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Limena A, Reschini M, Invernici D, Parazzini F, Li Piani L, Viganò P, Somigliana E, Basili L. Return rate following a live birth obtained with ART: frequency and determinants. Arch Gynecol Obstet 2024; 309:1621-1627. [PMID: 38310582 PMCID: PMC10894172 DOI: 10.1007/s00404-024-07382-9] [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: 10/31/2023] [Accepted: 01/07/2024] [Indexed: 02/06/2024]
Abstract
PURPOSE To understand how often couples return to ART centres for a second child. METHODS Retrospective monocentric cohort study including women who had a first live birth with IVF. The primary objective was to assess the rate of those returning for a second child within five years of the previous pregnancy. The secondary aim was to disentangle the determinants of this rate. RESULTS A total of 374 patients were included, of whom 188 returned (50%, 95% CI 45-55%). Among those who did not return (n = 186), four (2%) referred to another ART Center and 24 were unreachable. Of the 158 contacted subjects that did not refer for ART, 53 (34%, 95% CI 27-41%) conceived naturally, 57 (36%, 95% CI 29-44%) abandoned their intent of parenthood, and 48 (30%, 95% CI 24-38%) unsuccessfully attempted natural conception. These 48 women (13%) who expressed interest in a second child but did not undergo ART were compared to those seeking a second pregnancy through ART. Baseline characteristics were similar except for an older age (Median 36, IQR: 34-38 vs 34, IQR: 32-36, p = 0.001). Additionally, in terms of IVF cycle characteristics, women who did not return were more likely to achieve their first pregnancy with a fresh transfer rather than a frozen transfer (75% vs 59%, p = 0.05). They also had a higher number of retrieved oocytes (Median 10, IQR: 7-13 vs 9, IQR: 5-12) and less frequently cryopreserved embryos (27% vs 52%, p = 0.003). CONCLUSION The proportion of couples who have conceived with ART and who are interested in having a second child is high. Our results underline the importance of paying more attention to the number of intended children, as this information could influence clinical management.
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Affiliation(s)
- Alessia Limena
- Department of Clinical Sciences and Community Health, Università Degli Studi Di Milano, Milan, Italy.
- Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via M. Fanti, 6, 20122, Milan, Italy.
| | - Marco Reschini
- Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via M. Fanti, 6, 20122, Milan, Italy
| | - Dalila Invernici
- Department of Clinical Sciences and Community Health, Università Degli Studi Di Milano, Milan, Italy
| | - Fabio Parazzini
- Department of Clinical Sciences and Community Health, Università Degli Studi Di Milano, Milan, Italy
| | - Letizia Li Piani
- Department of Clinical Sciences and Community Health, Università Degli Studi Di Milano, Milan, Italy
| | - Paola Viganò
- Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via M. Fanti, 6, 20122, Milan, Italy
| | - Edgardo Somigliana
- Department of Clinical Sciences and Community Health, Università Degli Studi Di Milano, Milan, Italy
- Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via M. Fanti, 6, 20122, Milan, Italy
| | - Ludovica Basili
- Department of Clinical Sciences and Community Health, Università Degli Studi Di Milano, Milan, Italy
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Chen X, Liang J, Yang Q, Huang J, Li L, Deng K. Age affects the association between socioeconomic status and infertility: a cross-sectional study. BMC Womens Health 2023; 23:675. [PMID: 38115086 PMCID: PMC10729442 DOI: 10.1186/s12905-023-02680-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 09/30/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Previous studies have shown the interaction between age and socioeconomic status (SES) on the risk of infertility in the UK, but the association is still unclear in the United States. Therefore, the present study investigated the effect of age on the relationship between SES and the risk of infertility in American women. METHODS The study included adults who participated in the National Health and Nutrition Examination Survey (NHANES) from 2013 to 2018. The poverty income ratio (PIR) was used to represent the SES of the population. With participants stratified according to age category (< 35 years; ≥ 35 years), we further assessed differences in the relationship between PIR and infertility risk among participants of different age groups using multivariate logistic regression and interaction tests. RESULTS Approximately 3,273 participants were enrolled in the study. There were 399 cases of infertility and 2,874 cases without infertility. In women ≥ 35 years of age, PIR levels were significantly higher in infertile participants than in non-infertile participants, but no such difference was found in those < 35 years of age. The association of PIR with the risk of infertility appeared to differ between age < 35 years and age ≥ 35 years (OR: 0.99, 95%Cl: 0.86-1.13 vs. OR: 1.24, 95%Cl: 1.12-1.39) in a fully adjusted model. Furthermore, an interaction between age and PIR increased the risk of infertility (p-value for interaction < 0.001). CONCLUSION Our study found that age may influence the association between PIR and infertility. It is imperative to perform further studies to provide more evidence.
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Affiliation(s)
- Xiting Chen
- Department of Gynecology, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), No.1 Jiazi Road, Lunjiao, Shunde District, Foshan City, 528308, Guangdong Province, China
| | - Jiemei Liang
- Department of Gynecology, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), No.1 Jiazi Road, Lunjiao, Shunde District, Foshan City, 528308, Guangdong Province, China
| | - Qian Yang
- Department of Gynecology, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), No.1 Jiazi Road, Lunjiao, Shunde District, Foshan City, 528308, Guangdong Province, China
| | - Jinfa Huang
- Department of Gynecology, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), No.1 Jiazi Road, Lunjiao, Shunde District, Foshan City, 528308, Guangdong Province, China
| | - Lixin Li
- Department of Gynecology, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), No.1 Jiazi Road, Lunjiao, Shunde District, Foshan City, 528308, Guangdong Province, China
| | - Kaixian Deng
- Department of Gynecology, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), No.1 Jiazi Road, Lunjiao, Shunde District, Foshan City, 528308, Guangdong Province, China.
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Esposito G, Viganò P, Filippi F, Franchi M, Corrao G, Parazzini F, Somigliana E. The modest impact of assisted reproductive technology on the second birth: insights from a population-based study in Lombardy, Northern Italy. Eur J Obstet Gynecol Reprod Biol 2023; 288:56-60. [PMID: 37429199 DOI: 10.1016/j.ejogrb.2023.06.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 06/20/2023] [Accepted: 06/26/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND In the field of assisted reproductive technology (ART), family rate is a neglected but emerging issue. The aim of the study was to investigate the epidemiological impact of ART on the second birth during the period 2007-2020 in Lombardy, Northern Italy. METHODS We conducted a population-based study using administrative data from regional healthcare databases of Lombardy including first and second births occurred from 2007 to 2020. The proportion of deliveries after ART was calculated separately among first and second births. The probability of undergoing ART to achieve second birth compared to first one was estimated computing odds ratio (OR), crude and adjusted for maternal age, education, and nationality. We also assessed changes with age and calendar period. RESULTS We obtained a cohort including 553,190 first births and 317,976 second births. The proportion of ART babies among first and second births was 4.3% and 1.0% respectively (p < 0.001). The probability of undergoing ART to achieve second birth compared to first one, adjusted for age, education, and nationality, was 0.14 (95%CI: 0.13-0.15). The proportion of deliveries after ART increased with maternal age and along the calendar period but remained always markedly higher among first births rather than among second births. CONCLUSION ART played a significantly lower role in the determinism of the conception of a second birth in comparison to the conception of a first one.
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Affiliation(s)
- Giovanna Esposito
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
| | - Paola Viganò
- Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesca Filippi
- Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Matteo Franchi
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy; National Centre for Healthcare Research and Pharmacoepidemiology, Milan, Italy
| | - Giovanni Corrao
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy; National Centre for Healthcare Research and Pharmacoepidemiology, Milan, Italy
| | - Fabio Parazzini
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Edgardo Somigliana
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Somigliana E, Parazzini F, Goisis A, Esposito G, Li Piani L, Filippi F, Vigano' P. ART and the forgotten siblings: a call for research. Hum Reprod 2023:7147080. [PMID: 37119532 DOI: 10.1093/humrep/dead082] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 02/19/2023] [Indexed: 05/01/2023] Open
Abstract
A broader definition of infertility is the incapacity to have the intended number of children. However, most literature on ART exclusively focuses on live birth as an outcome, rather than on the capacity to fully realize the reproductive wishes of the couples. This issue has probably received scant attention because the total fertility rate is below replacement levels in affluent countries, and one may simplistically assume that only a minority of couples may be interested in more than one child. This assumption, however, is unproven and presumably erroneous. Unfortunately, evidence on the rate of return in couples who conceived their first child with ART is scant and information on the intended number of children in infertile couples is lacking. In general, we plea for more research on this subject. The documentation of an intended number of children above two and a high return rate in infertile couples may lead to changes in clinical practice, such as the storage of oocytes or embryos prior to initiating embryo transfers. This could improve the chance of conceiving the second child when the couple comes back some years later. In addition, the identification of the determinants for non-return as well as those explaining the gap between the intended and the realized number of children may reveal specific barriers and possibly how to tackle them. However, at present, available evidence is insufficient to advocate any intervention. Thorough research is warranted.
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Affiliation(s)
- Edgardo Somigliana
- Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Fabio Parazzini
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Alice Goisis
- Social Research Institute, University College London, London, UK
| | - Giovanna Esposito
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Letizia Li Piani
- Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Francesca Filippi
- Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paola Vigano'
- Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Ottolina J, Vignali M, Papaleo E, Viganò P, Somigliana E, Ferrari S, Liprandi V, Belloni G, Reschini M, Candiani M, Vercellini P, Benaglia L. Surgery versus IVF for the treatment of infertility associated to ovarian and deep endometriosis (SVIDOE: Surgery Versus IVF for Deep and Ovarian Endometriosis). Clinical protocol for a multicenter randomized controlled trial. PLoS One 2022; 17:e0271173. [PMID: 35921357 PMCID: PMC9348732 DOI: 10.1371/journal.pone.0271173] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 06/23/2022] [Indexed: 11/18/2022] Open
Abstract
The management of endometriosis-related infertility is still a challenging issue. Women can be managed with either surgery or in vitro fertilization (IVF). The decision is tailored to the patients considering pros and cons of both approaches. Surgery might increase the chances of natural conception and relieve symptoms. IVF may be more effective, but costs are higher and unoperated women face some peculiar additional risks during the procedure and pregnancy. The unavailability of randomized trials comparing the two strategies hampers the possibility to provide precise estimates. This Randomized Controlled Trial (RCT) aims at filling this gap. This is a multicenter, non-blinded, randomized controlled trial with parallel groups and allocation 1:1. Three Italian Academic Infertility Units will be involved. Main inclusion criteria are infertility for more than one year, age less than 40 years and a sonographic diagnosis of endometriosis (ovarian endometriomas or deep peritoneal lesions). Previous IVF and previous surgery for endometriosis are exclusion criteria. Women will be randomized to either surgery and then natural pregnancy seeking or a standard program of three IVF cycles. The primary aim is the comparison of live birth rate between the two groups (IVF versus surgery) within one year of randomization. The secondary aim is the evaluation of cost-effective profile of the two interventions. The present study can influence the clinical practice of infertility treatment in women with endometriosis. From a public health perspective, information on the more cost-effective clinical management strategy would consent a wiser allocation of resources. Trial registration:NCT04743167, registered on 8 February 2021.
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Affiliation(s)
- Jessica Ottolina
- Department of Gynecology and Obstetrics, San Raffaele Scientific Institute, Milan, Italy
- * E-mail:
| | - Michele Vignali
- Department of Biomedical Sciences for Health, Macedonio Melloni Hospital, University of Milan, Milan, Italy
| | - Enrico Papaleo
- Department of Gynecology and Obstetrics, San Raffaele Scientific Institute, Milan, Italy
| | - Paola Viganò
- Department of Gynecology and Obstetrics, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Edgardo Somigliana
- Department of Gynecology and Obstetrics, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Stefano Ferrari
- Department of Gynecology and Obstetrics, San Raffaele Scientific Institute, Milan, Italy
| | - Valeria Liprandi
- Department of Biomedical Sciences for Health, Macedonio Melloni Hospital, University of Milan, Milan, Italy
| | - Gaia Belloni
- Department of Biomedical Sciences for Health, Macedonio Melloni Hospital, University of Milan, Milan, Italy
| | - Marco Reschini
- Department of Gynecology and Obstetrics, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Massimo Candiani
- Department of Gynecology and Obstetrics, San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Vercellini
- Department of Gynecology and Obstetrics, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Laura Benaglia
- Department of Gynecology and Obstetrics, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
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Alteri A, Pisaturo V, Somigliana E, Viganò P. Cryopreservation in reproductive medicine during the COVID-19 pandemic: rethinking policies and European safety regulations. Hum Reprod 2021; 35:2650-2657. [PMID: 32744638 PMCID: PMC7454562 DOI: 10.1093/humrep/deaa210] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/14/2020] [Indexed: 12/29/2022] Open
Abstract
Cryopreservation of reproductive cells and tissues represents an essential aspect of ART practices that might be particularly strategic and helpful during severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emergency. However, recommendations on how and when to preserve reproductive tissues and cells during a novel severe pandemic are scanty. This article uses a SWOT (strengths, weaknesses, opportunities and threats) analysis to identify favourable and unfavourable factors and to recognize challenges and obstacles related to the use of cryopreservation procedures during the spreading of a new virus. One of the strengths associated with the cryopreservation is represented by the availability of robust European guidelines on storage safety to prevent sample contamination or cross-contamination by pathogens. These recommendations should be deep-rooted in all ART laboratories. Weaknesses include uncertainties regarding the management of COVID-19 affected asymptomatic patients, the suboptimal accuracy of diagnostic tests for the disease, the nebulous prospective regarding the duration of the pandemic and the additional costs. The application of the strategy represents an opportunity to postpone pregnancy in order to avoid a severe infectious disease during gestation while concomitantly counteracting the possible detrimental effect of time. Critical threats, at present still undefined, are represented by potential adverse events for the mother and offspring due to infected gametes or embryos after thawing and, subsequently, the re-spreading of the virus.
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Affiliation(s)
- Alessandra Alteri
- Obstetrics and Gynaecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Valerio Pisaturo
- Reproductive Medicine Department, International Evangelical Hospital, Genoa, Italy
| | - Edgardo Somigliana
- Obstetrics and Gynaecology Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Paola Viganò
- Reproductive Sciences Laboratory, Obstetrics and Gynaecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Liao S, Jin L, Dai W, Huang G, Pan W, Hu C, Pan W. A machine learning‐based risk scoring system for infertility considering different age groups. INT J INTELL SYST 2020. [DOI: 10.1002/int.22344] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- ShuJie Liao
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College Huazhong University of Science and Technology Wuhan Hubei China
| | - Lei Jin
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College Huazhong University of Science and Technology Wuhan Hubei China
| | - Wan‐Qiang Dai
- School of Economic and Management Wuhan University Wuhan China
| | - Ge Huang
- School of Economic and Management Wuhan University Wuhan China
| | - Wulin Pan
- School of Economic and Management Wuhan University Wuhan China
| | - Cheng Hu
- School of Economic and Management Wuhan University Wuhan China
| | - Wei Pan
- School of Applied Economics Renmin University of China Beijing China
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