Fertility

About: Fertility is a research topic. Over the lifetime, 29988 publications have been published within this topic receiving 681106 citations.

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.

Sexual dysfunction and infertility as late effects of cancer treatment

Abstract: Sexual dysfunction is a common consequence of cancer treatment, affecting at least half of men and women treated for pelvic malignancies and over a quarter of people with other types of cancer. Problems are usually linked to damage to nerves, blood vessels, and hormones that underlie normal sexual function. Sexual dysfunction also may be associated with depression, anxiety, relationship conflict, and loss of self-esteem. Innovations in cancer treatment such as robotic surgery or more targeted radiation therapy have not had the anticipated result of reducing sexual dysfunction. Some new and effective cancer treatments, including aromatase inhibitors for breast cancer or chemoradiation for anal cancer also have very severe sexual morbidity. Cancer-related infertility is an issue for younger patients, who comprise a much smaller percentage of total cancer survivors. However, the long-term emotional impact of being unable to have a child after cancer can be extremely distressing. Advances in knowledge about how cancer treatments may damage fertility, as well as newer techniques to preserve fertility, offer hope to patients who have not completed their childbearing at cancer diagnosis. Unfortunately, surveys in industrialised nations confirm that many cancer patients are still not informed about potential changes to their sexual function or fertility, and all modalities of fertility preservation remain underutilised. After cancer treatment, many patients continue to have unmet needs for information about restoring sexual function or becoming a parent. Although more research is needed on optimal clinical practice, current studies suggest a multidisciplinary approach, including both medical and psychosocial treatment options.

Reproductive history and mortality later in life: a comparative study of England and Wales and Austria.

Abstract: Does a woman's reproductive history influence her life span? This study explores the question with data from the contemporary female populations of England and Wales and Austria It is the first comparative study to investigate the relationship between fertility and mortality late in life We find similar patterns and age-specific trends of excess mortality in both populations: parity significantly influences longevity, as do both an early and a late birth These differences in longevity are not explained by differences in educational or family status The impact of a woman's reproductive history on her life span is small, however, compared to the influence of her level of education or family status

Men's status and reproductive success in 33 nonindustrial societies: Effects of subsistence, marriage system, and reproductive strategy.

Abstract: Social status motivates much of human behavior. However, status may have been a relatively weak target of selection for much of human evolution if ancestral foragers tended to be more egalitarian. We test the “egalitarianism hypothesis” that status has a significantly smaller effect on reproductive success (RS) in foragers compared with nonforagers. We also test between alternative male reproductive strategies, in particular whether reproductive benefits of status are due to lower offspring mortality (parental investment) or increased fertility (mating effort). We performed a phylogenetic multilevel metaanalysis of 288 statistical associations between measures of male status (physical formidability, hunting ability, material wealth, political influence) and RS (mating success, wife quality, fertility, offspring mortality, and number of surviving offspring) from 46 studies in 33 nonindustrial societies. We found a significant overall effect of status on RS (r = 0.19), though this effect was significantly lower than for nonhuman primates (r = 0.80). There was substantial variation due to marriage system and measure of RS, in particular status associated with offspring mortality only in polygynous societies (r = −0.08), and with wife quality only in monogamous societies (r = 0.15). However, the effects of status on RS did not differ significantly by status measure or subsistence type: foraging, horticulture, pastoralism, and agriculture. These results suggest that traits that facilitate status acquisition were not subject to substantially greater selection with domestication of plants and animals, and are part of reproductive strategies that enhance fertility more than offspring well-being.

Diagnosis and Management of Infertility: A Review.

Abstract: Importance In the US, approximately 12.7% of reproductive age women seek treatment for infertility each year. This review summarizes current evidence regarding diagnosis and treatment of infertility. Observations Infertility is defined as the failure to achieve pregnancy after 12 months of regular unprotected sexual intercourse. Approximately 85% of infertile couples have an identifiable cause. The most common causes of infertility are ovulatory dysfunction, male factor infertility, and tubal disease. The remaining 15% of infertile couples have “unexplained infertility.” Lifestyle and environmental factors, such as smoking and obesity, can adversely affect fertility. Ovulatory disorders account for approximately 25% of infertility diagnoses; 70% of women with anovulation have polycystic ovary syndrome. Infertility can also be a marker of an underlying chronic disease associated with infertility. Clomiphene citrate, aromatase inhibitors such as letrozole, and gonadotropins are used to induce ovulation or for ovarian stimulation during in vitro fertilization (IVF) cycles. Adverse effects of gonadotropins include multiple pregnancy (up to 36% of cycles, depending on specific therapy) and ovarian hyperstimulation syndrome (1%-5% of cycles), consisting of ascites, electrolyte imbalance, and hypercoagulability. For individuals presenting with anovulation, ovulation induction with timed intercourse is often the appropriate initial treatment choice. For couples with unexplained infertility, endometriosis, or mild male factor infertility, an initial 3 to 4 cycles of ovarian stimulation may be pursued; IVF should be considered if these approaches do not result in pregnancy. Because female fecundity declines with age, this factor should guide decision-making. Immediate IVF may be considered as a first-line treatment strategy in women older than 38 to 40 years. IVF is also indicated in cases of severe male factor infertility or untreated bilateral tubal factor. Conclusions and Relevance Approximately 1 in 8 women aged 15 to 49 years receive infertility services. Although success rates vary by age and diagnosis, accurate diagnosis and effective therapy along with shared decision-making can facilitate achievement of fertility goals in many couples treated for infertility.