Showing papers on "Fertility published in 2012"

Births: final data for 2010.

Abstract: OBJECTIVES This report presents 2010 data on U.S. births according to a wide variety of characteristics. Data are presented for maternal 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 plurality). 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 birth rates by age and race 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 4.0 million births that occurred in 2010 are presented. Denominators for population-based rates are postcensal estimates derived from the U.S. 2010 census. RESULTS The number of births declined to 3,999,386 in 2010, 3 percent less than in 2009. The general fertility rate also declined 3 percent, to 64.1 per 1,000 women aged 15-44. The teen birth rate fell 10 percent to 34.2 per 1,000. Birth rates for women in each 5-year age group from 20 through 39 years declined, but the rate for women aged 40-44 continued to rise. The total fertility rate (estimated number of births over a woman's lifetime) was down 4 percent to 1,931 per 1,000 women. The number, rate, and percentage of births to unmarried women declined. The cesarean deliver rate was down for the first year since 1996 to 32.8 percent. The preterm birth rate declines for the fourth year in a row to 11.99 percent; the low birthweight rate was stable at 8.15 percent. The twin birth rate declined slightly to 33.1 per 1,000 births; the triplet and higer-order multipe birth rate dropped 10 percent to 137.6 per 100,000.

Soap Operas and Fertility: Evidence from Brazil

Abstract: We estimate the effect of television on fertility in Brazil, where soap operas portray small families. We exploit differences in the timing of entry into different markets of Globo, the main novela producer. Women living in areas covered by Globo have significantly lower fertility. The effect is strongest for women of lower socioeconomic status and in the central and late phases of fertility, consistent with stopping behavior. The result does not appear to be driven by selec tion in Globo entry. We provide evidence that novelas, and not just television, affected individual choices, based on children's naming patterns and novela content. (JEL J13, J16, L82, 015, Z13) In the early 1990s, after more than 30 years of expansion of basic schooling, over 50 percent of 15 year olds in Brazil scored at the lowest levels of the literacy portion of the Programme for International Student Assessment (PISA), indicat ing that they could not perform simple tasks, such as locating basic information within a text. People with 4 or fewer years of schooling accounted for 39 percent of the adult population in the urban areas, and nearly 73 percent in rural areas as measured by the 2000 census. On the other hand, the share of households owning a television set had grown from 8 percent in 1970 to 81 percent in 1991, and remained approximately the same 10 years later. The spectacular growth in television viewer ship in the face of slow increases in education levels characterizes Brazil as well as many other developing countries. Most importantly, it suggests that a wide range of messages and values, including important ones for development policy, have the potential to reach households through the screen as well as through the classroom. This paper examines the effect of three decades of expansion of commercial tele vision on fertility patterns in Brazil. Fertility is an interesting dimension of develop ment to explore in the context of Brazil. In fact, this country experienced a dramatic drop in fertility in the past 40 years. The total fertility rate was 6.3 in 1960, 5.8 in

Economic recession and fertility in the developed world: Past evidence and recent trends

Abstract: I explore past evidence on the influence of economic recession on the timing and level of fertility. Subsequently, I look at the early impact of the recent economic rece ssion. Past evidence shows that fertility rates as well as marriage and partnership formation are typically ‘procyclical’ – they rise and fall with the business cycle, reacting with a time lag of 1-2 years. However, these reactions are often limited in scope and duration and mostly linked to the temporary postponement of births rather than a lasting decline in cohort fertility. Rising unemployment rates are particularly pertinent for fertility trends. Recent recession has brought an end to an upturn in period fertility rates across the developed world, which started in the late 1990s and peaked in 2008. Countries are differentiated in their initial fertility ‘responses’ to the recession and only a few, including the United States, have seen a sharp downward trend in fertility. However, there is a strong evidence of a renewed postponement of childbearing. Fertility rates in 2008-10 showed a clear age-patterned ‘reaction’ to the recession, declining strongly among women below age 30 (in line with the fact that the recession has hit especially young adults), whereas there was a stagnation or a further rise in fertility at older childbearing ages, especially among women aged 35 or older.

Demographic and medical consequences of the postponement of parenthood

Abstract: BACKGROUND Across the developed world couples are postponing parenthood. This review assesses the consequences of delayed family formation from a demographic and medical perspective. One main focus is on the quantitative importance of pregnancy postponement. METHODS Medical and social science databases were searched for publications on relevant subjects such as delayed parenthood, female and male age, fertility, infertility, time to pregnancy (TTP), fetal death, outcome of medically assisted reproduction (MAR) and mental well-being. RESULTS Postponement of parenthood is linked to a higher rate of involuntary childlessness and smaller families than desired due to increased infertility and fetal death with higher female and male age. For women, the increased risk of prolonged TTP, infertility, spontaneous abortions, ectopic pregnancies and trisomy 21 starts at around 30 years of age with a more pronounced effects >35 years, whereas the increasing risk of preterm births and stillbirths starts at around 35 years with a more pronounced effect >40 years. Advanced male age has an important but less pronounced effect on infertility and adverse outcomes. MAR treatment cannot overcome the age-related decline in fecundity. CONCLUSIONS In general, women have partners who are several years older than themselves and it is important to focus more on the combined effect of higher female and male age on infertility and reproductive outcome. Increasing public awareness of the impact of advanced female and male age on the reproductive outcome is essential for people to make well-informed decisions on when to start family formation.

Pretreatment fertility counseling and fertility preservation improve quality of life in reproductive age women with cancer.

Abstract: BACKGROUND: The post-treatment quality of life (QOL) impacts of receiving precancer-treatment infertility counseling and of pursuing fertility preservation have not been described in large-scale studies of reproductive age women with cancer. METHODS: In total, 1041 women who were diagnosed between ages 18 and 40 years responded to a retrospective survey and reported whether they received infertility counseling before cancer treatment and whether they took action to preserve fertility. Five cancer types were included: leukemia, Hodgkin disease, non-Hodgkin lymphoma, breast cancer, and gastrointestinal cancer. Validated QOL scales were used: the Decision Regret Score, the Satisfaction with Life Scale (SWLS), and the brief World Health Organization QOL questionnaire. RESULTS: Overall, 560 women (61%) who received treatment that potentially could affect fertility were counseled by the oncology team, 45 (5%) were counseled by fertility specialists, and 36 (4%) took action to preserve fertility. Pretreatment infertility counseling by a fertility specialist and an oncologist resulted in lower regret than counseling by an oncologist alone (8.4 vs 11.0; P < .0001). The addition of fertility preservation (6.6 vs 11.0; P < .0001) also was associated with even lower regret scores than counseling by an oncologist alone. Further improvements also were observed in SWLS scores with the addition of fertility specialist counseling (23.0 vs 19.8; P = .09) or preserving fertility (24.0 vs 19.0; P = .05). CONCLUSIONS: Receiving specialized counseling about reproductive loss and pursuing fertility preservation is associated with less regret and greater QOL for survivors, yet few patients are exposed to this potential benefit. Women of reproductive age should have expert counseling and should be given the opportunity to make active decisions about preserving fertility. Cancer 2011;. © 2011 American Cancer Society.

Fertility of men and women aged 15-44 years in the United States: National Survey of Family Growth, 2006-2010.

Abstract: This report presents national estimates of selected fertility measures for men and women aged 15-44 in the United States in 2011-2015 based on data from the National Survey of Family Growth (NSFG). Estimates for 2011-2015 are compared with those for 2006-2010.

Sperm wars and the evolution of male fertility

Abstract: Females frequently mate with several males, whose sperm then compete to fertilize available ova. Sperm competition represents a potent selective force that is expected to shape male expenditure on the ejaculate. Here, we review empirical data that illustrate the evolutionary consequences of sperm competition. Sperm competition favors the evolution of increased testes size and sperm production. In some species, males appear capable of adjusting the number of sperm ejaculated, depending on the perceived levels of sperm competition. Selection is also expected to act on sperm form and function, although the evidence for this remains equivocal. Comparative studies suggest that sperm length and swimming speed may increase in response to selection from sperm competition. However, the mechanisms driving this pattern remain unclear. Evidence that sperm length influences sperm swimming speed is mixed and fertilization trials performed across a broad range of species demonstrate inconsistent relationships between sperm form and function. This ambiguity may in part reflect the important role that seminal fluid proteins (sfps) play in affecting sperm function. There is good evidence that sfps are subject to selection from sperm competition, and recent work is pointing to an ability of males to adjust their seminal fluid chemistry in response to sperm competition from rival males. We argue that future research must consider sperm and seminal fluid components of the ejaculate as a functional unity. Research at the genomic level will identify the genes that ultimately control male fertility.

Impact of obesity on male fertility, sperm function and molecular composition.

Abstract: Male obesity in reproductive-age men has nearly tripled in the past 30 y and coincides with an increase in male infertility worldwide. There is now emerging evidence that male obesity impacts negatively on male reproductive potential not only reducing sperm quality, but in particular altering the physical and molecular structure of germ cells in the testes and ultimately mature sperm. Recent data has shown that male obesity also impairs offspring metabolic and reproductive health suggesting that paternal health cues are transmitted to the next generation with the mediator mostly likely occurring via the sperm. Interestingly the molecular profile of germ cells in the testes and sperm from obese males is altered with changes to epigenetic modifiers. The increasing prevalence of male obesity calls for better public health awareness at the time of conception, with a better understanding of the molecular mechanism involved during spermatogenesis required along with the potential of interventions in reversing these deleterious effects. This review will focus on how male obesity affects fertility and sperm quality with a focus on proposed mechanisms and the potential reversibility of these adverse effects.

Human semen quality in the new millennium: a prospective cross-sectional population-based study of 4867 men

Abstract: Objectives Considerable interest and controversy over a possible decline in semen quality during the 20th century raised concern that semen quality could have reached a critically low level where it might affect human reproduction. The authors therefore initiated a study to assess reproductive health in men from the general population and to monitor changes in semen quality over time. Design Cross-sectional study of men from the general Danish population. Inclusion criteria were place of residence in the Copenhagen area, and both the man and his mother being born and raised in Denmark. Men with severe or chronic diseases were not included. Setting Danish one-centre study. Participants 4867 men, median age 19 years, included from 1996 to 2010. Outcome measures Semen volume, sperm concentration, total sperm count, sperm motility and sperm morphology. Results Only 23% of participants had optimal sperm concentration and sperm morphology. Comparing with historic data of men attending a Copenhagen infertility clinic in the 1940s and men who recently became fathers, these two groups had significantly better semen quality than our study group from the general population. Over the 15 years, median sperm concentration increased from 43 to 48 million/ml (p=0.02) and total sperm count from 132 to 151 million (p=0.001). The median percentage of motile spermatozoa and abnormal spermatozoa were 68% and 93%, and did not change during the study period. Conclusions This large prospective study of semen quality among young men of the general population showed an increasing trend in sperm concentration and total sperm count. However, only one in four men had optimal semen quality. In addition, one in four will most likely face a prolonged waiting time to pregnancy if they in the future want to father a child and another 15% are at risk of the need of fertility treatment. Thus, reduced semen quality seems so frequent that it may impair the fertility rates and further increase the demand for assisted reproduction.

Happiness: Before and After the Kids

Abstract: Understanding how the process of childbearing influences parental well-being has great potential to explain variation in fertility. However, most research on fertility and happiness uses cross-sectional data, hindering causal conclusions. We study trajectories of parental happiness before and after the birth of a child using British and German panel data and methods which control for unobserved parental characteristics. We find that happiness increases prior to and in the year of having a child and decreases thereafter, but not below before-child levels. This general pattern is modified by sociodemographic characteristics. Those who become parents at young ages have a downward happiness trajectory, while those becoming parents at older ages have a higher happiness level after the birth. The first child tends to increase happiness a lot, the second much less, and the third may decrease happiness. Socioeconomic resources are important for men, as those with low education gain little in happiness from the birth of a child. Women experience stronger pre-birth highs and post-birth drops than men. These results, which are similar in Britain and Germany, suggest that childbearing increases parental happiness most among those who postpone and have more resources. This recipe for happiness is highly consistent with the fertility behavior that emerged during the second demographic transition and provides new insights into the causes behind low and late fertility.

Fertility awareness and parenting attitudes among American male and female undergraduate university students

Abstract: background: In the USA, the postponement of childbearing reflects contemporary social norms of delaying marriage, pursing educational goals and securing economic stability prior to attempting conception Although university students are more likely to delay childbearing, it is unclear to what extent they are aware of age-related fertility decline The current study is the first of its kind to assess fertility awareness and parenting attitudes of American undergraduate university students methods: Two-hundred forty-six randomly selected undergraduate university students (138 females and 108 males) completed an online self-report survey adapted from the Swedish Fertility Awareness Questionnaire Students were evenly distributed between the freshman, sophomore, junior and senior classes with a mean age of 204 years results: Participants wanted to have their first and last child within the window of a woman’s fertility However, participants demonstrated a lack of fertility awareness by vastly overestimating the age at which women experience declines in fertility, the likelihood of pregnancy following unprotected intercourse and the chances that IVF treatments would be successful in the case of infertility Nearly 9 in 10 participants want to have children in the future and viewed parenthood as a highly important aspect of their future lives conclusions: Delaying childbearing based on incorrect perceptions of female fertility could lead to involuntary childlessness Education regarding fertility issues is necessary to help men and women make informed reproductive decisions that are based on accurate information rather than incorrect perceptions

Fertility postponement is largely due to rising educational enrolment

Abstract: The rise in educational enrolment is often cited as a possible cause of the trend to later childbearing in developed societies but direct evidence of its contribution to the aggregate change in fertility tempo is scarce. We show that rising enrolment, resulting in later ages at the end of education, accounts for a substantial part of the upward shift in the mean age at first birth in the 1980s and 1990s in Britain and in France. The postponement of first birth over that period has two components: a longer average period of enrolment and a post-enrolment component that is also related to educational level. The relationship between rising educational participation and the move to later fertility timing is almost certainly causal. Our findings therefore suggest that fertility tempo change is rooted in macro-economic and structural forces rather than in the cultural domain.

Delayed childbearing: effects on fertility and the outcome of pregnancy.

Abstract: Purpose of reviewThe proportion of women who are intentionally delaying pregnancy beyond the age of 35 years has increased greatly in the past few decades because of the clash between the optimal biological period for women to have children with obtaining additional education and building a career.

Delayed child-bearing.

Abstract: Objective: To provide an overview of delayed child-bearing and to describe the implications for women and health care providers . Options: Delayed child-bearing, which has increased greatly in recent decades, is associated with an increased risk of infertility, pregnancy complications, and adverse pregnancy outcome . This guideline provides information that will optimize the counselling and care of Canadian women with respect to their reproductive choices . Outcomes: Maternal age is the most important determinant of fertility, and obstetric and perinatal risks increase with maternal age . Many women are unaware of the success rates or limitations of assisted reproductive technology and of the increased medical risks of delayed child-bearing, including multiple births, preterm delivery, stillbirth, and Caesarean section . This guideline provides a framework to address these issues .

Women's empowerment and choice of contraceptive methods in selected African countries.

Abstract: METHODS: Data came from the latest round of Demographic and Health Surveys conducted between 2006 and 2008 in Namibia, Zambia, Ghana and Uganda. Responses from married or cohabiting women aged 15–49 were analyzed for six dimensions of empowerment and the current use of female-only methods or couple methods. Bivariate and multivariate multinomial regressions were used to identify associations between the empowerment dimensions and method use. RESULTS: Positive associations were found between the overall empowerment score and method use in all countries (relative risk ratios, 1.1–1.3). In multivariate analysis, household economic decision making was associated with the use of either female-only or couple methods (1.1 for all), as was agreement on fertility preferences (1.3–1.6) and the ability to negotiate sexual activity (1.1–1.2). In Namibia, women’s negative attitudes toward domestic violence were correlated with the use of couple methods (1.1). CONCLUSIONS: Intervention programs aimed at increasing contraceptive use may need to involve different approaches, including promoting couples’ discussion of fertility preferences and family planning, improving women’s self-efficacy in negotiating sexual activity and increasing their economic independence.

Psychological and social aspects of infertility in men: an overview of the evidence and implications for psychologically informed clinical care and future research.

Abstract: Research concerning the psychosocial aspects of infertility and infertility treatment focuses more often on women than men. The aim of this review was to synthesize the English-language evidence related to the psychological and social aspects of infertility in men and discuss the implications of these reports for clinical care and future research. A structured search identified 73 studies that reported data concerning the desire for fatherhood and the psychological and social aspects of diagnosis, assisted reproductive technology (ART) treatment and unsuccessful treatment among men with fertility difficulties. The studies are diverse in conceptualisation, design, setting and data collection, but the findings were reasonably consistent. These studies indicated that fertile and infertile childless men of reproductive age have desires to experience parenthood that are similar to those of their female counterparts; in addition, diagnosis and initiation of treatment are associated with elevated infertility-specific anxiety, and unsuccessful treatment can lead to a state of lasting sadness. However, rates of clinically significant mental health problems among this patient population are no higher than in the general population. Infertile men who are socially isolated, have an avoidant coping style and appraise stressful events as overwhelming, are more vulnerable to severe anxiety than men without these characteristics. Men prefer oral to written treatment information and prefer to receive emotional support from infertility clinicians rather than from mental health professionals, self-help support groups or friends. Nevertheless, structured, facilitated psycho-educational groups that are didactic but permit informal sharing of experiences might be beneficial. There are gaps in knowledge about factors governing seeking, persisting with and deciding to cease treatment; experiences of invasive procedures; parenting after assisted conception; adoption and infertility-related grief and shame among men. Few resource-constrained countries have any data concerning male experiences of infertility.

A Demographic Explanation for the Recent Rise in European Fertility

Abstract: Between 1998 and 2008 European countries experienced the first continent-wide increase in the period total fertility rate (TFR) since the 1960s. After discussing period and cohort influences on fertility trends, we examine the role of tempo distortions of period fertility and different methods for removing them. We highlight the usefulness of a new indicator: the tempo- and parity-adjusted total fertility rate (TFRp*). This variant of the adjusted total fertility rate proposed by Bongaarts and Feeney also controls for the parity composition of the female population and provides more stable values than the indicators proposed in the past. Finally, we estimate levels and trends in tempo and parity distribution distortions in selected countries in Europe. Our analysis of period and cohort fertility indicators in the Czech Republic, Netherlands, Spain, and Sweden shows that the new adjusted measure gives a remarkable fit with the completed fertility of women in prime childbearing years in a given period, which suggests that it provides an accurate adjustment for tempo and parity composition distortions. Using an expanded dataset for ten countries, we demonstrate that adjusted fertility as measured by TFRp* remained nearly stable since the late 1990s. This finding implies that the recent upturns in the period TFR in Europe are largely explained by a decline in the pace of fertility postponement. Other tempo-adjusted fertility indicators have not indicated such a large role for the diminishing tempo effect in these TFR upturns. As countries proceed through their postponement transitions, tempo effects will decline further and eventually disappear, thus putting continued upward pressure on period fertility. However, such an upward trend may be obscured for a few years by the effects of economic recession.

Childbearing in adolescents aged 12–15 years in low resource countries: a neglected issue. New estimates from demographic and household surveys in 42 countries

Abstract: There is strong evidence that the health risks associated with adolescent pregnancy are concentrated among the youngest girls (e.g. those under 16 years). Fertility rates in this age group have not previously been comprehensively estimated and published. By drawing data from 42 large, nationally representative household surveys in low resource countries carried out since 2003 this article presents estimates of age-specific birth rates for girls aged 12-15, and the percentage of girls who give birth at age 15 or younger. From these we estimate that approximately 2.5 million births occur to girls aged under 16 in low resource countries each year. The highest rates are found in Sub-Saharan Africa, where in Chad, Guinea, Mali, Mozambique, Niger and Sierra Leone more than 10% of girls become mothers before they are 16. Strategies to reduce these high levels are vital if we are to alleviate poor reproductive health.

Racial, socioeconomic, and demographic disparities in access to fertility preservation in young women diagnosed with cancer.

Abstract: BACKGROUND: This study seeks to examine the relation between sociodemographic characteristics and the utilization of fertility preservation services in reproductive age women diagnosed with cancer. METHODS: A total of 1041 women diagnosed with cancer between the ages of 18 and 40 years responded to a retrospective survey on demographic information and reproductive health history. Five cancer types were included: leukemia, Hodgkin disease, non-Hodgkin lymphoma, breast cancer, and gastrointestinal cancer. Nine hundred eighteen women reported treatment with potential to affect fertility (chemotherapy, pelvic radiation, pelvic surgery, or bone marrow transplant). Student t test, linear regression, and multivariate logistic regression were used where appropriate to determine the relation between sociodemographic characteristics and the odds of using fertility preservation services. RESULTS: Sixty-one percent of women were counseled on the risk of cancer treatment to fertility by the oncology team. Overall, 4% of women pursued fertility preservation. In multivariate analysis, women who had not attained a bachelor's degree (odds ratio [OR], 0.7; 95% confidence interval [CI], 0.5-0.9) were less likely to be counseled. Trends also suggested possible disparities in access to fertility preservation with age older than 35 years (OR, 0.1; 95% CI, 0.0-1.4) or previous children (OR, 0.3; 95% CI, 0.1-1.1) at diagnosis. Disparities in access to fertility preservation based on ethnicity and sexual orientation were also observed. CONCLUSIONS: Sociodemographic health disparities likely affect access to fertility preservation services. Although awareness of fertility preservation has improved in the past decade, an unmet need remains for reproductive health counseling and fertility preservation in reproductive age women diagnosed with cancer. Cancer 2012. © 2012 American Cancer Society.

Recommendations for fertility preservation in patients with lymphoma, leukemia, and breast cancer.

Abstract: Fertility issues should be addressed to all patients in reproductive age before cancer treatment. In men, cryopreservation of sperm should be offered to all cancer patients in reproductive age regardless of the risk of gonadal failure. In women, the recommendation of fertility preservation should be individualized based on multiple factors such as the urgency of treatment, the age of the patient, the marital status, the regimen and dosage of cancer treatment.

Economic uncertainty and family dynamics in Europe: Introduction

Abstract: Background: Economic uncertainty has become an increasingly important factor in explanations of declining fertility and postponed family formation across Europe. Yet the micro-level evidence on this topic is still limited. Objective: This special collection of Demographic Research focuses on the issue of how economic and employment uncertainties relate to fertility and family dynamics in Europe. Methods: The collection is comprised of studies that explore how various dimensions of employment uncertainty, such as temporary working contracts and individual and aggregate unemployment, are related to the fertility and family formation of women and men across Europe. The studies cover Germany, the UK, France, Russia, Estonia, Sweden, Italy, Spain, and Israel. Results: The various micro-level studies that are assembled in this special collection do not provide a simple answer to the question of whether and how economic uncertainty suppresses (or stimulates) fertility. However, some systematic variation by welfare state regime is discernable. Conclusions: Given the recent economic volatility in Europe, we expect that labor market uncertainties will remain an important component of explanations of fertility developments in the 21st century.

Sex Differences in Fertility-Related Information Received by Young Adult Cancer Survivors

Abstract: Purpose The aim was to investigate male and female cancer survivors’ perception of fertility-related information and use of fertility preservation (FP) in connection with cancer treatment during reproductive age. Methods The study sample consisted of cancer survivors diagnosed from 2003 to 2007 identified in population-based registers in Sweden. Inclusion criteria included survivors who were age 18 to 45 years at diagnosis and had lymphoma, acute leukemia, testicular cancer, ovarian cancer, or female breast cancer treated with chemotherapy. Of 810 eligible participants, 484 survivors (60% response rate) completed a postal questionnaire.

How do you feel about fertility and parenthood? The voices of young female cancer survivors

Abstract: Purpose Young adult cancer survivors are often unaware of their fertility status and uninformed regarding their fertility and fertility preservation options. This qualitative research study explores the fertility and parenthood concerns of reproductive-age female cancer survivors and how they make parenthood decisions.

The insults of illicit drug use on male fertility.

Abstract: One-third of infertile couples may have a male factor present. Illicit drug use can be an important cause of male factor infertility and includes use of anabolic-androgenic steroids, marijuana, opioid narcotics, cocaine, and methamphetamines. The use of these illicit drugs is common in the United States, with a yearly prevalence rate for any drug consistently higher in males compared with females. We aim to provide a review of recent literature on the prevalence and effects of illicit drug use on male fertility and to aid health professionals when counseling infertile men whose social history suggests illicit drug use. Anabolic-androgenic steroids, marijuana, cocaine, methamphetamines, and opioid narcotics all negatively impact male fertility, and adverse effects have been reported on the hypothalamic-pituitary-testicular axis, sperm function, and testicular structure. The use of illicit drugs is prevalent in our society and likely adversely impacting the fertility of men who abuse drugs.

Fertility, sexuality and testicular adrenal rest tumors in adult males with congenital adrenal hyperplasia

Abstract: Objective: Fertility in males with congenital adrenal hyperplasia (CAH) is reported from normal to severely impaired. Therefore, we investigated fertility/fecundity, social/sexual situation, and pituitary– gonadal function in CAH males. Subjects and methods: The patient cohort comprised 30 males, aged 19–67 years, with 21-hydroxylase deficiency. Their fertility was compared with age-matched national population data. For the evaluation of social/sexual factors and hormone status, age-matched controls were recruited (nZ32). Subgroups of different ages (!30 years and older) and CYP21A2 genotypes (null (severe salt-wasting (SW)), I2splice (milder SW), and I172N (simple virilizing)) were also studied. Patients underwent testicular ultrasound examination (nZ21) and semen analysis (nZ14). Results: Fertility was impaired in CAH males compared with national data (0.9G1.3 vs 1.8G0.5 children/father, P!0.001). There were no major differences in social and sexual factors between patients and controls apart from more fecundity problems, particularly in the I172N group. The patients had lower testosterone/estradiol (E2) ratio and inhibin B, and higher FSH. The semen samples were pathological in 43% (6/14) of patients and sperm concentration correlated with inhibin B and FSH. Testicular adrenal rest tumors (TARTs) were found in 86% (18/21). Functional testicular volume correlated positively with the testosterone/E2 ratio, sperm concentration, and inhibin B. Patients with pathological semen had increased fat mass and indications of increased cardiometabolic risk. Conclusions: Fertility/fecundity was impaired in CAH males. The frequent occurrence of TARTs resulting in testicular insufficiency appears to be the major cause, but other factors such as elevated fat mass may contribute to a low semen quality.

Fertility after allogeneic haematopoietic stem cell transplantation in childhood and adolescence

Abstract: Infertility is a major late effect in patients receiving haematopoietic stem cell transplantation (HSCT). The aim of this study was to determine the proportion of patients having fertility impairment after allogeneic HSCT in childhood/adolescence and to identify the potential risk factors. Treatment and fertility data of paediatric patients with malignant and non-malignant diseases treated with allogeneic HSCT between 2000 and 2005 were collected from seven European centres. Data were obtained for 138 female and 206 male patients after a median follow-up of 6 years (range 3-12). The patients' median age was 13 years (range 4-28) at the time of HSCT and 19 (range 12-35) years at the time of the enquiry. Seven children were born to the overall group, all at term and healthy. Fertility impairment was suspected in 69% males and 83% females. Start of treatment at age 13 years was a risk factor in females (odds ratio (OR) 4.7; 95% confidence interval (CI), 1.5 to 14.9), whereas pre-pubertal therapy was a risk factor in males (OR 0.4; 95% CI, 0.2 to 0.8). The major treatment-related risk factors were BU in females (OR 47.4; 95% CI, 5.4 to 418.1) and TBI in males (OR 7.7; 95% CI, 2.3 to 25.4). In light of the significant proportion of HSCT patients reviewed with impaired fertility, fertility conservation procedures should be considered for all patients undergoing HSCT, particularly those receiving TBI or BU-based preparative regimens.

Making hard choices easier: a prospective, multicentre study to assess the efficacy of a fertility-related decision aid in young women with early-stage breast cancer

Abstract: Fertility is a priority for many young women with breast cancer. Women need to be informed about interventions to retain fertility before chemotherapy so as to make good quality decisions. This study aimed to prospectively evaluate the efficacy of a fertility-related decision aid (DA). A total of 120 newly diagnosed early-stage breast cancer patients from 19 Australian oncology clinics, aged 18–40 years and desired future fertility, were assessed on decisional conflict, knowledge, decision regret, and satisfaction about fertility-related treatment decisions. These were measured at baseline, 1 and 12 months, and were examined using linear mixed effects models. Compared with usual care, women who received the DA had reduced decisional conflict (β=−1.51; 95%CI: −2.54 to 0.48; P=0.004) and improved knowledge (β=0.09; 95%CI: 0.01–0.16; P=0.02), after adjusting for education, desire for children and baseline uncertainty. The DA was associated with reduced decisional regret at 1 year (β=−3.73; 95%CI: −7.12 to −0.35; P=0.031), after adjusting for education. Women who received the DA were more satisfied with the information received on the impact of cancer treatment on fertility (P<0.001), fertility options (P=0.005), and rated it more helpful (P=0.002), than those who received standard care. These findings support widespread use of this DA shortly after diagnosis (before chemotherapy) among younger breast cancer patients who have not completed their families.