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PubMedDate not supplied

Early fertility and lifetime fertility.

Teenage mothers are likely to have more children than those who postpone childbearing, but these differences are not as great as they used to be. There is also a pattern of convergence between black women and white women.

Adolescent↗
PubMed1996

Cumulative pregnancy rate following in-vitro fertilization: the significance of age and infertility aetiology.

During the years 1984-1992, 951 couples completed 2252 in-vitro fertilization (IVF) treatment cycles at the In-Vitro Fertilization Unit of The Chaim Sheba Medical Centre. This study was conducted to evaluate the success of IVF using the cumulative pregnancy rate (CPR), with special emphasis on the optimal number of treatment cycles, the age of the patients and female infertility factors. It was found that the CPR showed a constant rise during the six initial IVF treatments (56% CPR), and plateaued in the subsequent three cycles (63% CPR). Various female infertility factors did not influence this rate. Women > or = 40 years of age have a significantly lower CPR. Thus, it was concluded that the CPR in IVF declined after the sixth initial treatment cycle, and in women > or = 40 years of age. The infertility factor did not significantly influence CPR.

Adult↗
PubMed1997

Age, the desire to have a child and cumulative pregnancy rate.

The relation between women's age and fertility, and the factors that influence the age at which couples desire to have their first child, were analysed in a national sample of women aged 25-49 years. A random sample of 8050 households in the Netherlands was approached. In these households, 3295 women between the ages of 25 and 49 years answered a short questionnaire about planning their first pregnancy and about fertility. Furthermore, sociodemographic data were gathered. There appeared to be almost no variation in cumulative pregnancy rate between age 20 and 28: between 65 and 70% at 6 months, just below 90% at 12 months and approximately 93% at 24 months. After the age of 33 years, the cumulative pregnancy rate at 6 months decreased. From the age of 28 years the cumulative pregnancy rate at 12 months and at 24 months decreased gradually, reaching 75 and 80% respectively, by the age of 35 years. The year of birth of the woman (the 'time' factor) was the most important factor influencing the age at which couples desired to have their first child. In addition, demographic factors, particularly a high level of education, a high professional level and a high level of family income, were associated with the desire to have the first child at a relatively late age.

Adult↗
PubMed1995

Sterilization reversal: fertility results.

Fertility outcome following sterilization reversal by laparotomy was evaluated. We studied all sterilization reversals performed between January 1978 and December 1991; a total of 226 women were treated. Tubal anastomosis was performed according to the rules for microsurgery. The microsurgical technique comprised two main phases: preparation of the healthy tube segments and the anastomosis carried out on two layers. It was possible to study the subsequent fertility of 206 patients in all, as 20 patients were lost to follow-up (8.8%). Cumulative pregnancy rates were evaluated by life-table analysis. The overall intrauterine pregnancy rate, including births and miscarriages, was 69.9% (144 patients) after 2 years. The cumulative intrauterine pregnancy rate was 62% at 18 months. Analysis of the fertility results demonstrated that age was the most significant predictive factor. The cumulative intrauterine pregnancy rate at 2 years was 83.5% (61 cases) for patients < or = 33 years, 70% (35 cases) for patients aged 34-36 years, 62.5% (30 cases) for patients aged 37-39 years, and 51.4% (18 cases) for patients aged > or = 40 years. Even for patients aged approximately 40 years, microsurgical repermeabilization can be retained as the first choice rather than in-vitro fertilization.

Adult↗
PubMed2001

The lack of influence of age on male fertility.

OBJECTIVE: This study was undertaken to determine the effect of male aging on sperm quality as determined by semen analysis, the fertilization rate of human oocytes in vitro, and live birth rates. STUDY DESIGN: Retrospective analysis correlating outcome measures with male age was performed for 558 oocyte donation cycles in 441 couples. The oocyte donation model was chosen because it controls for oocyte quality and endometrial receptivity, which allows variations in sperm quality as a function of male age to be the only dependent variable. Outcome measures analyzed were semen analysis, fertilization rates in vitro, pregnancy rates, live birth rates, and cumulative live birth rates by life-table analysis. RESULTS: There was a negative correlation between male age and total sperm count, but there was no correlation between male age and any of the other parameters in the semen analysis. There was no association between male age and the fertilization rate of donated oocytes in vitro, pregnancy rates, or live birth rates. Recipient couples were grouped by quartiles of male age, and cumulative live birth rates were the same in the 4 groups. CONCLUSION: Whereas male aging is associated with a significant decline in total sperm count, this change is not reflected in a decreased fertilization rate or a decreased live birth rate in the oocyte donation model.

Adult↗
PubMedDate not supplied

Prognosis of subfertility in men with corrected or uncorrected varicocele.

To evaluate whether correction of varicocele improves fertility, pregnancy rates were compared in 115 varicocele patients consulting for infertility and having oligozoospermia, asthenospermia, or teratozoospermia, in any combination, and FSH levels within the normal range. Ninety of these patients had corrected, and 25 had uncorrected varicoceles, respectively. The value of clinical and seminal parameters for predicting the eventuality of pregnancy for varicocele patients was also studied. Although both groups were comparable in terms of duration of infertility, mean age, sperm density, motility or fertility index, cumulative pregnancy rates over 12 months were similar, whether or not the varicocele was corrected. The value of clinical or seminal parameters, in any combination, for the prediction of outcome for varicocele patients was poor. The prognosis was poor for men with less than 15% of spermatozoa with normal morphology, FSH levels higher than the mean + 3 SD of those values found in young fathers, and a fertility index below 3. In subjects who achieved pregnancy within one year, pretreatment sperm characteristics were similar in both the corrected and uncorrected groups. Correction of varicocele slightly improved sperm characteristics. It seems likely that in most men with subfertility and varicocele, other factors besides venous reflux are responsible for their infertility.

Adult↗
PubMed2000

[Estimated number of orphans due to maternal AIDS in Brazil, 1987-99].

This study proposes a procedure to estimate the number of orphans due to maternal AIDS. The procedure estimates the number of orphans by calendar year, multiplying the cumulative fertility rate by the number of AIDS deaths among women aged 15-49 years. Because the procedure refers to the number of children that are alive, the estimate is adjusted by contemplating the proportion of pediatric AIDS cases due to vertical transmission and the probability of survival in the 5-9-year age group. To estimate the number of AIDS orphans in Brazil from 1987 to 1999, the procedure was applied by stratifying according to geographical region, taking into account the differences in regional fertility rates, completeness of death reporting, and misclassification of AIDS-related deaths as due to other causes. The total number of cumulative AIDS orphans for 1987-99 was estimated at approximately 30,000.

Acquired Immunodeficiency Syndrome↗
PubMed2003

Estimated number of children left motherless by AIDS in the United States, 1978-1998.

When a mother dies of AIDS, basic needs of her children may be left unmet. To estimate the number and characteristics of maternal AIDS orphans in the United States, demographic techniques were applied to data from several sources. From the national HIV/AIDS surveillance system, reporting delays were adjusted for the number of deaths among women aged 15-44 diagnosed with AIDS through 1998 and reported as deceased by December 1999. No fertility was assumed in the year preceding death. To the adjusted number of deaths the annual age- and race-specific cumulative fertility and infant mortality rates from national vital statistics were applied. A perinatal infection rate of 25% was assumed among children born through 1994, and 10% among children born after 1994. Through 1998, 51,473 women died leaving 97,376 children motherless. Of the estimated 76,661-87,0018 uninfected children, 83% were younger than 21 years when orphaned. After increasing each year, the annual number of orphaned children younger than 21 years peaked in 1995. In 1998, between 4252-4489 uninfected youth were added to 47,863-54,025 existing orphans younger than age 21. Due to declines in AIDS deaths, the annual number of children orphaned by AIDS has declined. Nevertheless, each year thousands of youth are orphaned.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Reproduction following treatment for childhood leukemia: a population-based prospective cohort study of fertility and offspring.

Of all children diagnosed with leukemia in Denmark, Finland, Iceland, Norway, and Sweden, 981 had discontinued therapy before 1985 and had been followed up annually after cessation of therapy. Progeny was registered and fertility evaluated among survivors who passed age 18 years without a relapse (n = 299). By April 1989, 48 offspring were registered, one of whom had congenital anomalies. This was no more than expected from the incidence of birth defects in the general population. No childhood malignancies or genetic diseases have so far been diagnosed in the progeny. In the study group, none of the 19 female and 8 male survivors of myeloid leukemias had become parents, and only 4 fathers were reported among the 131 male survivors of acute lymphoblastic leukemia (ALL). However, 23 of the 149 females treated for ALL had delivered 41 children. Fertility was measured as cumulative rates of first birth by maternal age. In a Cox regression analysis, cases who had received prophylactic radiation of the central nervous system (CNS) had a lower first birth rate than those without radiation (rate ratio 0.39, 95% CI 0.15-1.00), indicating that doses of 18-24 Gy to the brain may possibly be a risk factor. By using the Norwegian birth cohort of 1966 as a control group, matching the median year of birth for the study subjects, the group of female ALL survivors as a whole was as likely as the general female population to have given birth up to the age of 23. The first generation of females successfully treated for childhood ALL seems to have a nearly normal reproductive pattern during young adulthood, without increased risk of congenital anomalies in the offspring. However, cranial radiation as CNS prophylaxis may possibly impair subsequent reproduction.

Adolescent↗
PubMed2000

Effect of HIV-1 infection on tuberculosis and fertility in a large workforce in Kinshasa, Democratic Republic of the Congo.

To determine the effect of an HIV counseling service on the incidence of HIV and tuberculosis infection and on the fertility rate in a large workforce cohort of adult men and women from Kinshasa, Democratic Republic of Congo (formerly Zaire), we conducted a 2-year prospective longitudinal cohort study, two large Kinshasa businesses (a commercial bank and a textile factory). We determined baseline HIV-1 seroprevalence, HIV-1 and tuberculosis mortality/morbidity, and fertility rates during 24 months of follow-up on 8866 employees and 6411 wives of male employees. The baseline HIV-1 seroprevalence was 2.8% in male employees (n = 6657), 8.4% in female employees (n = 417), and 2.4% in the wives of male employees (n = 4692). The HIV-1 seroincidence per 100 person-years of follow-up in these three groups was 0.9, 0.5 and 0.8, respectively. The incidence of tuberculosis was 2.4/100 person years in persistently seropositive individuals compared with a 0.38 rate in persistently seronegative individuals (p < 0.01). The annual fertility rate in persistently seronegative women was 250.0/1000 women compared with a rate of 140/1000 in persistently seropositive women (p < 0.001). Forty-eight (44%) of 105 male employees and 17 (26%) of 60 wives of male workers who died during follow-up were HIV-1 seropositive. HIV infection was responsible for nearly one half of all deaths in this large workforce. Tuberculosis incidence was six times higher in HIV-1-infected compared with uninfected individuals. Counseling of HIV-infected women and their husbands appeared to be effective as their cumulative fertility rate was 44% lower than the rate in similarly aged uninfected women.

AIDS-Related Opportunistic Infections↗
PubMed1999

Standard in vitro fertilization or intracytoplasmic sperm injection in advanced female age--what may be expected?

This study was conducted to evaluate the current results of standard in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) in the elderly (> or = 40 years of age) female population. Oocyte recovery, fertilization, embryo transfer, pregnancy and cumulative pregnancy rates were assessed. The results were analyzed for: the entire elderly population; the standard IVF group (group 1); all those in the ICSI group (group 2); and ICSI for severe male-factor category (group 3). A total of 330 IVF and 158 ICSI treatment cycles were carried out in 249 women. Forty-five (9.2%) clinical pregnancies were achieved. This rate was not statistically different from those achieved for groups 1, 2 and 3 (9.1%, 9.5% and 6.8%, respectively). The cumulative pregnancy rate for a total of five cycles was 19.2% and 26.4% for groups 1 and 2, respectively. For those who started their treatments at > or = 40 years, the cumulative pregnancy rate for three cycles was 26.5% and 36.5% in groups 1 and 2, respectively. These results clearly demonstrate that female age is a major success determinant, with similar influence on both standard IVF and ICSI therapy modalities.

Adult↗
PubMed2006

Fertility after discontinuation of treatment with an oral contraceptive containing 30 microg of ethinyl estradiol and 2 mg of dienogest.

OBJECTIVE: To examine the conception rate after cessation of a combination of 30 microg ethinyl E2 and 2 mg dienogest (EE/DNG). DESIGN: Prospective observational study. SETTING: Population-based cohort in Germany. PATIENT(S): Women who wished to become pregnant after cessation of an oral contraceptive (EE/DNG). INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Cumulative conception rate within 1 year after termination of EE/DNG and time to pregnancy. RESULT(S): After 1 year of follow-up, the cumulative pregnancy rate was 86.6% (full analysis set; n = 706). When all participants with complete data were analyzed (n = 652), the cumulative pregnancy rate was 94.0%. More than 15% of the patients conceived in each of the first three cycles after termination of EE/DNG; the mean time to pregnancy was 3.5 cycles. The preceding duration of treatment with EE/DNG did not influence the conception rate. Except in the youngest age group (16-18 years), a certain delay was observed in the other age groups. CONCLUSION(S): The present prospective study revealed only a slight delay in regaining fertility during the first three cycles after cessation of EE/DNG. Thereafter, the cumulative rate of conception did not differ from that observed in fertile women who attempted to become pregnant without prior contraception.

Adult↗
PubMedDate not supplied

Delayed childbearing in Canada: trends and factors.

"Using period and cohort birth order statistics, an overview of the phenomenon of delayed childbearing in Canada is presented. Data employed in the period analysis were mainly from the years 1944 to 1985, while women born between the years 1935 and 1960 were the subjects of the cohort analysis. An examination of selected indices, namely, age-specific first-birth fertility rates, median ages of women at first-order birth and cumulative first-order birth rates shows that there is an overall trend for women to postpone the initiation of childbearing until late twenties or early thirties.... The results indicate that work experience, education, occupation and year of marriage are important variables influencing age at first birth and first-birth interval." (SUMMARY IN FRE AND ITA)

Age Factors↗
PubMed1998

One thousand initiated cycles of in vitro fertilization in women > or = 40 years of age.

OBJECTIVE: To evaluate the results of IVF in women > or = 40 years of age using their own oocytes. DESIGN: Retrospective study. SETTING: Wolfson and Royal Masonic in vitro fertilization units, London, United Kingdom. PATIENT(S): A total of 1,087 IVF cycles were started in women > or = 40 years of age. INTERVENTION(S): Medical records of patient outcomes were reviewed. MAIN OUTCOME MEASURE(S): Clinical pregnancy, miscarriage, and delivery rates. RESULT(S): Of the 1,087 cycles started in 471 women > or = 40 years of age, 842 reached oocyte retrieval (77.5%) and 702 had embryos transferred (64.6%). The pregnancy rate (PR) was significantly lower in women > or = 40 years of age than in a control group of women <40 years of age (11.3% versus 28.2%). It decreased sharply in women >42 years of age, and no women >45 years of age had a child. Women > or = 40 years of age were more likely to miscarry (27% versus 12.7%). When only one embryo was available for transfer, the PR was 3.3%. When >2 embryos were available for transfer, the PR was similar whether 2 or 3 embryos were replaced. No triplet pregnancy occurred. Women > or = 40 years of age achieved a cumulative PR of 30% after three cycles with a cumulative "take home baby" rate of 21%. CONCLUSION(S): In vitro fertilization is a reasonable treatment for women <45 years of age using their own gametes. Those with a "good response" in their first attempt may be encouraged to complete three cycles with an acceptable chance of conception.

Adult↗