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Chen WA, Wu CL, Ho HY, Chang F, Yang JH, Kung FT, Chen MJ, Chen MJ. Social determinants of health that impact the time to diagnosis and treatment of infertility in Taiwan. J Formos Med Assoc 2024:S0929-6646(24)00238-9. [PMID: 38710607 DOI: 10.1016/j.jfma.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 05/01/2024] [Accepted: 05/03/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND/PURPOSE Taiwan is one of the countries with the lowest birth rate in the world. We investigated factors associated with the time to diagnosis and treatment of infertility in Taiwan. METHODS The study was conducted through an online questionnaire in December 2021. The questionnaire was adapted from a previously published multinational survey, and culture-specific questions were added. 91 infertile patients and 89 partners of patients in Taiwan, aged 20- to 45- year-old, were included. RESULTS The average duration before diagnosis was 2.9 years, followed by 1.5 years before treatment. Older age at marriage (p = 0.0024), higher education level (P = 0.0001), and a higher gender equality score (p = 0.0031) were associated with earlier diagnosis. Conversely, folk therapy use was linked to later diagnosis (p < 0.0001) and treatment (p < 0.0001). Notably, in the female (p = 0.039) and patient (p = 0.0377) subgroups, a higher gender equality score was associated with a shorter duration of folk therapy. Subjectively, the most frequent factor influencing treatment decision was affordability or lack thereof. The government subsidy for in vitro fertilization led to increased treatment willingness for 46.3% of respondents, and 47.3% reported more likely to pursue earlier treatment. CONCLUSIONS This study highlights the influence of education, gender equality, folk therapy, and government subsidy on fertility care decisions. To improve the timeliness of infertility healthcare in Taiwan, potential strategies include promoting education, fostering gender equality, providing financial support, and raising awareness on the association between folk therapy and delayed medical care.
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Affiliation(s)
- Wei-An Chen
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, No. 7, Zhongshan S. Rd., Taipei City, 100, Taiwan.
| | - Chia-Ling Wu
- Department of Sociology, National Taiwan University, No. 1, Sec. 4, Roosevelt Rd., Taipei City, 106, Taiwan.
| | - Hsin-Yi Ho
- Department of Obstetrics and Gynecology, Taiwan Adventist Hospital, No. 424, Sec. 2, Bade Rd., Taipei City, 105, Taiwan.
| | - Fan Chang
- Chang's Fertility Center, No. 566, Sec. 3, Taiwan Blvd., Taichung City, 407, Taiwan.
| | - Jehn-Hsiahn Yang
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, No. 7, Zhongshan S. Rd., Taipei City, 100, Taiwan.
| | - Fu-Tsai Kung
- Department of Obstetrics and Gynecology, Kaoshiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No. 123, Dapi Rd., Kaohsiung City, 833, Taiwan.
| | - Ming-Jer Chen
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Women's Health, Taichung Veterans General Hospital, No. 1650, Sec. 4, Taiwan Blvd., Taichung City, 407, Taiwan; Department of Obstetrics and Gynecology, School of Medicine, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong St., Taipei City, 112, Taiwan.
| | - Mei-Jou Chen
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, No. 7, Zhongshan S. Rd., Taipei City, 100, Taiwan; Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, No. 1, Sec. 1, Jenai Rd., Taipei City, 100, Taiwan.
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Fauser BCJM, Adamson GD, Boivin J, Chambers GM, de Geyter C, Dyer S, Inhorn MC, Schmidt L, Serour GI, Tarlatzis B, Zegers-Hochschild F. Declining global fertility rates and the implications for family planning and family building: an IFFS consensus document based on a narrative review of the literature. Hum Reprod Update 2024; 30:153-173. [PMID: 38197291 PMCID: PMC10905510 DOI: 10.1093/humupd/dmad028] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 09/25/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Family-planning policies have focused on contraceptive approaches to avoid unintended pregnancies, postpone, or terminate pregnancies and mitigate population growth. These policies have contributed to significantly slowing world population growth. Presently, half the countries worldwide exhibit a fertility rate below replacement level. Not including the effects of migration, many countries are predicted to have a population decline of >50% from 2017 to 2100, causing demographic changes with profound societal implications. Policies that optimize chances to have a child when desired increase fertility rates and are gaining interest as a family-building method. Increasingly, countries have implemented child-friendly policies (mainly financial incentives in addition to public funding of fertility treatment in a limited number of countries) to mitigate decreasing national populations. However, the extent of public spending on child benefits varies greatly from country to country. To our knowledge, this International Federation of Fertility Societies (IFFS) consensus document represents the first attempt to describe major disparities in access to fertility care in the context of the global trend of decreasing growth in the world population, based on a narrative review of the existing literature. OBJECTIVE AND RATIONALE The concept of family building, the process by which individuals or couples create or expand their families, has been largely ignored in family-planning paradigms. Family building encompasses various methods and options for individuals or couples who wish to have children. It can involve biological means, such as natural conception, as well as ART, surrogacy, adoption, and foster care. Family-building acknowledges the diverse ways in which individuals or couples can create their desired family and reflects the understanding that there is no one-size-fits-all approach to building a family. Developing education programs for young adults to increase family-building awareness and prevent infertility is urgently needed. Recommendations are provided and important knowledge gaps identified to provide professionals, the public, and policymakers with a comprehensive understanding of the role of child-friendly policies. SEARCH METHODS A narrative review of the existing literature was performed by invited global leaders who themselves significantly contributed to this research field. Each section of the review was prepared by two to three experts, each of whom searched the published literature (PubMed) for peer reviewed full papers and reviews. Sections were discussed monthly by all authors and quarterly by the review board. The final document was prepared following discussions among all team members during a hybrid invitational meeting where full consensus was reached. OUTCOMES Major advances in fertility care have dramatically improved family-building opportunities since the 1990s. Although up to 10% of all children are born as a result of fertility care in some wealthy countries, there is great variation in access to care. The high cost to patients of infertility treatment renders it unaffordable for most. Preliminary studies point to the increasing contribution of fertility care to the global population and the associated economic benefits for society. WIDER IMPLICATIONS Fertility care has rarely been discussed in the context of a rapid decrease in world population growth. Soon, most countries will have an average number of children per woman far below the replacement level. While this may have a beneficial impact on the environment, underpopulation is of great concern in many countries. Although governments have implemented child-friendly policies, distinct discrepancies in access to fertility care remain.
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Affiliation(s)
- Bart C J M Fauser
- University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
| | | | | | | | | | - Silke Dyer
- Groot Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Adamson GD, Zegers-Hochschild F, Dyer S. Global fertility care with assisted reproductive technology. Fertil Steril 2023; 120:473-482. [PMID: 36642305 DOI: 10.1016/j.fertnstert.2023.01.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 01/09/2023] [Indexed: 01/13/2023]
Abstract
Assisted reproductive technology has progressed greatly since the birth of Louise Brown in 1978. The pregnancy rates have increased, care is safer with significantly reduced multiple pregnancy and complication rates, infants have good health, and millions of people have been able to have the families they desired. The major challenges facing assisted reproductive technology are to continue to increase the quality of care, increase utilization through more societal funding, and expand care to nontraditional and marginalized populations in all countries, especially lower- and middle-income countries where access is currently limited. Significant collaboration among professionals, organizations, the World Health Organization, and policymakers is occurring and will be necessary to achieve these goals.
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Affiliation(s)
- G David Adamson
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, ACF, Stanford University, Stanford, California.
| | - Fernando Zegers-Hochschild
- Programa de Ética y Políticas Públicas en Reproducción Humana Facultad de Medicina, Universidad Diego Portales, Santiago, Chile
| | - Silke Dyer
- Reproductive Medicine Unit, Department of Obstetrics and Gynaecology, University of Cape Town, Cape Town, South Africa
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Mackay A, Taylor S, Glass B. Inequity of Access: Scoping the Barriers to Assisted Reproductive Technologies. PHARMACY 2023; 11:pharmacy11010017. [PMID: 36649027 PMCID: PMC9887590 DOI: 10.3390/pharmacy11010017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/12/2023] [Accepted: 01/12/2023] [Indexed: 01/18/2023] Open
Abstract
Infertility impacts millions of people of reproductive age worldwide, with approximately 10-15% of couples affected. When infertility is present, there are many potential barriers to treatment, leading to inequity of access. Assisted reproductive technologies (ART) are the mainstay of medical treatment for infertility and include procedures such as in vitro fertilisation. This scoping review aims to explore the barriers to accessing assisted reproductive technologies to highlight a potential role for the pharmacist in addressing these barriers. Five databases, including CINAHL, Emcare, Medline, Scopus, and Web of Science, were searched using keywords that resulted in 19 studies that explored barriers to initially accessing or continuing ART. Studies identified more than one barrier to accessing ART, with the most mentioned barrier being the geographic location of the patient, with others themed as psychological, financial, minority groups, educational level, and the age of the patient. Recommendations were made to address barriers to accessing ART, which included changes to government regulations to increase health education and promotion of infertility. Pharmacists' accessibility, even in geographically remote locations, places them in an ideal position to address many of the challenges experienced by people accessing infertility treatment to improve outcomes for these people.
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Affiliation(s)
- Amanda Mackay
- Pharmacy, College of Medicine and Dentistry, James Cook University, Douglas, Townsville, QLD 4811, Australia
- Correspondence:
| | - Selina Taylor
- Centre for Rural and Remote Health, James Cook University, Mount Isa, QLD 4825, Australia
| | - Beverley Glass
- Pharmacy, College of Medicine and Dentistry, James Cook University, Douglas, Townsville, QLD 4811, Australia
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Nargund G, Datta A, Campbell S, Patrizio P, Chian R, Ombelet W, Von Woolf M, Lindenberg S, Frydman R, Fauser BC. The case for mild stimulation for IVF: ISMAAR recommendations. Reprod Biomed Online 2022; 45:1133-1144. [DOI: 10.1016/j.rbmo.2022.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/25/2022] [Accepted: 07/29/2022] [Indexed: 10/16/2022]
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Jwa SC, Ishihara O, Kuwahara A, Saito K, Saito H, Terada Y, Kobayashi Y, Maeda E. Social capital and use of assisted reproductive technology in young couples: Ecological study using application information for government subsidies in Japan. SSM Popul Health 2021; 16:100995. [PMID: 34950764 PMCID: PMC8671120 DOI: 10.1016/j.ssmph.2021.100995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 11/28/2021] [Accepted: 12/03/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Assisted reproductive technology (ART) is a globally established treatment; however, large disparities exist in ART use among young couples. We investigated regional-level factors associated with ART use in Japan. METHODS We calculated the use rate of ART using the number of women aged <35 years who applied for government subsidies in 2017; we divided that figure by the number of women aged 20-35 years in each prefecture. Prefectural-level average household income; social capital indicators including voting rate, volunteer rate, and move-in rate; and Gini coefficients as indicators of income inequality were linked to ART use, adjusting for prefectural size, the mean age of women at first marriage, number of ART facilities, and additional prefectural subsidies. RESULTS The rate of ART use (per 10,000 women) varied significantly from 22.0 to 58.8 across Japan's 47 prefectures. Multivariate analysis demonstrated that the use rate increased by 0.048 (95% confidence interval [CI], 0.007 to 0.088) for each 10,000-yen increase in average household income and 1.5 (95% CI, 0.65 to 2.3) for each 1% increase in volunteer rate. Conversely, the use rate decreased by 18.4 (95% CI, -28.6 to -8.1) for each 1% increase in the move-in rate. There was no significant association between ART use and income inequality. CONCLUSION Although we cannot infer causal relationships, the findings suggest that improving financial access and enhancing social capital may increase access to ART. Further research, particularly multilevel analysis using individual data, is required to confirm these findings.
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Affiliation(s)
- Seung Chik Jwa
- Department of Obstetrics and Gynecology, Saitama Medical University, 38 Morohongo, Moroyama, Saitama, 350-0495, Japan
| | - Osamu Ishihara
- Department of Obstetrics and Gynecology, Saitama Medical University, 38 Morohongo, Moroyama, Saitama, 350-0495, Japan
| | - Akira Kuwahara
- Department of Obstetrics and Gynecology, Graduate School of Biomedical Sciences, Tokushima University, 3-18-15, Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Kazuki Saito
- Department of Pediatrics, Perinatal, and Maternal Medicine (Ibaraki), Graduate School, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Hidekazu Saito
- Umegaoka Women's Clinic, 1-33-3, Umegaoka, Setagaya-ku, Tokyo, 154-0022, Japan
| | - Yukihiro Terada
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Akita University, 1-1-1, Hondo, Akita, 010-8543, Japan
| | - Yasuki Kobayashi
- Department of Public Health, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Eri Maeda
- Department of Environmental Health Science and Public Health, Akita University Graduate School of Medicine, 1-1-1, Hondo, Akita, 010-8543, Japan
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Somigliana E, Bertoli M, Caputo A, Reschini M, Bardiani I, Bruno GM, Di Matteo S, Colombo GL. Wastage of gonadotropins during IVF cycles: Real life data from two Italian infertility centers. Eur J Obstet Gynecol Reprod Biol 2021; 267:56-60. [PMID: 34715508 DOI: 10.1016/j.ejogrb.2021.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 10/04/2021] [Accepted: 10/13/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Gonadotropins represent an important component of IVF costs. In order to reduce costs, much attention was given to the type of gonadotropins (recombinant versus urinary) and the daily dose. In this study, we decided to focus on gonadotropin wastage, a neglected aspect that may harbor a relevant source of useless economic expenditure. MATERIALS AND METHODS Women who performed oocytes collection following ovarian hyperstimulation with gonadotropins in two Italian IVF Centers were prospectively recruited. They were interviewed using a standardized questionnaire aimed at capturing drug wastage. Physicians of the participating units were blinded to the study. Recruited women were requested to hide their participation to their physicians. RESULTS Three-hundred nine women were recruited. Two hundred eighty-eight (93 %; 95 %CI: 90-96 %) reported to have wasted some drug. For the whole cohort, the median [Interquartile range] IUs of drug used and drug wasted was 2,100 [1,575 - 2,850] and 825 [400 - 1,200], respectively. This corresponds to a median increase in the costs of ovarian hyperstimulation of 39 %. When data on wastage was analyzed separately for the different available drugs, a statistically significant difference emerged (p = 0.026). Reasons behind this difference could not be clearly disentangled. CONCLUSIONS IVF is associated with a considerable wastage of gonadotropins. Improving this aspect can allow to reduce the costs of the procedure.
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Affiliation(s)
- Edgardo Somigliana
- Dept of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Massimo Bertoli
- Infertility Unit, Dept Obstetrics and Gynecology, "Carlo Poma" Hospital, Mantova, Italy
| | - Alessandra Caputo
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marco Reschini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Ivana Bardiani
- Infertility Unit, Dept Obstetrics and Gynecology, "Carlo Poma" Hospital, Mantova, Italy
| | - Giacomo M Bruno
- S.A.V.E. Studi Analisi Valutazioni Economiche S.r.l, Health Economics & Outcomes Research, Milan, Italy; Dept of Drug Sciences, Università degli Studi di Pavia, Pavia, Italy
| | - Sergio Di Matteo
- S.A.V.E. Studi Analisi Valutazioni Economiche S.r.l, Health Economics & Outcomes Research, Milan, Italy
| | - Giorgio L Colombo
- S.A.V.E. Studi Analisi Valutazioni Economiche S.r.l, Health Economics & Outcomes Research, Milan, Italy; Dept of Drug Sciences, Università degli Studi di Pavia, Pavia, Italy
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