Utilization of fertility-related services in the United States

The association between preconception body mass index and subfertility among Hispanic and non-Hispanic women: A cross-sectional study from Utah's Pregnancy Risk Assessment Monitoring System survey (2012-2015)

OBJECTIVE

To investigate the association between pre-pregnancy body mass index (BMI) and subfertility within a population-based cohort, exploring Hispanic ethnicity as a potential effect modifier.

METHODS

We used cross-sectional study data from the Utah Pregnancy Risk Assessment Monitoring System from 2012-2015. Relationships between maternal pre-pregnancy BMI and subfertility were evaluated via Poisson regression models with robust error variance, accounting for the stratified survey sampling. Preconception BMI was analyzed continuously and categorically. Women's subfertility was defined via self-report in two ways: 1) time trying to achieve pregnancy; and 2) report of using fertility-related drugs/medical procedures.

RESULTS

The median age was 27.0; 18.8% were obese, and 15.9% were Hispanic. Women with preconception obesity (BMI>30kg/m²), compared to normal weight women (18.4kg/ m²<BMI<25kg/m²) had a 1.85 (95% CI 1.43, 2.38) higher adjusted prevalence ratio (aPR) for having subfertility defined by time trying and a 1.73 (95% CI 1.20, 2.32) higher aPR for receiving fertility-enhancing drugs/medical procedures. Continuous models indicated a linear relationship between BMI and subfertility (aPR 1.04, 95% CI 1.03, 1.06 for time trying; and 1.06, 95% CI 1.03, 1.10 for receiving fertility-enhancing drugs/medical procedures).

CONCLUSIONS

Obese women, but not underweight or overweight women, reported higher subfertility than normal-weight women. Findings among this cohort of at-risk new mothers, oversampled on low education and birth weight and comprised of higher than the national average of Hispanics, indicated a dose-response relationship between obesity and subfertility.

IMPLICATIONS

Our findings highlight the importance of population-oriented obesity prevention for at-risk women with intentions to conceive.

Supply of and demand for assisted reproductive technologies in the United States: clinic- and population-based data, 1995-2010

OBJECTIVE

To study national-level trends in assisted reproduction technology (ART) treatments and outcomes as well as the characteristics of women who have sought this form of infertility treatment.

DESIGN

Population-based study.

SETTING

Not applicable.

PATIENT(S)

For CDC: All reporting clinics from 1996-2010. For NSFG: for the logistic analysis, sample comprising 2,325 women aged 22-44 years who have ever used medical help to get pregnant, excluding women who used only miscarriage prevention services.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

CDC data (number of cycles, live birth deliveries, live births, patient diagnoses); and NSFG data (individual use of ART procedures).

RESULT(S)

Between 1995 and 2010, use of ART increased. Parity and age are strong predictors of using ART procedures. The other correlates are higher education, having had tubal surgery, and having a current fertility problem.

CONCLUSION(S)

The two complementary data sets highlight the trends of ART use. An increase in the use of ART services over this time period is seen in both data sources. Nulliparous women aged 35-39 years are the most likely to have ever used ART services.

Influence of acupuncture on the outcomes of in vitro fertilisation when embryo implantation has failed: a prospective randomised controlled clinical trial

OBJECTIVE

To evaluate the effectiveness of acupuncture and moxibustion as an adjuvant treatment in women undergoing in vitro fertilisation (IVF) when embryo implantation has failed.

METHODS

A prospective, randomised controlled clinical trial was conducted with 84 infertile patients who had had at least two unsuccessful attempts of IVF. The patients were randomised in three groups: control (n=28), sham (n=28) and acupuncture (n=28). The sample size was calculated by assuming a pregnancy rate of 10% when embryo implantation had failed. The pregnancy rates of the current IVF cycle were evaluated by measurement of blood β human chorionic gonadotrophin (βhCG) and subsequent transvaginal ultrasound. Acupuncture was performed on the first and seventh day of ovulation induction, on the day before ovarian puncture and on the day after embryo transfer. In the acupuncture group, patients were treated with moxibustion at nine acupuncture points (BL18, BL22, BL23, BL52, CV3, CV4, CV5, CV7, GV4) and needling at 12 points. In the sham group needles were inserted in eight areas that did not correspond to known acupuncture points.

RESULTS

The clinical pregnancy rate in the acupuncture group was significantly higher than that in the control and sham groups (35.7% vs 7.1% vs 10.7%; p=0.0169).

CONCLUSIONS

In this study, acupuncture and moxibustion increased pregnancy rates when used as an adjuvant treatment in women undergoing IVF, when embryo implantation had failed.

Infertility treatment in a population-based sample: 2004-2005

To describe the characteristics of women seeking infertility treatment and the types of fertility treatment sought within a population-based sample. We analyzed data from the cross-sectional Pregnancy Risk Assessment Monitoring System (PRAMS) of women with a live birth using data from seven states. Logistic regression was used to determine factors associated with infertility treatment utilization. Infertility treatment was reported by 10.5% of women who were trying to become pregnant. The most common treatment reported was fertility enhancing drugs (29%), followed by assisted reproductive technology including in vitro fertilization (21%), and artificial insemination together with fertility enhancing drugs (15%). Some women reported using other types of treatment (23%). The PRAMS data provide insights into the use of infertility treatment among women giving birth in the United States. Further research is needed to understand the true prevalence of infertility, factors that influence treatment choices, and the longitudinal impact of infertility treatment on outcomes.

Infertility service use among U.S. women: 1995 and 2002

OBJECTIVE

To examine trends in use of medical services for infertility, by individual characteristics of women.

DESIGN

Pooled data from two cycles (1995 and 2002) of the National Survey of Family Growth, a periodically conducted, nationally representative, cross-sectional survey of women 15-44 years of age.

PARTICIPANT(S)

The analysis sample was composed of 2,005 women 22-44 years of age with current fertility problems.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

Ever having used infertility services, and highest level of services used.

RESULT(S)

Between 1995 and 2002, ever-use of infertility services by fertility-impaired women age 22-44 years continued to be closely associated with older age, nulliparity, formal marital status, and higher socioeconomic status (education, household income, and private health insurance). Net of these factors, race and Hispanic origin, showed no significant association with either the use of services overall or the highest level of services used. After controlling for compositional changes in these individual characteristics, a slight decline was seen in ever-use of services overall from 1995 to 2002. No effect of survey year was noted in the highest level of services.

CONCLUSION(S)

Infertility service use among fertility-impaired women remains closely tied with socioeconomic factors. The "threshold effect" of these factors has shifted upward to the receipt of more costly services such as assisted reproductive technologies. These higher level services remain a relatively small fraction of the services reported in a general population sample of fertility-impaired women.