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Liu A, Akimova ET, Ding X, Jukarainen S, Vartiainen P, Kiiskinen T, Koskelainen S, Havulinna AS, Gissler M, Lombardi S, Fall T, Mills MC, Ganna A. Evidence from Finland and Sweden on the relationship between early-life diseases and lifetime childlessness in men and women. Nat Hum Behav 2024; 8:276-287. [PMID: 38110509 PMCID: PMC10896715 DOI: 10.1038/s41562-023-01763-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 10/18/2023] [Indexed: 12/20/2023]
Abstract
The percentage of people without children over their lifetime is approximately 25% in men and 20% in women. Individual diseases have been linked to childlessness, mostly in women, yet we lack a comprehensive picture of the effect of early-life diseases on lifetime childlessness. We examined all individuals born in 1956-1968 (men) and 1956-1973 (women) in Finland (n = 1,035,928) and Sweden (n = 1,509,092) to the completion of their reproductive lifespan in 2018. Leveraging nationwide registers, we associated sociodemographic and reproductive information with 414 diseases across 16 categories, using a population and matched-pair case-control design of siblings discordant for childlessness (71,524 full sisters and 77,622 full brothers). The strongest associations were mental-behavioural disorders (particularly among men), congenital anomalies and endocrine-nutritional-metabolic disorders (strongest among women). We identified new associations for inflammatory and autoimmune diseases. Associations were dependent on age at onset and mediated by singlehood and education. This evidence can be used to understand how disease contributes to involuntary childlessness.
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Affiliation(s)
- Aoxing Liu
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland.
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA.
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, USA.
| | - Evelina T Akimova
- Leverhulme Centre for Demographic Science, Nuffield Department of Population Health, and Nuffield College, University of Oxford, Oxford, UK
| | - Xuejie Ding
- Leverhulme Centre for Demographic Science, Nuffield Department of Population Health, and Nuffield College, University of Oxford, Oxford, UK
| | - Sakari Jukarainen
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
| | - Pekka Vartiainen
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
| | - Tuomo Kiiskinen
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Sara Koskelainen
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
| | - Aki S Havulinna
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Mika Gissler
- Finnish Institute for Health and Welfare, Helsinki, Finland
- Research Centre for Child Psychiatry and Invest Research Flagship, University of Turku, Turku, Finland
- Academic Primary Health Care Centre, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | | | - Tove Fall
- Molecular Epidemiology, Department of Medical Sciences, and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Melinda C Mills
- Leverhulme Centre for Demographic Science, Nuffield Department of Population Health, and Nuffield College, University of Oxford, Oxford, UK.
- Department of Economics, Econometrics and Finance, Faculty of Economics and Business, University of Groningen, Groningen, the Netherlands.
- Department of Genetics, University Medical Centre Groningen, Groningen, the Netherlands.
| | - Andrea Ganna
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland.
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA.
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, USA.
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Merlino L, Chiné A, Carletti G, Del Prete F, Codacci Pisanelli M, Titi L, Piccioni MG. Appendectomy and women’s reproductive outcomes: a review of the literature. Eur Surg 2021. [DOI: 10.1007/s10353-021-00703-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Summary
Background
The most frequent abdominal surgery performed for benign disease in females of fertile age is appendectomy, which remains among the most common surgeries and is a possible cause of peritoneal adhesions. The fact that appendectomy can cause adhesions may lead one to think that this may be a relevant risk factor for infertility; however, there is no universal agreement regarding the association between appendectomy and fertility. The aim of this review is to evaluate weather appendectomy may have a relevant impact on female fertility.
Methods
The search was conducted in PubMed and there was no limitation set on the date of publication. All studies regarding populations of female patients who had undergone appendectomy for inflamed appendix, perforated appendix, or negative appendix between childhood and the end of the reproductive period were included.
Results
Some authors believe that pelvic surgery can cause adhesions which can potentially lead to tubal infertility by causing tubal obstruction or by altering motility of fimbriae, tubal fluid secretion, and embryo transport. On the other hand, the most recent evidence reported that removal of the appendix seems to be associated with an increased pregnancy rate in large population studies.
Conclusion
Despite the existence of contrasting opinions concerning fertility after appendectomy, the most recent evidence suggests that appendectomy may actually lead to improved fertility and decreased time to pregnancy. Appendectomy seems to be correlated with improved fertility and higher pregnancy rates.
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Margaux Becker V, Silver S, Seufert R, Muensterer OJ. The Association of Appendectomy, Adhesions, Tubal Pathology, and Female Infertility. JSLS 2019; 23:JSLS.2018.00099. [PMID: 30846898 PMCID: PMC6400250 DOI: 10.4293/jsls.2018.00099] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background and Objectives The aim of the study was to investigate a potential association between previous childhood appendectomy, tube pathology, and female infertility. Methods We reviewed patients seeking care at the fertility clinic of our university medical center between 2006 and 2016. The history of previous appendectomy was extracted from hospital documentation and by telephone follow-up. Tubal patency was assessed by diagnostic laparoscopy and chromopertubation. Results In our study cohort (N = 237), 24.9% (n = 59) had a history of previous appendectomy. Previous appendectomy, therefore, was about 3-fold more prevalent in women seeking fertility treatment than in the general population. Patients with previous appendectomy had more intra-abdominal adhesions (P < .001) and patients with adhesions tended to have compromised tubal patency (P = .05). However, there was no direct correlation between a previous appendectomy and tube pathology (P = .727). Conclusion Because previous appendectomy was associated with intra-abdominal adhesions, and these were in turn associated with tube pathology, but appendectomy was not directly associated with compromised tubal patency, previous appendectomy may indirectly affect female fertility through mechanisms other than direct tubal obstruction. This is one of the largest study analyzing laparoscopic chromopertubation in association with previous childhood appendectomy.
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Affiliation(s)
- Victoria Margaux Becker
- Department of Pediatric Surgery, University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | - Saskia Silver
- Department of Pediatric Surgery, University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | - Rudolf Seufert
- Department of Obstetrics and Gynecology, University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | - Oliver J Muensterer
- Department of Pediatric Surgery, University Medical Center of the Johannes Gutenberg University Mainz, Germany
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Rasmussen T, Fonnes S, Rosenberg J. Long-Term Complications of Appendectomy: A Systematic Review. Scand J Surg 2018; 107:189-196. [PMID: 29764306 DOI: 10.1177/1457496918772379] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Appendectomy is a common surgical procedure, but no overview of the long-term consequences exists. Our aim was to systematically review the long-term complications of appendectomy for acute appendicitis. MATERIALS AND METHODS This systematic review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A protocol was registered on PROSPERO (CRD42017064662). The databases PubMed and EMBASE were searched for original reports on appendectomy with n ≥ 500 and follow-up >30 days. The surgical outcomes were ileus and incisional hernia; other outcomes were inflammatory bowel disease, cancer, fertility, and mortality. RESULTS We included 37 studies. The pooled estimate of the ileus prevalence was 1.0% over a follow-up period of 4.6 (range, 0.5-15) years. Regarding incisional hernia, we found a pooled estimate of 0.7% prevalence within a follow-up period of 6.5 (range, 1.9-10) years. Ulcerative colitis had a pooled estimate of 0.15% prevalence in the appendectomy group and 0.19% in controls. The opposite pattern was found regarding Crohn's disease with a pooled estimate of 0.20% prevalence in the appendectomy group and 0.12% in controls. No clear pattern was found regarding most of the examined cancers in appendectomy groups compared with background populations. Pregnancy rates increased after appendicitis compared with controls in most studies. Mortality was low after appendectomy. CONCLUSION Appendectomy had a low prevalence of long-term surgical complications. We did not find any significant other long-term complications, though the prevalence of Crohn's disease was higher and the prevalence of ulcerative colitis was lower after appendectomy than in controls. Appendectomy did not impair fertility.
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Affiliation(s)
- T Rasmussen
- Centre for Perioperative Optimization (CPO), Department of Surgery, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - S Fonnes
- Centre for Perioperative Optimization (CPO), Department of Surgery, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - J Rosenberg
- Centre for Perioperative Optimization (CPO), Department of Surgery, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
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Gleicher N, Kushnir VA, Barad DH. Redirecting reproductive immunology research toward pregnancy as a period of temporary immune tolerance. J Assist Reprod Genet 2017; 34:425-430. [PMID: 28188592 PMCID: PMC5401695 DOI: 10.1007/s10815-017-0874-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 01/16/2017] [Indexed: 01/06/2023] Open
Abstract
Referring to two recent publications, we here propose that clinical reproductive immunology has for decades stagnated because reproductive medicine, including assisted reproduction (AR), has failed to accept embryo implantation as an immune system-driven process, dependent on establishment of maternal tolerance toward the implanting fetal semi-allograft (and complete allograft in cases of oocyte donation). Pregnancy represents a biologically unique period of temporary (to the period of gestation restricted) tolerance, otherwise only known in association with parasitic infections. Rather than investigating the immune pathways necessary to induce this rather unique state of tolerance toward the rapidly growing parasitic antigen load of the fetus, the field, instead, concentrated on irrelevant secondary immune phenomena (i.e., "immunological noise"). It, therefore, does not surprise that interesting recent research, offering new potential insights into maternal tolerance during pregnancy, was mostly published outside of the field of reproductive medicine. This research offers evidence for existence of inducible maternal tolerance pathways with the ability of improving maternal fecundity and, potentially, reducing such late pregnancy complications as premature labor and preeclampsia/eclampsia due to premature abatement of maternal tolerance. Increasing evidence also suggests that tolerance-inducing immune pathways are similar in successful pregnancy, successful organ transplantation and, likely also in the tolerance of "self" (i.e., prevention of autoimmunity). Identifying and isolating these pathways, therefore, may greatly benefit all three of these clinical areas, and research in reproductive immunology should be accordingly redirected.
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Affiliation(s)
- Norbert Gleicher
- The Center for Human Reproduction, 21 East 69th Street, New York, NY, 10021, USA.
- Foundation for Reproductive Medicine, New York, NY, 10022, USA.
- Laboratory of Stem Cell Biology and Molecular Embryology, The Rockefeller University, New York, NY, 10065, USA.
- Department of Obstetrics and Gynecology, University of Vienna School of Medicine, 1090, Vienna, Austria.
| | - Vitaly A Kushnir
- The Center for Human Reproduction, 21 East 69th Street, New York, NY, 10021, USA
- Department of Obstetrics and Gynecology, Wake Forest University, Winston Salem, NC, 27109, USA
| | - David H Barad
- The Center for Human Reproduction, 21 East 69th Street, New York, NY, 10021, USA
- Foundation for Reproductive Medicine, New York, NY, 10022, USA
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Blumenfeld Z. Appendectomy, tonsillectomy, and conceptions. Fertil Steril 2016; 106:1043-1044. [PMID: 27473354 DOI: 10.1016/j.fertnstert.2016.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 07/01/2016] [Indexed: 01/07/2023]
Affiliation(s)
- Zeev Blumenfeld
- Reproductive Endocrinology, Department of Obstetrics and Gynecology, Rambam Health Care Campus, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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