Showing papers on "Fertility published in 2010"

World Health Organization reference values for human semen characteristics

Abstract: BACKGROUND Semen quality is taken as a surrogate measure of male fecundity in clinical andrology, male fertility, reproductive toxicology, epidemiology and pregnancy risk assessments. Reference intervals for values of semen parameters from a fertile population could provide data from which prognosis of fertility or diagnosis of infertility can be extrapolated. METHODS Semen samples from over 4500 men in 14 countries on four continents were obtained from retrospective and prospective analyses on fertile men, men of unknown fertility status and men selected as normozoospermic. Men whose partners had a time-to-pregnancy (TTP) of < or =12 months were chosen as individuals to provide reference distributions for semen parameters. Distributions were also generated for a population assumed to represent the general population. RESULTS The following one-sided lower reference limits, the fifth centiles (with 95th percent confidence intervals), were generated from men whose partners had TTP < or = 12 months: semen volume, 1.5 ml (1.4-1.7); total sperm number, 39 million per ejaculate (33-46); sperm concentration, 15 million per ml (12-16); vitality, 58% live (55-63); progressive motility, 32% (31-34); total (progressive + non-progressive) motility, 40% (38-42); morphologically normal forms, 4.0% (3.0-4.0). Semen quality of the reference population was superior to that of the men from the general population and normozoospermic men. CONCLUSIONS The data represent sound reference distributions of semen characteristics of fertile men in a number of countries. They provide an appropriate tool in conjunction with clinical data to evaluate a patient's semen quality and prospects for fertility.

Births: final data for 2007.

Abstract: OBJECTIVES This report presents 2007 data on U.S. births according to a wide variety of characteristics; preliminary 2008 data are also referenced on key measures where available. Final 2007 data are presented for maternal demographic characteristics including age, live-birth order, race and Hispanic origin, marital status, and educational attainment; maternal lifestyle and health characteristics (medical risk factors, weight gain, and tobacco use); medical care utilization by pregnant women (prenatal care, obstetric procedures, characteristics of labor and/or delivery, attendant at birth, and method of delivery); and infant characteristics (period of gestation, birthweight, Apgar score, congenital anomalies, and multiple births). Birth and fertility rates by age, live-birth order, race and Hispanic origin, and marital status also are presented. Selected data by mother's state of residence are shown, as well as data on month and day of birth, sex ratio, and age of father. Trends in fertility patterns and maternal and infant characteristics are described and interpreted. METHODS Descriptive tabulations are presented of data reported on the birth certificates of the 4.3 million births that occurred in 2007. Preliminary 2008 data are based on 99.9 percent of births occurring in 2008. Denominators for population-based rates are postcensal estimates derived from the U.S. 2000 census. RESULTS A total of 4,316,233 births were registered in the United States in 2007, the largest number of births ever reported. The general fertility rate increased 1 percent to 69.5 per 1,000. Birth rates increased for women in nearly all age groups. The rate for teenagers rose 1 percent for the year and is up 5 percent from 2005. The total fertility rate increased 1 percent to 2,122.0 births per 1,000 women. Preliminary data for 2008, however, suggest a decline in the number and rate of births overall, and for most age groups under age 40 years. All measures of unmarried childbearing reached record levels in 2007. The cesarean delivery rate rose to another all-time high--31.8 percent. Preterm and low birthweight rates declined slightly, and twin and triplet and higher-order multiple birth rates were essentially unchanged. Preliminary findings for 2008 suggest that these trends continued for cesarean delivery, unmarried childbearing, and preterm births.

Toxicity of Chemotherapy and Radiation on Female Reproduction

Abstract: One of the most devastating consequences of cancer treatment in the young female population is ovarian damage, resulting in diminished fertility potential. The extent of damage is related to age, chemotherapeutic regimen, and dose of pelvic radiation received. It is crucial that physicians know the impact each of these factors has on future fertility to advice patients on fertility preservation options. Anticancer drugs injure the female reproductive system through ovarian follicular and stromal damage. Although the exact mechanisms of damage remain unclear, it is essential to better understand these mechanisms to develop methods to diminish ovarian injury.

Births: final data for 2008.

Abstract: Objectives This report presents 2008 data on U.S. births according to a wide variety of characteristics. Data are presented for maternal demographic characteristics including age, live-birth order, race and Hispanic origin, marital status, attendant at birth, method of delivery, and infant characteristics (period of gestation, birthweight, and multiple births). Birth and fertility rates by age, live-birth order, race and Hispanic origin, and marital status also are presented. Selected data by mother's state of residence are shown, as well as data on age of father. Trends in fertility patterns and maternal and infant characteristics are described and interpreted. Methods Descriptive tabulations of data reported on the birth certificates of the 4.25 million births that occurred in 2008 are presented. Denominators for population-based rates are postcensal estimates derived from the U.S. 2000 census. Results A total of 4,247,694 births were registered in the United States in 2008, 2 percent less than in 2007. The general fertility rate declined 1 percent to 68.6 per 1,000. The teenage birth rate declined 2 percent to 41.5 per 1,000. Birth rates for women aged 20 to 39 years were down 1-3 percent, whereas the birth rate for women aged 40-44 rose to the highest level reported in more than 40 years. The total fertility rate declined 2 percent to 2,084.5 per 1,000 women. All measures of unmarried childbearing reached record levels-40.6 percent of births were to unmarried women in 2008. The cesarean delivery rate rose again to 32.3 percent. The preterm birth rate declined for the second consecutive year to 12.3 percent; the low birthweight rate was down very slightly. The twin birth rate increased 1 percent to 32.6 per 1,000; the triplet and higher-order multiple birth rate was stable.

The impact of genetic selection for increased milk yield on the welfare of dairy cows.

Abstract: Milk yield per cow has more than doubled in the previous 40 years and many cows now produce more than 20,000 kg of milk per lactation. The increase in production should be viewed with concern because: i) the increase in milk yield has been accompanied by declining fertility, increasing leg and metabolic problems and declining longevity; ii) there are unfavourable genetic correlations between milk yield and fertility, mastitis and other production diseases, indicating that deterioration in fertility and health is largely a consequence of selection for increased milk yield; and iii) high disease incidence, reduced fertility, decreased longevity and modification of normal behaviour are indicative of substantial decline in cow welfare. Improving welfare is important as good welfare is regarded by the public as indicative of sustainable systems and good product quality and may also be economically beneficial. Expansion of the Profitable Lifetime Index used in the UK to include mastitis resistance and fertility could increase economic response to selection by up to 80%, compared with selection for milk production alone. In the last 10 years, several breeding organisations in Europe and North America followed the example of Nordic Countries and have included improving fertility and reducing incidence of mastitis in their breeding objectives, but these efforts are still timid. A multi-trait selection programme in which improving health, fertility and other welfare traits are included in the breeding objective, and appropriately weighted relative to production traits, should be adopted by all breeding organisations motivated in their goal of improving welfare.

The effect of obesity on sperm disorders and male infertility.

Abstract: The results of several studies point to an increased likelihood of abnormal semen parameters among overweight men, and an elevated risk for subfertility among couples in which the male partner is obese. Obesity is, therefore, associated with a higher incidence of male factor infertility. Several mechanisms might account for the effect of obesity on male infertility, both directly and indirectly, by inducing sleep apnea, alterations in hormonal profiles (reduced inhibin B and androgen levels accompanied by elevated estrogen levels) and increased scrotal temperatures, ultimately manifesting as impaired semen parameters (decreased total sperm count, concentration and motility; increased DNA fragmentation index). Neither the reversibility of obesity-associated male infertility with weight loss nor effective therapeutic interventions have been studied in-depth. The increasing prevalence of obesity calls for greater clinical awareness of its effects on fertility, better understanding of underlying mechanisms, and exploration into avenues of treatment.

Fertility of Male Survivors of Childhood Cancer: A Report From the Childhood Cancer Survivor Study

Abstract: Purpose This study was undertaken to determine the effect of treatment for childhood cancer on male fertility. Patients and Methods We reviewed the fertility of male Childhood Cancer Survivor Study survivor and sibling cohorts who completed a questionnaire. We abstracted the chemotherapeutic agents administered, the cumulative dose of drug administered for selected drugs, and the doses and volumes of all radiation therapy from medical records. Risk factors for siring a pregnancy were evaluated using Cox proportional hazards models. Results The 6,224 survivors age 15 to 44 years who were not surgically sterile were less likely to sire a pregnancy than siblings (hazard ratio [HR], 0.56; 95% CI, −0.49 to 0.63). Among survivors, the HR of siring a pregnancy was decreased by radiation therapy of more than 7.5 Gy to the testes (HR, 0.12; 95% CI, −0.02 to 0.64), higher cumulative alkylating agent dose (AAD) score or treatment with cyclophosphamide (third tertile HR, 0.42; 95% CI, −0.31 to 0.57) or procarbazine (...

The "missing girls" of China and the unintended consequences of the one child policy.

Abstract: High ratios of males to females in China have concerned researchers (Sen 1990, Yi et al. 1993) and their recent increase has alarmed policymakers worldwide. This paper presents an analysis of China's census data that indicates that the "missing girls" phenomenon is causally linked to enforcement of the One Child Policy. Fertility is lower and sex ratios are higher among those under stricter fertility control, and the overall increase in the sex ratio is driven

Paternal age and reproduction

Abstract: BACKGROUND Due to various sociological factors, couples in developed countries are increasingly delaying childbearing. Besides ethical, economical and sociological issues, this trend presents us with several complex problems in reproduction. Although it is well-known that maternal age has a negative effect on fertility and increases the risk of adverse outcome during pregnancy and in offspring, the paternal influence on these outcomes is less well researched and not well-known. METHODS We performed a systematic search of PubMed, and retrieved original articles and review articles to update our previous survey in this journal. RESULTS This review highlights the link between male age and genetic abnormalities in the germ line and summarizes the knowledge about the effects of paternal age on reproductive function and outcome. Increasing paternal age can be associated with decreasing androgen levels, decreased sexual activity, alterations of testicular morphology and a deterioration of semen quality (volume, motility, morphology). Increased paternal age has an influence on DNA integrity of sperm, increases telomere length in spermatozoa and is suggested to have epigenetic effects. These changes may, at least in part, be responsible for the association of paternal age over 40 years with reduced fertility, an increase in pregnancy-associated complications and adverse outcome in the offspring. CONCLUSION Although higher maternal age can be an indication for intensive prenatal diagnosis, including invasive diagnostics, consideration of the available evidence suggests that paternal age itself, however, provides no rationale for invasive procedures.

Fertility Preservation in Adolescents and Young Adults With Cancer

Abstract: Preservation of fertility is important to adolescent and young adult (AYA) survivors of cancer. Many survivors will maintain their reproductive potential after the successful completion of treatment for cancer. However total-body irradiation, radiation to the gonads, and chemotherapy regimens containing high-dose alkylators can place women at risk for acute ovarian failure or premature menopause and men at risk for temporary or permanent azoospermia. The most effective and established means of preserving fertility in this population is embryo cryopreservation in women and sperm cryopreservation in men before the initiation of cancer-directed therapy. Cryopreservation of mature oocytes is also becoming more commonplace as methods of thawing become more sophisticated. The use of in vitro fertilization and intracytoplasmic sperm injection has added to the viability of sperm and oocyte cryopreservation. Cryopreservation and transplantation of gonadal tissue in both males and females remains experimental but continues to be evaluated. Hormonal suppression has not been shown to be effective in males but may have promise in females, although larger scale trials are needed to evaluate this. Providing information about risk of infertility and possible interventions to maintain reproductive potential are critical for the AYA population at the time of diagnosis. Given the competing demands of providing complicated and detailed information about cancer treatment, the evolving information related to fertility preservation, and the ethical issues involved, it may be preferable, where possible, to have a specialized team, rather than the primary oncologist, address these issues with AYA patients.

The trade-off between fertility and education: evidence from before the demographic transition

Abstract: The trade-off between child quantity and quality is a crucial ingredient of unified growth models that explain the transition from Malthusian stagnation to modern growth We present first evidence that such a trade-off indeed existed already in the nineteenth century, exploiting a unique census-based dataset of 334 Prussian counties in 1849 Furthermore, we find that causation between fertility and education runs both ways, based on separate instrumental-variable models that instrument fertility by sex ratios and education by landownership inequality and distance to Wittenberg Education in 1849 also predicts the fertility transition in 1880–1905

A Global Perspective on Happiness and Fertility

Abstract: The literature on fertility and happiness has neglected comparative analysis. We investigate the fertility-happiness association using data for 86 countries. We find that globally, happiness decreases with the number of children. This association, however, is strongly modified by individual and contextual factors. Most importantly, we find that the association between happiness and fertility evolves from negative to neutral to positive above age 40, and is strongest among those who are likely to benefit most from upward intergenerational transfers. In addition, analyses by welfare regime show that the negative fertility-happiness association for younger adults is weakest in countries with high public support for families, and the positive association above age 40 is strongest in countries where old-age support depends mostly on the family. Overall these results suggest that children are a long-term investment in well-being, and highlight the importance of the life-cycle stage and contextual factors in explaining the happiness-fertility association.

Male infertility in cancer patients: Review of the literature.

Abstract: The number of men surviving cancer at a young age has increased dramatically in the past 20 years as a result of early detection and improved cancer treatment protocols; more than 75% of young cancer patients nowadays are long-term survivors. Quality of life has become an important issue in childhood and adult cancer patients. The commonest cancers in patients of reproductive age are leukaemia, Hodgkin's lymphomas and testicular germ cell tumors. Fertility is often impaired after chemotherapy and radiation therapy. Cryopreservation of semen before cancer treatment starts is currently the only method to preserve future male fertility. In some malignancies, especially in germ cell tumors, sperm quality is already abnormal at the time of diagnosis. In approximately 12% of men, no viable spermatozoa are present for cryopreservation before the start of chemotherapy. Cytotoxic therapy influences spermatogenesis at least temporarily and in some cases permanently. The amount of damage inflicted by chemotherapy on spermatogenesis depends on the combination of drugs used and on the cumulative dose given for cancer treatment. Alkylating agents, such as cyclophosphamide and procarbazine, are most detrimental to germ cells. Radiation therapy, especially whole-body irradiation, is also associated with the risk of permanent sterility. Besides the cancer treatment, tumor type and pretreatment fertility are of prognostic value for future fertility in male cancer survivors. After cancer treatment, many men need artificial reproductive techniques to achieve fatherhood; usually in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) is indicated for successful treatment. About 15% of men will use their cryopreserved semen because of persistent azoospermia after cancer treatment. Treatment results with cryopreserved semen are generally good and comparable to general IVF and ICSI results. So far, no studies have reported an increased rate of congenital abnormalities or malignancies in children born from fathers who had cancer treatment is the past, but close follow up is warranted, especially in children born after IVF/ICSI.

Impact of Antiretroviral Therapy on Incidence of Pregnancy among HIV-Infected Women in Sub-Saharan Africa: A Cohort Study

Abstract: Background: With the rapid expansion of antiretroviral therapy (ART) services in sub-Saharan Africa there is growing recognition of the importance of fertility and childbearing among HIV-infected women. However there are few data on whether ART initiation influences pregnancy rates. Methods and Findings: We analyzed data from the Mother-to-Child Transmission-Plus (MTCT-Plus) Initiative, a multicountry HIV care and treatment program for women, children, and families. From 11 programs in seven African countries, women were enrolled into care regardless of HIV disease stage and followed at regular intervals; ART was initiated according to national guidelines on the basis of immunological and/or clinical criteria. Standardized forms were used to collect sociodemographic and clinical data, including incident pregnancies. Overall 589 incident pregnancies were observed among the 4,531 women included in this analysis (pregnancy incidence, 7.8/100 person-years [PY]). The rate of new pregnancies was significantly higher among women receiving ART (9.0/100 PY) compared to women not on ART (6.5/100 PY) (adjusted hazard ratio, 1.74; 95% confidence interval, 1.19–2.54). Other factors independently associated with increased risk of incident pregnancy included younger age, lower educational attainment, being married or cohabiting, having a male partner enrolled into the program, failure to use nonbarrier contraception, and higher CD4 cell counts. Conclusions: ART use is associated with significantly higher pregnancy rates among HIV-infected women in sub-Saharan Africa. While the possible behavioral or biomedical mechanisms that may underlie this association require further investigation, these data highlight the importance of pregnancy planning and management as a critical but neglected component of HIV care and treatment services. Please see later in the article for the Editors’ Summary.

Evaluating the impact of community-based health interventions: evidence from Brazil's Family Health Program.

Abstract: This paper analyzes the direct and indirect impacts of Brazil's Family Health Program, using municipality level mortality data from the Brazilian Ministry of Health, and individual level data from the Brazilian household survey. We estimate the effects of the program on mortality and on household behavior related to child labor and schooling, employment of adults, and fertility. We find consistent effects of the program on reductions in mortality throughout the age distribution, but mainly at earlier ages. Municipalities in the poorest regions of the country benefit particularly from the program. For these regions, implementation of the program is also robustly associated with increased labor supply of adults, reduced fertility, and increased school enrollment. Evidence suggests that the Family Health Program is a highly cost-effective tool for improving health in poor areas.

The patients' perspective on fertility care: a systematic review

Abstract: BACKGROUND: Patient-centered reproductive medicine (PCRM) is important for quality of care, and this is increasingly being recognized. However, its scientific basis is unclear. The main research questions addressed in this review are: 'How has the patients' perspective on fertility care been examined (method and quality)?' and 'What is the perspective of patients in developed countries on fertility care?'. METHODS: A systematic search of electronic databases was conducted and inclusion criteria with respect to eligibility and quality were applied. The methodology of the studies was critically appraised; the findings of the studies were synthesized and organized according to: patients' value clarification and assessment of service quality and dimensions of patient-centeredness. Additionally data on patient preferences and determinants of patients' perspective on care were collected. RESULTS: In 51 selected studies, patients' perspective on fertility care was examined with (few or many item) questionnaires and/or qualitative interviews. Significant methodological problems were observed. Fertility patients attached importance to seven out of eight dimensions of patient-centeredness (Picker institute) and two new dimensions 'fertility clinic staff' and 'skills' were developed. Overall, fertility patients want to be treated like human beings with a need for: medical skills, respect, coordination, accessibility, information, comfort, support, partner involvement and a good attitude of and relationship with fertility clinic staff. Patients' preferences between procedures and demographic, medical and psychological determinants of their perspective were defined. CONCLUSIONS: Fertility patients have 'human needs' besides their need for medical care. Evidence on PCRM is available but significant methodological limitations call for the development and validation of a European questionnaire.

Sperm chromatin structure assay as an independent predictor of fertility in vivo: a case-control study.

Abstract: Standard sperm parameters have a limited power for prediction of the chance of natural conception. Recent studies have indicated that the sperm chromatin structure assay (SCSA) DNA fragmentation index (DFI), a measure for the fraction of sperms with DNA damage, is associated with fertility in vivo. The aim of this study was to evaluate the value of this parameter for prediction of infertility. One hundred and twenty-seven men from infertile couples with no known female factor and 137 men with proven fertility were included. Semen analysis was performed as recommended by the WHO. DFI was assessed using SCSA. Logistic binary regression was used to compute the odds ratios (OR) for infertility. As compared with men with a DFI 20% (OR 8.4; 95% CI: 3.0-23). In men with normal standard semen parameters (sperm concentration, motility and morphology) the OR for infertility was increased with DFI >20% (OR 5.1, 95% CI: 1.2-23), whereas if one of the standard semen parameters was abnormal, the OR for infertility was increased already at DFI above 10% (OR 16, 95% CI: 4.2-60). We conclude that SCSA DFI adds to the value of semen analysis in prediction of the chance of natural conception.

The Correspondence Between Fertility Intentions and Behavior in the United States

Abstract: Using data from the 1979 National Longitudinal Survey of Youth, we describe the correspondence between intended family size and observed fertility for US men and women in the 1957–64 birth cohorts. Mean fertility intentions calculated from reports given in the mid-20s modestly overstate completed fertility. But discrepancies between stated intent and actual fertility are common—the stated intent at age 24 (for both women and men) is more likely to miss than to match completed fertility. We focus on factors that predict which women and men will have fewer or more children than intended. Consistent with life-course arguments, those unmarried, childless, or (for women) still in school at approximately age 24 were most likely to underachieve their intended parity (i.e., had fewer children than intended at age 24). We discuss how such discrepancies between intentions and behavior may cumulate to produce sizable cross-group fertility differences.

China's below-replacement fertility: government policy or socioeconomic development?

Abstract: The article challenges the notion that below-replacement fertility and its local variation in China are primarily attributable to the government's birth planning policy. Data from the 2000 census and provincial statistical yearbooks are used to compare fertility in Jiangsu and Zhejiang, two of the most developed provinces in China, to examine the relationship between socioeconomic development and low fertility. The article demonstrates that although low fertility in China was achieved under the government's restrictive one-child policy, structural changes brought about by socioeconomic development and ideational shifts accompanying the new wave of globalization played a key role in China's fertility reduction.

Fertility preservation in girls during childhood: is it feasible, efficient and safe and to whom should it be proposed?

Abstract: BACKGROUND In prepubertal and adolescent girls, fertility may be impaired by gonadotoxic treatments, repeat ovarian surgery or genetic disorders. Cryopreservation of ovarian cortex is an existing option to preserve fertility in these young girls at risk of premature ovarian failure (POF). The efficacy, feasibility and risks of ovarian cryopreservation in children must be assessed in order to validate the technique. METHODS Here, we conducted a review of ovarian cryopreservation in adults and, more specifically, in children using the PubMed databases. In addition, our own experience with ovarian cryopreservation in children was evaluated and compared with the literature. RESULTS Analysis of the literature and six published series on ovarian cryopreservation in children, as well as our own series of 58 cases, show that there is no reason to doubt its efficacy in this young population. However, no consensus has yet been reached on the indications for the technique. Indeed, with existing models, the real risk of POF may be over- or underestimated. CONCLUSION Our review suggests that ovarian cortex cryopreservation is feasible and as safe as comparable operative procedures in children. Although no births have yet resulted from freeze-thawing of prepubertal ovarian cortex, the results of this approach in adults are encouraging. However, the absence of consensus on the indications for fertility preservation, as well as the optimal timing and quantity of ovarian cortex for cryopreservation, should be taken into consideration when discussing fertility issues with girls at risk of POF and their parents.

Persistent high fertility in Uganda: young people recount obstacles and enabling factors to use of contraceptives.

Abstract: Background High fertility among young people aged 15-24 years is a public health concern in Uganda. Unwanted pregnancy, unsafe induced abortions and associated high morbidity and mortality among young women may be attributed to low contraceptive use. This study aims at exploring reasons for low contraceptive use among young people.

Fertility in women with nonclassical congenital adrenal hyperplasia due to 21-hydroxylase deficiency.

Abstract: Objective: In contrast to subfertility often reported in women suffering from the classical form of congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency, fertility in nonclassical CAH (NC-CAH) has been rarely studied. Our objective was to evaluate fertility in NC-CAH women. Material and Methods: We studied 190 NC-CAH women (161 probands + 29 first degree relatives). Only 20 probands had consulted for infertility (12%), either alone or associated with hirsutism or menstrual cycle disorders. The diagnosis was established on post-ACTH 17-hydroxyprogesterone 10 ng/ml or greater and further characterized by CYP21A2 gene analysis. Results: Ninety-five of the 190 women wanted pregnancy (aged 26.7 ± 8.9 yr); 187 pregnancies occurred in 85 women, which resulted in 141 births in 82 of them. Ninety-nine pregnancies (52.9%) occurred before the diagnosis of NC-CAH (96 spontaneously and three with ovulation inducers) whereas 98 occurred after diagnosis (11 spontaneously and 77 with hydrocortisone treat...

The Impact of Family Policy Expenditure on Fertility in Western Europe

Abstract: This article analyzes the impact on fertility of changes in national expenditure for family allowances, maternity- and parental-leave benefits, and childcare subsidies. To do so, I estimate a model for the timing of births using individual-level data from 16 western European countries, supplemented with data on national social expenditure for different family policy programs. The latter allow approximation of the subsidies that households with children receive from such programs. The results show that increased expenditure on family policy programs that help women to combine family and employment-and thus reduce the opportunity cost of children—generates positive fertility responses.

Contraception as development? new evidence from family planning in colombia

Abstract: There has been considerable debate in the last decade about whether or not family planning programmes in developing countries reduce fertility or improve socio-economic outcomes. This article provides new evidence by studying the expansion of one of the worlds oldest and largest family planning organisations -- Profamilia of Colombia. It finds that family planning explains less than 10% of Colombias fertility decline during its demographic transition. As in wealthy countries however lowering the costs of first birth postponement produced important socio-economic gains enabling young women to obtain more education and to work more and live independently later in life.

Obesity: modern man's fertility nemesis.

Abstract: The obesity pandemic has grown to concerning proportions in recent years, not only in the Western World, but in developing countries as well. The corresponding decrease in male fertility and fecundity may be explained in parallel to obesity, and obesity should be considered as an etiology of male fertility. Studies show that obesity contributes to infertility by reducing semen quality, changing sperm proteomes, contributing to erectile dysfunction, and inducing other physical problems related to obesity. Mechanisms for explaining the effect of obesity on male infertility include abnormal reproductive hormone levels, an increased release of adipose-derived hormones and adipokines associated with obesity, and other physical problems including sleep apnea and increased scrotal temperatures. Recently, genetic factors and markers for an obesity-related infertility have been discovered and may explain the difference between fertile obese and infertile obese men. Treatments are available for not only infertility related to obesity, but also as a treatment for the other comorbidities arising from obesity. Natural weight loss, as well as bariatric surgery are options for obese patients and have shown promising results in restoring fertility and normal hormonal profiles. Therapeutic interventions including aromatase inhibitors, exogenous testosterone replacement therapy and maintenance and regulation of adipose-derived hormones, particularly leptin, may also be able to restore fertility in obese males. Because of the relative unawareness and lack of research in this area, controlled studies should be undertaken and more focus should be given to obesity as an etiolgy of male infertility.

The Oncofertility Consortium—addressing fertility in young people with cancer

Abstract: The number of young cancer survivors is increasing owing to advances in cancer therapeutics, but many face infertility as a result of their treatment. Technologies that already exist for cancer patients concerned about their future fertility include sperm banking for men and hormonal intervention followed by in vitro fertilization and embryo cryopreservation for women. However, logistical barriers to timely patient referral and coordination of care between specialties can limit patient access to all the available options. Moreover, there are few alternatives for young women and girls who cannot delay their cancer treatment, or who are unable to undergo hormonal intervention. The Oncofertility Consortium is a network of researchers, physicians and scholars who are advancing fertility preservation options for young cancer patients. Research into the societal, ethical, and legal implications is also an important part of the work performed by the Oncofertility Consortium, which is providing new perspectives on patient decision-making about how to access these emerging reproductive technologies. Experts in the fields of oncology, reproductive medicine, the social sciences, law, education, and the humanities are working together to develop next-generation reproductive interventions and promote communication between scholars, clinicians, patients, and the public to ensure that young cancer patients are equipped with the most appropriate information and options for having a family in the future.

East Asian childbearing patterns and policy developments.

Abstract: Childbearing behavior in east asian countries has changed rapidly and fundamentally during the past 50 to 60 years. in the middle of the twentieth century large families with an average of five to seven children were the rule. in Japan almost immediately thereafter, and in the other countries 20 to 30 years later, replacement level was reached and since then fertility has continued its decline to the lowest levels in the world. Fifty years ago almost all women in east asia married and had children, whereas at present up to one-quarter of women may remain single at age 50 and one-fifth to onethird may remain childless. analyses of the institutional and socioeconomic environment affecting childbearing point to the likelihood of protracted very low fertility (Jones et al. 2009). Concern is growing about the future decline of these populations and their aging. in east asia increasingly perceive that the societal costs of rapid population aging and shrinkage are likely to outweigh possible benefits (ibid.). therefore , at the end of the first decade of the twenty-first century most east asian governments are pursuing pronatalist policies, whereas 50 years ago they were pioneers in implementing antinatalist policies. thus far, the pronatalist policies have not generated the desired results. the analysis in this article reinforces the conclusion that fertil ity is likely to remain very low for years if not decades and that trends will not be reversed unless forceful and innovative policies are implemented. 1 the first section analyzes fertility trends in Hong Kong, Japan, Singapore, South Korea, and taiwan primarily using cohort fertility data and methods. 2 this is followed by an examination of the social and economic causes of the childbearing trends. the next section provides an overview