of health, illness and fertility., Conclusions: Understanding patients' CAM use may help clinicians provide culturally sensitive, patient-centered care.

Objective: To investigate differences in ovarian reserve markers (antimüllerian hormone [AMH] and antral follicle count [AFC]) in Indian and Spanish women., Design: Cross-sectional study., Setting: In vitro fertilization (IVF) clinics., Patient(s): Infertile Spanish (n=229) and Indian (n=236) women who underwent controlled ovarian stimulation for IVF from January to October 2012., Intervention(s): None., Main Outcome Measure(s): Data on ovarian reserve markers and results after ovarian stimulation were collected., Result(s): The mean age of women undergoing their first or second IVF cycle was significantly higher in Spanish than in Indian women (37.5±3.3 years vs. 31.5±3.8 years). Despite this 6-year age gap, AFCs were similar (9.5±4.7 vs. 9.9±4.6), as were day 3 FSH levels (7.5±4.5 IU/L vs. 6.9±2.3 IU/L). AMH levels were slightly lower in Spanish women (1.6±1.7 ng/mL vs. 2.5±1.6 ng/mL). Multivariate regression analysis showed that being Indian decreased AFC by 2.3, such that AFC in Indian women was similar to that in Spanish women 6.3 years older (95% confidence interval 3.39-1.10)., Conclusion(s): Similar ovarian reserve markers and ovarian response were observed in women with a 6-year age difference in favor of the Spanish, suggesting ethnic differences in ovarian aging. Further research is needed to understand whether these differences are genetically induced or are caused by other variables, such as nutrition. Our results may help clinicians to counsel infertile women when discussing assisted reproductive technology outcomes according to age and ethnic background., (Copyright © 2014 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Asking why some diseases gain global attention whereas others are neglected, we present two case studies that demonstrate the unequal treatment and financing options available for HIV/AIDS versus infertility treatments. We track three key phenomena central to understanding the unequal public attention given to certain ailments: peace and security, subordination of the social to the biological, and a "global" quality. Existing concepts such as global assemblages or therapeutic citizenship are quite limited when it comes to bodily conditions that result in social suffering and do not satisfy the conditions of advocacy. Since it is not enough to observe "flowing" and "moving," we propose the concept of medicoscapes, to acknowledge that such activities simultaneously entail channeling and carving out. Medicoscapes enhance the analysis of linkages between different health conditions regardless of whether they are biological or social and how they interconnect places, sites, and people., (© 2014 by the American Anthropological Association.)

Objectives: This report presents nationally representative estimates and trends for infertility service use among women aged 15-44 and 25-44 in the United States in 1982-2010. While greater detail on types of infertility service is shown for women, basic data on types of infertility service use, as reported by men aged 25-44, are also presented., Methods: Data for this report come primarily from the 2006-2010 National Survey of Family Growth (NSFG), consisting of 22,682 interviews with men and women aged 15-44, conducted from June 2006 through June 2010. The response rate for females in the 2006-2010 NSFG was 78%, and for males was 75%. Selected trends are shown based on prior NSFG cycles., Results: Twelve percent of women aged 15-44 in 2006-2010 (7.3 million women), or their husbands or partners, had ever used infertility services. Among women aged 25-44, 17% (6.9 million) had ever used any infertility service, a significant decrease from 20% in 1995. Thirty-eight percent of nulliparous women with current fertility problems in 2006-2010 had ever used infertility services, significantly less than 56% of such women in 1982. In all survey years, ever-use of medical help to get pregnant was highest among older and nulliparous women, non-Hispanic white women, women with current fertility problems, and women with higher levels of education and household income. The most commonly used infertility services among women aged 25-44 in 2006-2010 were advice, testing, medical help to prevent miscarriage, and ovulation drugs. Ever-use of infertility services was reported by 9.4% of men aged 25-44 in 2006-2010, similar to levels seen in 2002., (All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.)

Disparities on the basis of race and ethnicity have been described in a variety of survivorship outcomes, including late and long-term effects of treatment, surveillance and health maintenance, and psychosocial outcomes. However, the current body of literature is limited in scope and additional research is needed to better define and address disparities among cancer survivors., (© 2013 Elsevier Inc. All rights reserved.)

Infertility affects more than 10% of the world's population. In developing countries, there are severe social, psychological and economic consequences for infertile men and women. All of the cited references are compiled from primary peer-reviewed research articles that were conducted through one-to-one interviews or focus groups in countries of developing regions, such as Africa, Asia and the Middle East. The following paper seeks to raise awareness of the consequences of infertility in developing nations and identify infertility as an under-observed, but significant public health issue. It is proposed that education programmes tailored to each society's specific religious beliefs and grounded traditions must be implemented in order to reverse the social stigma, detrimental psychological effects, and loss of economic security that results from infertility.

Objective: To explore that it is necessary to routinely detect chromosomes in fertile couples, we detected peripheral blood lymphocyte karyotype in 14965 infertile couples living in Central China and analyzed the incidence and type of chromosomal anomaly., Methods: G-banding karyotype analysis of peripheral blood lymphocytes was performed in 14965 couples who went to the outpatient department of our reproductive medical center for counseling on infertility between January 2004 and December 2011. Semen analysis was performed three times in all the men from the 14965 couples., Results: The rate of chromosomal anomaly in the 14965 infertile couples was 3.84 % (1150/29930). The rate of chromosomal anomaly in the men from 14965 couples was 6.84 % (1024/14965) and in the women 0.84 % (126/14965). The rates of chromosomal anomaly were 1.69 % in normal semen group, 11.82 % in light oligo-astheno-spermis group, 6.58 % in moderate to severe olig-astheno-spermia group and 17.26 % in azoospermia group., Conclusion: Since the rates of chromosomal anomaly are 1.69 % and 11.82 % even in normal semen group and light oligo-astheno-spermia group, respectively, it is necessary to detect peripheral blood lymphocyte karyotype in all infertile couples.

Objective: To describe a novel method of altering conventional gonadotropin-releasing hormone (GnRH) antagonist in vitro fertilization (IVF) cycles, thereby allowing for the observance of ritual Jewish practices, and to investigate the impact of these cycle modifications on IVF outcomes., Design: Retrospective cohort study., Setting: Academic medical center., Patient(s): Orthodox Jewish couples undergoing GnRH antagonist IVF cycles at The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical College from January 1, 2007, to November 1, 2011, in whom cycle starts were delayed using GnRH antagonists and estradiol patches., Intervention(s): GnRH antagonist administration on cycle days 2, 3, and 4, as well as estradiol patch application on cycle days 2, 4, and 6., Main Outcome Measure(s): Days of stimulation, total cycle length, implantation, clinical pregnancy, and live-birth rate were compared for 42 Orthodox Jewish couples undergoing a "mikveh patching protocol" versus 42 control patients matched for age, diagnosis, and IVF cycle characteristics., Result(s): The protocol modifications successfully ensured the ability to visit the mikveh before retrieval by extending total cycle length by 3.85 days on average, with no decrement in implantation (43.2% vs. 39.3%), clinical pregnancy (57.1% vs. 59.5%), or live-birth rates (50.0% vs. 54.8%) as compared with controls., Conclusion(s): GnRH antagonist cycles can be successfully modified to allow for IVF that remains consistent with the observance of Orthodox Jewish practices., (Copyright © 2013. Published by Elsevier Inc.)

Background: Infertility is a global reproductive health issue that affects many individuals and couples. Despite the high prevalence of infertility in Ghana, no study has been done on the experiences of infertile couples in Northern Ghana. This study therefore explored the experiences of infertile couples in Northern Ghana using the Upper West Region as a case study., Methods: We interviewed fifteen childless couples, forty-five couples with children, and eight key informants using a semi-structured interview guide. We also carried out three focus group discussions; one for childless women, one for women with children and one for men with children. The data were transcribed, coded, arranged and analyzed for categories and themes., Results: Infertile couples are socially stigmatised and excluded from leadership roles in their communities. Couples without children are denied membership in the ancestral world thereby losing the opportunity to live again. Both males and females are engaged in sex with multiple partners to prove their fertility., Conclusions: Both men and women suffer from the social effects of childlessness. The desire to have biological children in a pronatalist society results in unhealthy practices. Health policy makers and gender advocates should be more concerned about infertility.

This study explores the psychometric properties and factor structure of the Portuguese version of the Infertility Self-Efficacy Scale (ISE-P), using translation and back-translation of the original version; principal component analysis; confirmatory factor analysis (CFA); and internal consistency, and test-retest reliability analyses. A total of 287 participants (156 women and 131 men) seeking medical treatment were recruited from public and private fertility centers. CFA revealed that the single-component model fit the data well. The instrument showed excellent internal consistency, good test-retest reliability, and correlations with other mental health measures suggesting good convergent and discriminant validity. In conclusion, The ISE-P is a valid and reliable Portuguese-language measure of perceived self-efficacy to cope with infertility., (Copyright © 2012 Wiley Periodicals, Inc.)

This article analyzes a public controversy surrounding the hormonal treatment of infertility associated with observance of rabbinic law to illuminate the reach of rabbi-doctor relations in a local configuration of religion and biomedicine that I call "kosher medicine." I combine a historical perspective on the evolution of religious laws governing menstruation, and the rabbi-doctor relations with a contemporary ethnography of these relations and laws to illuminate the interplay of continuities, discontinuities, tradition, and modernity and their uses and abuses in the contemporary mode of interpenetration between observant Judaism and biomedicine. The controversy highlights asymmetric permeations into biomedical and rabbinic professional domains. Collaborations persist as long as doctors who declare their incompetence in rabbinic law accommodate to demands of rabbis who are expert in it and also claim competence to challenge medical decisions. Once a doctor demonstrates competence in rabbinic law to challenge rabbinic directives a crisis develops.