Pregnancy management of IVF-ET pregnancies in a patient with classical 21-hydroxylase deficiency: A case report and review of the literature

OBJECTIVE

To report a rare case of a woman with classical 21-hydroxylase deficiency who twice had singleton pregnancies with live births after in vitro fertilization and embryo transfer (IVF-ET).

DESIGN

Case report and literature review.

PATIENT

A 35-year-old woman with classical 21-hydroxylase deficiency underwent external genital plastic surgery during adolescence and achieved second pregnancy after IVF-ET with long-term glucocorticoid replacement therapy.

METHODS

During regular antenatal testing, we focus on monitoring patients' weight gain, blood pressure, increasing trend of uterine height and abdominal circumference, and fetal growth trend. Individualized glucocorticoid therapy during pregnancy, glucocorticoid stress dose at delivery, management of systemic metabolism to prevent maternal and infant complications, and newborn screening are realized.

RESULT

In the second pregnancy, the glucocorticoid dosage was not increased. 17-hydroxyprogesterone and testosterone tended to increase in late pregnancy, but they were lower than in the first pregnancy. Blood pressure and blood glucose were normal, but lipids were abnormally elevated, D-dimer also showed a sharp rise under labor stress. A mature male infant was delivered by cesarean at 33+4 weeks of gestation due to placental abruption.

CONCLUSION

Repeated pregnancies in patients with classical 21-hydroxylase deficiency are rare, especially with Assisted Reproductive Technology. We present a case including a comparison of her two pregnancy monitoring indicators, glucocorticoid medication and delivery to achieve a successful delivery. We review the available literature to analyze pregnancies with classical 21-hydroxylase deficiency.

A bivariate Poisson regression to analyse impact of outlier women on correlation between female schooling and fertility in Malawi

BACKGROUND

Women's levels of education and fertility are commonly associated. In Sub-Saharan Africa, the pace of decreasing fertility rates varies greatly, and this is linked to women's levels of education. However, this association may be influenced by unusual females who have uncommon measurements on both variables. Despite this, most studies that researched this association have only analysed the data descriptively, without taking into account the effect of potential outliers. This study aimed to examine the presence and impact of outlier women on the relationship between female education and fertility in Malawi, using regression methods.

METHODS

To analyse the correlation between women's schooling and fertility and evaluate the effect of outliers on this relationship, a bivariate Poisson model was applied to three recent demographic and health surveys in Malawi. The R software version 4.3.0 was used for model fitting, outlier computations, and correlation analysis. The STATA version 12.0 was used for data cleaning.

RESULTS

The findings revealed a correlation of -0.68 to -0.61 between schooling and fertility over 15 years in Malawi. A few outlier women were identified, most of whom had either attended 0 or at least 9 years of schooling and had born either 0 or at least 5 children. The majority of the outliers were non-users of modern contraceptive methods and worked as domestic workers or were unemployed. Removing the outliers from the analysis led to marked changes in the fixed effects sizes and slight shifts in correlation, but not in the direction and significance of the estimates. The woman's marital status, occupation, household wealth, age at first sex, and usage of modern contraceptives exhibited significant effects on education and fertility outcomes.

CONCLUSION

There is a high negative correlation between female schooling and fertility in Malawi. Some outlier women were identified, they had either attended zero or at least nine years of schooling and had either born zero or at least five children. Most of them were non-users of modern contraceptives and domestic workers. Their impact on regression estimates was substantial, but minimal on correlation. Their identification highlights the need for policymakers to reconsider implementation strategies for modern contraceptive methods to make them more effective.

Does Abortion Liberalisation Accelerate Fertility Decline? A Worldwide Time-Series Analysis

Since WWII, the two most important global trends in family planning have been fertility decline and abortion liberalisation. But are they related? Specifically: Does abortion liberalisation affect changes in fertility rates? The demographic literature has yet to answer this important question and instead offers two opposing predictions. Some studies argue that liberalisation of this medical procedure reduces fertility rates. By contrast, others note that such legal reforms may merely have an average, negligible effect on fertility levels. We adjudicate between the two approaches by conducting, in our view, the most comprehensive global, quantitative analysis of the relationship between those legal reforms and changing fertility rates. The analysis relies on two-way fixed models and three different indicators of abortion policy liberalism created by independent research teams to estimate the relationship between abortion liberalisation and total fertility changes. The data cover 185 independent states between 1970 and 2019. Fertility rates are significantly related to average public education levels and alternative contraceptive use. Using multiple model specifications, however, abortion reforms do not have a robust association with the outcome. Replication materials for this article can be found at https://figshare.com/s/5336a4422f47c8c39228 .

Impact of Alpinia galanga and zinc on semen quality and some reproductive hormone constituents in California rabbit bucks

The objective of the current study was to investigate the influence of synergism of the dry powder of Alpinia galanga rhizomes (AGR) and/or zinc sulfate in the diet on semen quality and reproductive traits of California rabbit bucks. The study was conducted in two stages. First stage: appreciation of semen characteristics, 36 California rabbit bucks (aged 5 months) with average body weights of 2980 g were divided randomly into six treatments (six individuals each). The treatment groups were: first group, control fed basal diet (C); second group, fed basal diet plus 1 g AGR/kg dry matter (DM) (AGR1); third group, fed basal diet plus 2 g AGR/kg DM (AGR2); fourth group, fed basal diet plus 200 mg Zn/litre drinking water (Zn); fifth group, fed basal diet plus 1 g AGR/kg DM and 200 mg Zn/litre drinking water (AGR1 + Zn); sixth group, fed basal diet plus 2 g AGR/kg DM and 200 mg Zn/litre drinking water (AGR2 + Zn). Second stage: the previous bucks were used to determine the efficiency of semen on reproductive fertility traits, 48 mature does (aged 6 months, nulliparous) with an average body weight of 3050 ± 20.7 g were divided randomly into six treatments and inseminated with previous groups of treated bucks. The results of the first stage, recorded high activity on gonadotropins hormones: follicle-stimulating hormone (FSH) and luteinizing hormone (LH), free testosterone (FT), progesterone (P₄) and oestrogen (E₂17β) concentrations for AGR1 + Zn and AGR2 + Zn compared with the control group. Groups AGR1, AGR2, AGR1 + Zn and AGR2 + Zn had significantly lowered concentrations of triglycerides, total cholesterol, low-density lipoprotein, and malondialdehyde (MDA), whereas high-density lipoprotein and total antioxidant capacity (TAC) were increased significantly compared with the control group. The group supplemented with AGR with or without Zn had significantly improved ejaculate volume, advanced motility, sperm concentration, and cell integrity. Fertility rate and litter size were improved in all groups compared with the control. It was concluded that supplementing diets with Alpinia galanga and Zn significantly increased sperm percentage, motility and reproductive hormones (testosterone, FSH, LH, E₂17β, P₄). This suggested that this plant when used may be favourable for improved sperm quality and fertility parameters.

On-station comparative analysis of reproductive and survival performance between Red Maasai, Dorper, and Merino sheep breeds

The reproductive performance of ewes and the survivability of lambs to weaning have a critical economic impact on sheep farming worldwide. Further, knowledge of major mortality causes allows an opportunity for improved flock management to evade financial losses. The maximum likelihood estimates for generalised linear mixed models and chi-square test methods were used to examine 971 mating records, 839 and 763 lambs born and weaned (singles or twins) from the Naivasha Sheep and Goats station in Kenya for the years 2011 to 2020 consisting of Dorper, Red Maasai (RedM), and Merino breeds. The RedM (P < 0.05) outperformed Dorper and Merino in weaning rate, whereas reproductive performance between the three breeds was not significantly different (P > 0.05) in litter size and multiple lambings per ewe lambing. On the one hand, Dorper significantly (P < 0.05) outperformed the other two breeds only in weaning weight per lamb born. In addition, among all the major causes of death, pneumonia appeared to be the one to which Dorper breeds were most susceptible (chi-square test, P < 0.05). According to the findings of this study, neither the Dorper nor the Merino sheep breeds were reproductively superior to the RedM in an extensive semi-arid production environment. In addition, Dorper's susceptibility to the leading causes of mortality, particularly pneumonia and sheep pox, were relatively high compared to other breeds and could be a precursor to massive economic losses for Dorper sheep producers. In contrast to the indigenous RedM breed, imported sheep breeds appeared to be more susceptible to major mortality-related under an extensive production system. Therefore, regardless of weaning weight, RedM breed production appears to be a more viable investment for small-scale farmers, particularly in semi-arid regions.

Effects of incentive-based population policies on sustainability of China's recent maternity insurance system reform: a system dynamics simulation

BACKGROUND

This paper seeks to assess the sustainability of the reformed maternity insurance system and the extent to which China's current maternity insurance system can support different levels of fertility incentives in the future. Our findings will serve as a reference for countries in a similar demographic predicament and those about to face it.

METHODS

This study used a combination of qualitative and quantitative methods. In the qualitative assessment, we used a grounded theory model to generalize the factors influencing the sustainability of maternity insurance funds. For the quantitative analysis, we used a novel and comprehensive system dynamics model to visualize the status of the combined operation of maternity and health insurance. Data are mainly derived from the historical data of the Statistical Yearbook of Jiangsu Province and the National Bureau of Statistics of China.

RESULTS

In the short term, fertility incentive payments can be set to motivate people to have children. It is therefore recommended that when the scope of the fertility incentive policy is limited to two children, and an average amount above RMB 10 000 could be set, it would be prudent to set the amount at a level not exceeding RMB 10 000 when the scope of the fertility incentive policy is for all newborns. In the long term, a system of incentives for childbirth should be built from education policy, house price regulation, tax relief and childcare services.

CONCLUSION

Our research not only highlights the significance of improving the resilience of maternity insurance by combining maternity insurance and health insurance funds, but also suggests a way to economically incentivize beneficiaries to have children so as to mitigate the decline in China's birth rate and cope with the crisis of an ageing population.

The relationship between changes in the korean fertility rate and policies to encourage fertility

BACKGROUND

Korean government has established various policies to counter the low fertility rate since the mid-2000s, but it still has the lowest fertility rate among OECD member countries. This study investigated the relationship between changes in the Korean fertility rate and policies to encourage fertility.

METHODS

This study utilized data of the total fertility rate of 250 local governments between 2014 and 2018, and a casebook of local government birth promotion policies. The dependent variable was fertility rate, and the independent variable was fertility promotion policy. Using SPSS 25.0 and M-plus 8.0 programs, descriptive statistical analysis and latent growth modeling were conducted. An unconditional quadratic function change model was selected as a final model of this study.

RESULTS

The average of the initial fertility rate and the linear rate of change in the Korean fertility rate, and the rate of change of the quadratic function were all statistically significant, meaning that the fertility rate of decline increases over time. Also, the linear rate of change and the quadratic function change rate were significant, showing significant differences in the initial level and rate of change of the fertility rate between local governments. Among fertility policies, only the in-kind policy had a significant effect on the initial value of the fertility rate, meaning that the higher the number of in-kind policies, the higher the fertility rate.

CONCLUSION

This study is crucial as it examined the changes in the fertility rate of Korean local governments as well as the policy factors affecting the fertility rate at a quantitative level.

Weighted Bayesian Poisson Regression for The Number of Children Ever Born per Woman in Bangladesh

Number of children ever born to women of reproductive age forms a core component of fertility and is vital to the population dynamics in any country. Using Bangladesh Multiple Indicator Cluster Survey 2019 data, we fitted a novel weighted Bayesian Poisson regression model to identify multi-level individual, household, regional and societal factors of the number of children ever born among married women of reproductive age in Bangladesh. We explored the robustness of our results using multiple prior distributions, and presented the Metropolis algorithm for posterior realizations. The method is compared with regular Bayesian Poisson regression model using a Weighted Bayesian Information Criterion. Factors identified emphasize the need to revisit and strengthen the existing fertility-reduction programs and policies in Bangladesh.

Supplementary Information

The online version contains supplementary material available at 10.1007/s44199-022-00044-2.

The effects of glutathione supplementation on post-thawed Turkey semen quality and oxidative stress parameters and fertilization, and hatching potential

This study was conducted to investigate the effect of semen extenders enriched with glutathione (GSH) on in vitro quality parameters and fertility of post-thawed turkey. In experiment 1, pools of semen diluted in glucose-based extender containing 0.5, 1, and 2 mM of GSH were cryopreserved. During the next step, a different variable such as motility and motion parameters, plasma membrane integrity (PMI) and functionality (PMF), DNA integrity, lipid peroxidation (MDA), total antioxidant capacity (TAC), catalase (CAT), glutathione peroxidase (GPx) and superoxide dismutase (SOD) activity were determined in the post-thawed samples. In the second experiment, artificial insemination was used to evaluate the fertility and hatchability performances of the post-thawed semen. The results of the first experiment showed that the extenders supplemented with 2, 1 and 0.5 mM of GSH had higher levels (p ≤ 0.05) of motility and motion parameters, PMI, PMF, TAC, CAT and SOD activity and lower abnormal morphology, DNA damage, and lipid peroxidation respectively in comparison to the control group (only extender with semen). Notably, the second experiment showed a higher rate of fertility (p ≤ 0.05) in 2 mM of GSH compared to the control group. It can be concluded that adding 2, 1 and 0.5 mM of glutathione leads to an improvement in the survival of the post-thawed turkey, while 2 mM of GSH can increase the fertility strength of the turkey sperm; hence it can be used to improve fertility and hatchability performance.

Childhood Emotional Abuse Is Associated With the Desire to Get Married and Have Children in Korean Young Adults

OBJECTIVE

Young adults putting off marriage and having less children have become recent trends in many modern societies. Yet less is known about the psychological factors underlying the drastically low marriage and fertility rates. We hypothesized that childhood maltreatment experience may have a negative association with one's marriage and childbearing intention.

METHODS

A total of 1,004 college students (mean age of 20.8±2.3 years, 56.1% female) completed self-questionnaires including sociodemographic information, marriage and childbearing intention, Patient Health Questionnaire 9 (PHQ-9), and Childhood Trauma Questionnaire (CTQ). Multivariable logistic regression analyses were conducted to evaluate the effect of childhood trauma on marriage and childbearing intentions after controlling for sociodemographic variables and depression.

RESULTS

29.7% had no intention to get married and 40.4% had no intention to have children in the future. The prevalence of physical, sexual, and emotional abuse was 33.1%, 18.5%, and 22.3%, respectively. Multivariable logistic regression analyses revealed that female (p<0.001), poor health status (p=0.001), and childhood emotional abuse (p=0.01) were independent predictors of no desire to get married. Female (p<0.001), poor health status (p<0.001), and childhood emotional abuse (p=0.038) were also predictors of no desire to have children.

CONCLUSION

Childhood emotional abuse may be the most damaging form among other types of childhood maltreatment because it can occur more pervasively and persist for a longer period, causing extensive damage to a child's emotional, social and cognitive development. Raising awareness regarding the life-long consequences of childhood emotional abuse and the need to prevent and detect childhood emotional abuse should be emphasized.

Effect of egg yolk of free-range chicken and methanol as a cryoprotective agent for the sperm preservation of cyprinid fish, Neolissochilus soroides (Valenciennes, 1842)

The objective of this study was to determine the optimum concentration of egg yolk of free-range chicken as a cryoprotective agent on cyprinid fish, Neolissochilus soroides sperm after 48 h frozen. One level of methanol (10%) combined with six levels of egg yolk solution (0%, 5%, 10%, 15%, 20% and 25%) were tested. Fish Ringer's solution was used as an extender. The diluted sperm was equilibrated for 10 min at 5 °C, then kept at -10 °C temperature for 48 h. Sperm was thawed for 1 min at 40 °C. Spermatozoa viability, abnormality, and fertilization rates were analysed afterwards. The one-way ANOVA showed that the combination methanol with several concentrations of egg yolk solution had a significant effect on spermatozoa viability, abnormality, and fertilization rates (P < 0.05) by improving semen character. The study revealed that the 5% egg yolk solution combined with 10% methanol resulted in the highest rates of viability (82.13 ± 1.75%) and fertility rates (92.96 ± 1.94%), with the lowest abnormality (25.25 ± 2.22%). A 5% egg yolk solution was identified as the best cryoprotective agent for N. soroides spermatozoa preservation at -10 °C for 48 h.

Effects of fertility on breast cancer incidence trends: comparing France and US

PURPOSE

Breast cancer incidence rates are now higher in France than most other European countries as well as the United States (US). Increasing breast cancer incidence rates globally have often been attributed to declining fertility rates.

METHODS

We compared temporal trends in breast cancer incidence in France and the US, and examined the extent temporal trends in national fertility rates can explain the temporal trends in breast cancer incidence. This study of temporal trends used estimates of annual percent change (APC) from cancer registry data in France and the US (1978-2016) and national fertility data (1958-2011). We estimated the APCs for all ages (overall APC) and for specific age groups (under 50, 50-64 years, and 65 years and over).

RESULTS

The overall APC was over three times higher in France than the US (France APC = 1.63%, 95% CI 1.43-1.84; US APC = 0.51, 95% CI 0.31-0.72). The overall APCs remained positive and statistically significant after adjusting for fertility trends irrespective of assumptions on fertility lags (France APC = 1.61-0.91 for a 5-year to 20-year lag, respectively; US APC = 0.37-0.36 for a 5-year to 20-year lag, respectively). Similarly, among women under 50, the APC was over 3.5 times higher in France than the US (France APC = 1.22, 95% CI 1.07-1.37; US APC = 0.33, 95% CI 0.22-0.44), and APCs remained positive after adjusting for fertility (France APC = 1.21-1.28 for a 5-year to 20-year lag, respectively; US APC = 0.38-0.26 for a 5-year to 20-year lag, respectively).

CONCLUSIONS

Based on these trend analyses, changes in fertility rate trends do not fully explain the increase incidence in breast cancer seen in both France and the US, nor the magnitude of difference between the two countries. This was seen overall and in age-specific groups.

Educational Differences in Cohort Fertility Across Sub-national Regions in Europe

Educational differences in female cohort fertility vary strongly across high-income countries and over time, but knowledge about how educational fertility differentials play out at the sub-national regional level is limited. Examining these sub-national regional patterns might improve our understanding of national patterns, as regionally varying contextual conditions may affect fertility. This study provides for the first time for a large number of European countries a comprehensive account of educational differences in the cohort fertility rate (CFR) at the sub-national regional level. We harmonise data from population registers, censuses, and large-sample surveys for 15 countries to measure women’s completed fertility by educational level and region of residence at the end of the reproductive lifespan. In order to explore associations between educational differences in CFRs and levels of economic development, we link our data to regional GDP per capita. Empirical Bayesian estimation is used to reduce uncertainty in the regional fertility estimates. We document an overall negative gradient between the CFR and level of education, and notable regional variation in the gradient. The steepness of the gradient is inversely related to the economic development level. It is steepest in the least developed regions and close to zero in the most developed regions. This tendency is observed within countries as well as across all regions of all countries. Our findings underline the variability of educational gradients in women’s fertility, suggest that higher levels of development may be associated with less negative gradients, and call for more in-depth sub-national-level fertility analyses by education.

Cervical artificial insemination in sheep: sperm volume and concentration using an antiretrograde flow device

There has been development of an antiretrograde flow device (DARIO), for sheep cervical artificial insemination (CAI). There, however, needs to be optimization of sperm volume and concentration of insemination doses when the DARIO is used for CAI. Objectives were to compare fertility rates (proportion of ewes lambing as a result of CAI) when there was use of the DARIO for CAI: two sperm volumes containing equal numbers of spermatozoa: 0.25 mL of 1,600 × 10⁶ spermatozoa/mL and 0.50 mL of 800 × 10⁶ spermatozoa/mL (Test 1 group), and two sperm volumes with a different number of spermatozoa/AI dose: 0.25 mL and 0.50 mL of 1,600 × 10⁶ spermatozoa/mL (Test 2 group). There were 335 ewes from seven farms assigned to 60 batches (equally divided into a Control and Test 1 group). For the Test 2 group, 462 ewes from nine farms were assigned to 88 batches (equally proportioned into Control group and Test 2 groups). For the Test 1 group, proportion of ewes lambing as a result of CAI were 0.701 ± 0.2679 and 0.595 ± 0.2393 for the Control and Test 1 groups, respectively (P = 0.163). For the Test 2 group, proportions of ewes lambing were 0.550 ± 0.2598 and 0.658 ± 0.2412 for the Control and Test 2 group, respectively (P = 0.041). An inclusion of a larger number of spermatozoa per insemination in a 0.50 mL dose volume resulted improved proportion of ewes lambing as a result of CAI when there was used of the DARIO.

Post-operative management and follow-up of surgical treatment in the case of rectovaginal and retrocervical endometriosis

Introduction

Deep infiltrating endometriosis (DIE) affects between 3.8% and 37% of all endometriosis patients, mostly affecting rectovaginal septum or retrocervical space and characterized by the severe endometriosis-related complaints. Nowadays, generally managed with surgery. However, this is associated with a risk of postoperative complications. To better evaluate intra- and postoperative complications and outcomes for rectovaginal (RVE) and retrocervical endometriosis (RCE), the preoperative management should be accurately described and compared.

Methodology

This is a cohort retrospective study performed at the Endometriosis Centre of Charité-University Clinic, Berlin. 34 patients were investigated in their reproductive age, n = 19 with RVE and n = 15 RCE, operated between 2011 and 2015. The surgical approach was divergent in both groups. Single laparoscopy was performed in RCE patients (RCEP) and vaginal assisted laparoscopy in RVE patients (RVEP). Long-term postoperative outcome included complications, fertility rate and recurrence rate.

Results

The median follow-up time was three years (y). Symptom-free status was revealed in n = 12 RVEP and n = 9 RCEP. Postoperatively, endometriosis-related complaints were presented in n = 7 RVEP and n = 6 RCEP, but with significant pain relief. From n = 8 RVE patients seeking fertility, pregnancy occurred in n = 7 and from n = 9 RCEP pregnancy appeared in n = 5 patients in the meantime of 6 months. Postoperative complications were reported in n = 1 RVEP with early postoperative bleeding, after ureter leakage and n = 1 RCEP with postoperative anastomotic insufficiency. The postoperative recurrence rate was equivalent to zero.

Conclusion

The appropriate surgical approach for each group, preserving anatomy and functionality of the organs, seems to be very essential and efficient.

The impacts of COVID-19 measures on global environment and fertility rate: double coincidence

The study aims to examine the effects of coronavirus disease-2019 (COVID-19) measures on global environment and fertility rate by using the data of 1980 to 2019. The results show that communicable diseases including COVID-19 measures decrease carbon emissions and increase the chances of fertility rates in an account of city-wide lockdown. The knowledge spillover substantially decreases carbon emissions, while high energy demand increases carbon emissions. Poverty incidence increases fertility rate in the short-run; however, in the long-run, the result only supported with vulnerable employment and food prices that lead to increase fertility rates worldwide. The study concludes that besides some high negative externalities associated with COVID-19 pandemic in the form of increasing death tolls and rising healthcare costs, the global world should have to know how to direct high mass carbon emissions and population growth through acceptance of preventive measures, which would be helpful to contain coronavirus pandemic at a global scale.

The Impact of the Flint Water Crisis on Fertility

Flint switched its public water source in April 2014, increasing exposure to lead and other contaminants. We compare the change in the fertility rate and in health at birth in Flint before and after the water switch to the changes in other cities in Michigan. We find that Flint fertility rates decreased by 12 % and that overall health at birth decreased. This effect on health at birth is a function of two countervailing mechanisms: (1) negative selection of less healthy embryos and fetuses not surviving (raising the average health of survivors), and (2) those who survived being scarred (decreasing average health). We untangle this to find a net of selection scarring effect of 5.4 % decrease in birth weight. Because of long-term effects of in utero exposure, these effects are likely lower bounds on the overall effects of this exposure.

A drain or drench on biocapacity? Environmental account of fertility, marriage, and ICT in the USA and Canada

In either case of ecological and biocapacity surplus or deficit, the precautionary effort toward optimizing the natural capital posits a potential framework for environmental sustainability. In studying the environmental account of fertility, marriage, and technological advancement in the USA and Canada, the autoregressive distributed lad-bound testing is employed over the experimental period 1990-2014. Importantly, the study revealed that the interaction of fertility and marriage exerts a significant and negative impact of biocapacity in both the USA and Canada and in short run and long run. Moreover, while the impact of energy use in both countries is significant and positive in both the short and long run, the magnitude of the impact is almost negligible. Similarly, an improvement in technological advancement in the countries is empirically observed to cause a decline in the biocapacity in both the long and short term. These posit that both energy use and technological advancement in Canada and the USA do not necessarily improve the productive capacity of the countries ecosystems. In general, the study provides policy frameworks for stakeholders toward addressing the environmental peculiarity of the USA (a biocapacity debtor) and Canada (a biocapacity creditor).

Epilepsy in China: Factors influencing marriage status and fertility

PURPOSE

To investigate the current status of marriage and fertility of patients with epilepsy (PWE) and characterize its influencing factors.

METHODS

A total of 1,823 adult patients (males age 22 years or older, females age 20 years or older) were included in this study. Data concerning sociodemographic and clinical characteristics were collected. Descriptive analyses, followed by univariate and multivariate logistic regression analyses were utilized to examine factors associated with marriage and fertility of PWE. Marital status of PWE was compared with Chinese population. Standardized marriage rate (SMR) for age and sex was estimated based on the 2010 sixth national population census.

RESULTS

1,132 patients (62.1%) were married and 823 (45.1%) had a history of fertility. Patients had lower marriage rates than Chinese population (62.1% vs 78.4%). Patients with adult-onset epilepsy (>18 years) had a significantly higher rate of marriage and fertility (p ＜ 0.001) compared to those with childhood-onset epilepsy (≤18 years). Employed patients had higher marriage rates than unemployed patients (64.9% vs 58.6%, p = 0.006), with only male patients being significantly affected by employment status (p ＜ 0.001). Multiple logistic regression revealed that age, age at first seizure onset, and employment status were related to both marriage and fertility.

CONCLUSION

Epilepsy had negative effects on marriage and fertility status. Marriage and fertility rates were lower in patients with Childhood-onset epilepsy (≤18 years). Furthermore, employment status mainly affected the marriage rate of male patients.

Melatonin treatment and male replacement every week on the reproductive performance in Sarda sheep breed

The aim of this study was to highlight whether the combination of melatonin treatment and weekly male replacement could influence reproductive performances in Sarda sheep breed. In a preselected farm, on 5th March 2016, 400 lactating ewes were identified, aged 3-5 years, with body condition score (BCS) 2.5-4.0, who lambed between 20th October and 1st December 2015. The 400 chosen animals were subsequently divided into 4 groups with 100 animals in each group (M, MR, C and CR). On 20th March 2016 the animals of Group M and MR (consisting of 100 ewes each) were treated with melatonin implants and on 24th April 2016 five entire rams were introduced into each group. In groups MR and CR, males were replaced each week with other males whereas in groups M and C the introduced males were not replaced. The MR group showed the highest fertility (number of lambed ewes) compared to the other three groups (P < 0.01). Both the melatonin treated groups (M and MR) exhibited an increase in fertility greater than the controls groups C and CR (P < 0.01). However, when the two groups treated with melatonin were compared, the MR group showed a higher fertility than the M group (P < 0.01). The same can be said for the two control groups, of which the CR group showed a greater increase in fertility than the C group (P < 0.01). The mean interval of days from male introduction to lambing was lower in the treated than in the control groups (P < 0.05). The MR group presented the lowest mean interval of days from male introduction to lambing amongst all of the groups (P < 0.05). A similar trend was recorded for group CR when compared to group C (P < 0.05). In the MR and M groups the lambing peak was recorded close to 170 days after the males introduction, whereas the CR group and the C group were reported to be around 180 days and 190 days, respectively. At the 170th day from the male introduction the number of ewes lambed in the MR group was greater than that of the M group (P < 0.05) (60 vs. 42), and more than double of that of the C and CR groups (P < 0.01). In conclusion, weekly male replacement improved the reproductive activity and strengthened the effect of the pineal hormone on reproductive efficiency. Therefore male replacement either in untreated animals or in association with the melatonin implants, can be straightforwardly applied to guarantee a more efficient reproduction in sheep breeding.

Comparisons in geese of the courtship, mating behaviors and fertility of the Carlos and Sichuan breeds and the breed crosses

The Chinese goose originated from the swan goose (Anser cygnoides) and the European goose originated from the greylag goose (Anser anser). The Chinese and European geese have the potential to crossbreed. Whether interspecific differences in mating behaviors affect successful hybridization is unknown. In this study, 10-month-old Carlos geese (n = 120; Anser anser) and Sichuan geese (Anser cygnoides) were selected, and 12 multi-male parent families (3♂+12♀) were established. The courtship and mating behaviors of pure and cross-bred combinations of the Carlos and Sichuan geese were recorded using video cameras. Initiative courtship by males was the main type of courtship. Fixed mating, mating interference, and uncooperative mating were common in the flocks. The frequencies of some courtship and mating behaviors were less in the cross-bred groups (Carlos ganders × Sichuan geese, Sichuan ganders × Carlos geese) compared with the Sichuan pure-bred groups (P < 0.05). The Carlos male geese had some unique mating behaviors (i.e., one-to-one mating, formation of distinct hierarchies, and competition interference). The fertility rate had a significant correlation with the frequency of successful mating (r_p = 0.992, P < 0.05), rather than with the courtship behavior. These results indicate there were lesser frequencies of courtship and successful matings in the cross-breeding than purebreeding groups. Furthermore, the fertility rate depended largely on the successful mating behavior and was independent of the courtship behavior.

Association between fertility rate reduction and pre-gestational exposure to ambient fine particles in the United States, 2003-2011

Ambient pollutants are associated with clinical and sub-clinical indicators of infertility, such as poor sperm quality. However, the link between the ambient fine particle (PM_2.5) concentration and the fertility rate (FR) is unclear. In this epidemiological study, we examined the association between PM_2.5 concentration and childlessness in the United States (US). We conducted a nationwide spatiotemporal study of ~29 million births in 520 US counties from 2003 to 2011. We obtained monthly numbers and demographic data of newborns from the Centers for Disease Control and Prevention, and PM_2.5 estimates from a downscaling model of in situ observations and outputs from the Community Multiscale Air Quality Model. We evaluated the association between the mean PM_2.5 concentration and the FR during the gestational (0-8 months before birth) and pre-gestational (9-11 months before birth) periods using a Poisson model with demographic and socioeconomic covariates. We found a significant association between the FR and PM_2.5 exposure during pre-gestation but not gestation. Each 5 μg/m³ increase in pre-gestational PM_2.5 exposure was associated with a 0.7% (0.0%, 1.4%) reduction in the FR. Nonlinear analysis suggested a sublinear association between the reduction in the FR and PM_2.5 concentration without a safety threshold. Additionally, an annual mean reduction of 1.16 (1.15, 1.17) births per 1000 females aged 15-44 years was attributable to PM_2.5. This study established, for the first time, an association in the US between the FR and PM_2.5 concentration, a finding that adds to the extant epidemiological evidence of the effects of ambient pollutants on fertility, and extends the scope of the impact of low air quality on health.

Increment of ambient exposure to fine particles and the reduced human fertility rate in China, 2000-2010

Epidemiological and toxicological studies suggest that exposure to ambient fine particles (PM_2.5) can reduce human reproductive capacity. We previously reported, based on spatial epidemiology, that higher levels of PM_2.5 exposure were associated with a lower fertility rate (FR) in China. However, that study was limited by a lack of temporal variation. Using first-difference regression, we linked temporal changes in FR and PM_2.5 with adjustment for ecological covariates across 2806 counties in China during 2000-2010. Next, we performed a sensitivity analysis of the variation in the PM_2.5-FR association according to (1) geographic region, (2) indicators of the level of development, and (3) PM_2.5 concentrations. Also, we quantified the reduction in the FR attributable to ambient PM_2.5 in China for the first time. The FR decreased by 3.3% (1.2%, 5.3%) for each 10 μg/m³ increment in PM_2.5. The association varied significantly among the geographic regions, but not with the level of development. Nonlinearity analysis suggested a linear exposure-response function with an effect threshold of ~8 μg/m³. We also found that comparing to the 2000 scenario, increment of PM_2.5 in 2010 might result in a reduction of 2.50 (2.44, 2.60) infants per 1000 women aged 15-44 years per year in China. Our results confirm the statistical association between ambient particles and FR and suggest that poor air quality may contribute to childlessness in China.

Associating ambient exposure to fine particles and human fertility rates in China

BACKGROUND

Adverse effects of ambient fine particles (PM_2.5) on sperm quality and oocyte fertilization have been identified by previous research. However, insufficient human studies tested associations between PM_2.5 and decreased fertility rates.

METHODS

We associated long-term exposure to PM_2.5 and county-level fertility rates reported by 2010 census across China. Exposure assessments were based on PM_2.5 maps (2009-2010) with a spatial resolution of 0.1° derived from satellite remote sensing data from another published study. We used a Poisson regression to examine the relationship between PM_2.5 and fertility rates with adjustment of potential confounders including county-level socioeconomic factors (e.g. sex ratio) and a spatially smoothed trend.

RESULTS

We found that fertility rates were significantly decreased by 2.0% (95% confidence interval: 1.8%, 2.1%) per 10 μg/m³ increment of PM_2.5. We also found a geographical variation of the associations.

CONCLUSIONS

The study add to epidemiological evidences on adverse effects of PM_2.5 on fertility rates.

Exploring perceptions of policymakers about main strategies to enhance fertility rate: A qualitative study in Iran

Background

Total fertility rate in Iran has declined unprecedentedly over the past thirty years. However, debating on proper strategies to increase fertility is still a matter of discussion among experts.

Objective

To explain the main strategies to increase fertility from the viewpoints of the policy makers.

Methods

This is a qualitative study using content analysis. Purposeful sampling approach was used to gather data. The data were collected via semi-structured interviews. Eight experts participated in the study and the main criteria were executive experience related to public health, scientific publication in these areas and availability as well as their own interest. Content analysis was used to extract the codes.

Results

The main theme extracted was improving the infrastructures. Almost all participants agreed on interventions around removing marriage obstacles, improving working conditions for women, improving the quality of the educational system, training and consultation, research, and improving services to increase fertility rate.

Conclusions

The government should formulate long-term instead of short-term policies, and note that improving the economic conditions along with the promotion of social welfare, and enabling women in balancing work and family, are highly influential in childbearing decision-making, as they ensure a better future for the next generation. In addition, people should touch on the potential risk of future fertility reduction, so it is suggested to inform the public through free discussions.

Fertility and Economic Development: Quantile Regression Evidence on the Inverse J-shaped Pattern

This paper analyses empirically the relationship between economic development and fertility. Through a new sample selection and quantile regression, it investigates whether there is an inverse J-shaped pattern between these two variables, and, if so, whether it depends on development and fertility levels. Our results confirm that the inverse J-shaped pattern exists, but only when a certain level of economic development is attained. Results also suggest an innovative finding: the J-shape depends not only on the development but also on the fertility level. The higher the fertility rate, the higher the GDP per capita needed to reverse fertility decline, and the faster the negative and positive segments of the J-shape fall and grow.

Fertility is below replacement in Harar Health and Demographic Surveillance System (Harar HDSS), Harar town, Eastern Ethiopia

Background

Population growth is determined by fertility, mortality and migration rates. Fertility is the prime determinant of population growth, which is highly associated with family planning, literacy, urbanization, and expansion of health system. In many part of Africa, its level is more than twice the replacement level. In Ethiopia, a significant decline in fertility mainly in the urban setting has been reported over the past decade, yet there is a paucity of information on the level of the decline. Therefore, this analysis aims to assess the level of fertility in Harar Health and Demographic Surveillance System (Harar HDSS) Eastern Ethiopia.

Methods

Harar HDSS is an urban HDSS located in the city of Harar, eastern Ethiopia. It was established in 2011. All the population under surveillance are followed regularly and updated every six month for any change in the population demographic characteristics. Data were collected on a face-to-face interview to record demographic and socio-economic characteristics. Data were entered into customized HRS-2 software used for capturing longitudinal data and exported to computational software for analysis. For this analysis fertility data of the year 2013 were used. Fertility levels were analyzed using descriptive statistics.

Results

The total population of Harar HDSS in 2013 was 30,055. Of these, 15,701 (52.2 %) were females and 14, 354 (47.8 %) were males. The crude birth rate and general fertility rate for the year 2013 were 20.3 and 64 births per 1000, respectively. In 2013, the Total Fertility Rate (TFR) was 1.9 births per women of reproductive age. The 25 to 29 age group has the highest age-specific fertility rates (128.1 births per 1000 women), followed by the 20 to 24 year old women (89.3 births per 1000 women).

Conclusion

Total fertility rate was relatively low. However, there were a significant number of births among adolescent women. Improving and sustaining access for reproductive health care for young women is highly recommended.

Pregnancy in Women With Intellectual and Developmental Disabilities

OBJECTIVE

Our objectives were to describe the general fertility rate (GFR) and age-specific fertility rates (ASFRs) of women with intellectual and developmental disabilities (IDD) and the social and health characteristics of those with a singleton live birth, and to compare these to women without IDD.

METHODS

In this population-based retrospective cohort study using linked Ontario health and social services administrative data, we identified 18- to 49-year-old women with IDD (N = 21 181) and without IDD (N = 990 776). The GFR and ASFRs (2009) were calculated for both groups and compared using rate ratios (RR) and 95% confidence intervals (CI). Among women with a singleton live birth (N = 423 with, N = 42 439 without IDD), social and health characteristics were compared using Pearson's Chi square tests.

RESULTS

The GFR in women with IDD (20.3 per 1000) was lower than that in women without IDD (43.4 per 1000) (RR 0.47; 95% CI 0.43 to 0.51). ASFRs in 18- to 24-year-olds were similar in both groups. Among women with a singleton live birth, those with IDD were younger and had higher rates of poverty, epilepsy, obesity, and mental health issues. They also had high rates of medication use during pregnancy.

CONCLUSION

In the largest study of fertility in women with IDD to date, we found that ASFRs are similar in young women with and without IDD. Women with IDD with a singleton live birth experience significant social and health disparities during pregnancy. These findings suggest the need to develop services to support the reproductive health of this vulnerable group.

Effect of sperm concentration on characteristics and fertilization capacity of rooster sperm frozen in the presence of the antioxidants catalase and vitamin E

The objective of this study conducted was to determine the influence of different levels of sperm concentration, including catalase (CAT) and vitamin E (VitE) in rooster semen extender on postthawed quality and fertility of rooster semen. Semen was collected twice a week from six roosters (Arian) and diluted according to experimental treatments consisting of sperm suspensions containing different sperm concentrations (200, 400, and 600 × 106 sperm/mL) without antioxidant supplementation as control (Con) groups (Con200, Con400, and Con600, respectively), sperm suspensions containing different sperm concentrations (200, 400, and 600 × 106 sperm/mL) supplemented with 5-μg/mL VitE (VitE200, VitE400, and VitE600, respectively) and different sperm concentrations (200, 400, and 600 × 106 sperm/mL) supplementation with 100 IU/mL CAT (CAT200, CAT400, and CAT600, respectively). After thawing; sperm motility, membrane integrity, and mitochondrial function were assessed. Fertility and hatchability rates were determined by using 100 artificially inseminated hens. The percentage of total motility (TM) and activity of mitochondria decreased (P < 0.05) as the sperm concentration increased in control groups. So, the lowest percentage of the TM and activity of mitochondria were observed in the Con600 as compared with other treatment groups. Extenders containing 100 IU/mL CAT and 5-μg/mL VitE resulted in higher (P < 0.05) TM, progressive motility, membrane integrity, and activity of mitochondria compared with control groups. Adding VitE and CAT in different sperm concentrations, the percentage of TM, membrane integrity, and activity of mitochondria decreased (P < 0.05) as the sperm concentration decreased. The highest (P < 0.05) membrane integrity, TM, and progressive motility were recorded at VitE400 and CAT400. Including VitE and CAT in rooster extender with different level sperm concentrations had no effect (P > 0.05) on fertility and hatchability rates. In conclusion, although adding VitE and CAT in extender with different levels of sperm concentration improved postthawed quality of rooster semen, but adding VitE and CAT in the extender have no effect on fertility rate.

Reconstructing Past Populations With Uncertainty From Fragmentary Data

Current methods for reconstructing human populations of the past by age and sex are deterministic or do not formally account for measurement error. We propose a method for simultaneously estimating age-specific population counts, fertility rates, mortality rates, and net international migration flows from fragmentary data that incorporates measurement error. Inference is based on joint posterior probability distributions that yield fully probabilistic interval estimates. It is designed for the kind of data commonly collected in modern demographic surveys and censuses. Population dynamics over the period of reconstruction are modeled by embedding formal demographic accounting relationships in a Bayesian hierarchical model. Informative priors are specified for vital rates, migration rates, population counts at baseline, and their respective measurement error variances. We investigate calibration of central posterior marginal probability intervals by simulation and demonstrate the method by reconstructing the female population of Burkina Faso from 1960 to 2005. Supplementary materials for this article are available online and the method is implemented in the R package “popReconstruct.”

The changing trends in live birth statistics in Korea, 1970 to 2010

Although Korean population has been growing steadily during the past four decades, the nation is rapidly becoming an aging society because of its declining birth rate combined with an increasing life expectancy. In addition, Korea has one of the lowest fertility rates in the world due to fewer married couples, advanced maternal age, and falling birth rate. The prevalence of low birth weight infants and multiple births has been increased compared with the decrease in the birth rate. Moreover, the number of congenital anomalies is expected to increase due to the advanced maternal age. In addition, the number of interracial children is expected to increase due to the rise in the number of international marriages. However, the maternal education level is high, single-mother birth rate is low, and the gender imbalance has lessened. The number of overweight babies has been decreased, as more pregnant women are receiving adequate prenatal care. Compared to the Asian average birth weight, the average birth weight is the highest in Asia. Moreover, the rate of low birth weight infants is low, and infant mortality is similarly low across Asia. Using birth data from Statistics Korea and studies of birth outcomes in Korea and abroad, this study aimed to assess the changes in maternal and infant characteristics associated with birth outcomes during the past four decades and identify necessary information infrastructures to study countermeasures the decrease in birth rate and increase in low birth weight infants in Korea.

A study of fertility patterns of ever married women in oman

OBJECTIVE

To examine the relation between age, education, residence and fertility rate and change in fertility rate between 1994/95 and 1999/2000.

METHODS

The data for the study was extracted from the Oman National Health Survey, 2000. The birth histories data was used to extract data on woman years and births in the periods 1990 to 1994 and 1995 to 2000.

RESULTS

The marital fertility rate in 1999/2000 was 7.12 births. The rates for rural and urban dwellers were 8.07 and 6.75 respectively in 1999/2000. Corresponding rates in 1994/95 (8.65, 8.30 and 9.69 respectively) were significantly higher than those in 1999/2000 for all categories, indicating a reduction in rates. In both periods the higher the education level of the mother the lower her fertility.

CONCLUSION

Education was a strong determinant of fertility. This study confirms that the higher the education of the woman the lower her fertility and that fertility is on the decline in Oman.