OBJECTIVE: To evaluate the effect of acupuncture on reproductive outcome in patients treated with IVF/intracytoplasmic sperm injection (ICSI). One group of patients received acupuncture on the day of ET, another group on ET day and again 2 days later (i.e., closer to implantation day), and both groups were compared with a control group that did not receive acupuncture. DESIGN: Prospective, randomized trial. SETTING: Private fertility center. PATIENT(S): During the study period all patients receiving IVF or ICSI treatment were offered participation in the study. On the day of oocyte retrieval, patients were randomly allocated (with sealed envelopes) to receive acupuncture on the day of ET (ACU 1 group, n = 95), on that day and again 2 days later (ACU 2 group, n = 91), or no acupuncture (control group, n = 87). INTERVENTION(S): Acupuncture was performed immediately before and after ET (ACU 1 and 2 groups), with each session lasting 25 minutes; and one 25-minute session was performed 2 days later in the ACU 2 group. MAIN OUTCOME MEASURE(S): Clinical pregnancy and ongoing pregnancy rates in the three groups. RESULT(S): Clinical and ongoing pregnancy rates were significantly higher in the ACU 1 group as compared with controls (37 of 95 [39%] vs. 21 of 87 [26%] and 34 of 95 [36%] vs. 19 of 87 [22%]). The clinical and ongoing pregnancy rates in the ACU 2 group (36% and 26%) were higher than in controls, but the difference did not reach statistical difference. CONCLUSION(S): Acupuncture on the day of ET significantly improves the reproductive outcome of IVF/ICSI, compared with no acupuncture. Repeating acupuncture on ET day +2 provided no additional beneficial effect.
BACKGROUND: Our aim was to examine the association between use of alcohol and subsequent incidence of primary infertility. METHODS: The study subjects were chosen from a population-based cohort of Danish women aged 20-29 years. Eligible women were nulliparous and not pregnant (n = 7760). Information on alcohol intake and potential confounders (age, education, marital status, diseases in the reproductive organs, and cigarette smoking) was assessed at enrollment. The incidence of fertility problems during follow-up was obtained by record linkage with the Danish Hospital Discharge Register and the Danish Infertility Cohort Register. Main outcome measures were hazard ratios of infertility according to alcohol intake at baseline estimated in a multivariate Cox proportional hazards model. RESULTS: During a mean follow-up of 4.9 years, 368 women had experienced infertility. Alcohol intake at baseline was unassociated with infertility among younger women, but was a significant predictor for infertility among women above age 30. In this age group, the adjusted hazard ratio for consuming seven or more drinks per week was 2.26 (95% confidence interval: 1.19-4.32) compared with women consuming less than one drink per week. CONCLUSIONS: These findings suggest that alcohol intake is a predictor for infertility problems among women in the later reproductive age group.
OBJECTIVE: To study the predictive value of initial low response (LR) in IVF/intracytoplasmic sperm injection (ICSI). DESIGN: Retrospective analysis. SETTING: Two Finnish fertility centers. PATIENT(S): A total of 3,846 IVF/ICSI cycles performed from 1994 to 2002. INTERVENTION(S): Consecutive cycles in the same subject were identified. The study groups consisted of subjects who had three treatment cycles and at least one LR cycle (n = 80). MAIN OUTCOME MEASURE(S): Pregnancy rate (PR), total gonadotropin dose, and embryo quality. RESULT(S): Only 2.5% (2/80) of subjects had a LR in all three consecutive cycles. In 43 women an initial LR was followed by >/=1 normal response (NR) cycle, and in 35 women an initial NR was followed by >/=1 LR cycle. The PR/cycle was similarly low in women with an initial LR and an initial NR (10.1% vs. 16.2%). An increase in gonadotropin dose resulted in a higher number of oocytes in women with an initial LR (from 2.1 +/- 0.9 to 6.7 +/- 2.7) but the PR/cycle remained low, compared to the overall mean PR (27.2%). In cycles in which top quality embryos were transferred, subjects with an initial LR had a lower PR than women with an initial NR (17.8% vs. 41.2%). CONCLUSION(S): An initial LR is a predictor of poor outcome in subsequent cycles, even if ovarian response is improved by increasing the gonadotropin dose or a top quality embryo is replaced.
The association of birth interval, maternal age and season of birth with the fertility of daughters: a retrospective cohort study based on family reconstitutions from nineteenth and early twentieth century Quebec.
In a historical follow-up study, we evaluated the association of the fertility of daughters with five perinatal factors: short ( or = 45 months) preceding birth interval, low ( or = 40 years) maternal age and season of birth. We used data concerning 2062 women married before the age of 31 and born in the Saguenay region of Quebec, Canada, between 1850 and 1899. Time between the wedding and first birth was used for the estimation of differences in fertility. Using logistic regression and controlling for several potential confounders, we found a slightly increased risk of monthly failure of conception for daughters born after a short but not for those born after a long birth interval (odds ratios [ORs] 1.09 [0.89, 1.33] and 0.87 [0.65, 1.16], respectively, with intervals between 21 and 32 months as the reference category). A slightly increased risk of conceptive failure was also seen for daughters of younger and older mothers (ORs 1.08 [0.89, 1.30] and 1.11 [0.91, 1.35], respectively, compared with maternal age between 24 and 30 years as the reference category). Fertility varied by season of birth (P = 0.02), with summer-born daughters having lowest and winter-born daughters having highest fertility. These results are consistent with the idea that maternal factors before or around birth play a role in the aetiology of reduced fertility. The data, however, do not unequivocally support the hypothesis that gave rise to the present study, namely that ovarian development may be disturbed after conception in conditions with an increased risk of maternal menstrual cycle irregularities.
Although perforation of the appendix is considered a risk factor for female tubal infertility, the epidemiologic evidence supporting this relation is inconsistent. Risk factors for tubal infertility were compared for 121 women with documented primary tubal infertility attending in vitro fertilization clinics in Toronto, Canada, from July to December 1998 and 490 controls who were pregnant during the same time period. Self-administered questionnaires and review of medical records were used to assess exposures. The authors found that neither history of acute appendicitis nor perforation of the appendix was a statistically significant risk factor for tubal infertility. The crude odds ratio for perforated appendicitis was 3.4 (95% confidence interval (CI): 0.9, 12.9), and the adjusted odds ratio was 1.4 (95% CI: 0.3, 6.2). In addition to increased age and annual income, cigarette smoking (odds ratio (OR) = 2.0, 95% CI: 1.2, 3.2), history of endometriosis (OR = 6.0, 95% CI: 2.8,12.8), and history of pelvic inflammatory disease (OR = 6.0, 95% CI: 2.8, 12.8) were significantly associated with tubal infertility in multivariate analysis. These data do not provide substantial evidence that perforation of the appendix is an important risk factor for female tubal infertility.
More women of fertile age are long-term survivors of cancer. However, population-based data on birth rates of female cancer survivors are rare.
A total of 42,691 women = 45 years with a history of cancer were identified from the Swedish Multi-Generation Register and the Swedish Cancer Register, for whom relative birth rates were calculated as compared to the background population, ie, standardized birth ratios (SBRs). Independent factors associated with reduced birth rates among cancer survivors were estimated using Poisson modeling.
Compared to the background population, cancer survivors were 27% less likely to give birth (SBR = 0.73, 95% confidence interval [CI] = 0.72-0.75). Large difference in SBRs existed by cancer site, with high SBRs for survivors of melanoma skin, thoracic, head and neck, and thyroid cancers, and low SBRs for reproductive, breast, brain and eye, and hematopoietic cancer survivors. Parity status at diagnosis affected fertility: women who already had a child at the time of diagnosis were less likely to give birth (SBR = 0.50, 95% CI = 0.48-0.53) than were nulliparous women (SBR = 0.87, 95% CI = 0.85-0.90). Multivariate analysis showed that cancer site (reproductive organs), age at onset of cancer (
Several studies have examined the association between body mass index and infertility. We compared body mass index in 597 women diagnosed with ovulatory infertility at seven infertility clinics in the United States and Canada with 1,695 primiparous controls who recently gave birth. The obese women (body mass index > or = 27) had a relative risk of ovulatory infertility of 3.1 [95% confidence interval (CI) = 2.2-4.4], compared with women of lower body weight (body mass index 20-24.9). We found a small effect in women with a body mass index of 25-26.9 or less than 17 [relative risk (RR) = 1.2, 95% CI = 0.8-1.9; and RR = 1.6, 95% CI = 0.7-3.9, respectively). We conclude that the risk of ovulatory infertility is highest in obese women but is also slightly increased in moderately overweight and underweight women.
OBJECTIVE: The aim of the study was to evaluate the importance of increased use of assisted reproduction technologies (ART) for the fertility trends in the Czech Republic. DATA AND METHODS: Comparative analysis based on demographic and ART data was used. Demographic data have been published by EUROSTAT and the Czech Statistical Office. ART data have collected by ESHRE. FINDINGS: In the 1990s a trend towards later childbearing contributed greatly to the decline in total fertility rate (TFR) in the Czech Republic. Recently, recuperation of delayed births has resulted in the increase of TFR to 1.5 children per woman which is considered to be a critical minimum level. The highest increase in fertility rates occurred in the age group of 35-39, in which the contribution of ART treatments usually is greatest. Moreover, a substantial increase of multiple births has been registered. In 2005 the estimated share of children born after ART in the Czech Republic (3%) was close to countries with the highest share (Nordic countries, Belgium or Slovenia). However, the Czech Republic registered only half the number of ART cycles per million inhabitants than in those countries. Contrary to Nordic countries the Czech Republic faced an extremely low TFR of 1.28 children per woman. As the estimation of average number of cycles suggests, the need for fertility treatment has not been met in the Czech Republic yet. Moreover, due to the continuous postponement of childbearing to higher women s age, demand for ART treatment will be even higher in the near future and will probably result in the need of more than 2 500 cycles per million inhabitants in the Czech Republic. CONCLUSIONS: Spreading of ART is particularly relevant in the countries caught in the low fertility trap as higher impact on fertility trends could be expected. In the Czech Republic there is a chance to get over the critical level of TFR if comprehensive population policy including the improved access to ART based on well-considered strategy with explicit aim to optimize the quality of health care was accepted. However, from the demographic perspective the risk of further delay of childbearing encouraged by ART treatment should be taken into account while making these decisions.
With the aid of data in the Swedish Medical Birth Registry for infants with hypospadias and controls, a number of variables were compared. Records of infants born in 1982-1983 (188 cases and 376 matched controls) contained information on involuntary infertility, previous spontaneous and induced abortions, use of oral contraceptives or a remaining IUD at conception, smoking in early pregnancy, occupation in early pregnancy, family situation, and diagnoses given during pregnancy and at delivery, including information on caesarean section and vacuum extraction. Among all variables studied, only one group of statistically significant differences appeared: women whose sons had hypospadias more often than controls had a diagnosis of weak contractions, a higher rate of induced deliveries, and also a higher rate of caesarean sections. The finding of a higher caesarean section rate in infants with hypospadias was verified in a separate study of 1,736 hypospadic infants delivered in 1973-1981 and compared with all births in Sweden during that period. No difference in the rate of vacuum extractions was seen. This finding is interpreted as a result of an abnormality of the fetal-placental-maternal organism interaction, perhaps also disturbing the early pregnancy and increasing the risk for hypospadias.
The paper presents data on multienvironmental pollution in the area exposed to emission from an aluminum works and on the reproductive function of women living in the areas where these enterprises are located. Reconstruction of an Urals aluminum plant (SUAL-UAZ) has improved the environment, reducing the incidence of pregnancy and labor abnormalities and improving the neonatal infants' health.