Fertility Preservation Counselling for Women With Endometriosis: A European Online Survey

Background: Endometriosis is a common cause for infertility. Decreased ovarian reserve due to pathology or surgical management can reduce the chances of natural pregnancy and limit the effectiveness of controlled ovarian stimulation during fertility treatment. Cryopreservation of oocytes or ovarian cortex prior to surgery or before loss of follicular capital are strategies to preserve fecundity. Methods: An online survey was sent to reproductive specialists and gynaecological surgeons representing major centers of reproductive medicine in Europe to investigate current fertility preservation practices for endometriosis patients. Results: Of 58 responses, 45 (77.6%) in 11/13 countries reported the existence of endometriosis management guidelines, of which 37/45 (82.2%) included treatment recommendations for infertile patients. Most centers (51.7%) reserved fertility counselling for severe endometriosis (large endometriomas with or without deep endometriosis) while 15.5% of centers did not offer fertility preservation for endometriosis. Conclusions: To address non-uniformity in available guidelines and the diversity in fertility preservation practices, we propose an algorithm for managing patients with severe endometriosis most likely to be impacted by reduced ovarian reserve. Improved awareness about the possibilities of fertility preservation and clear communication between gynaecological surgeons and reproductive medicine specialists is mandatory to address the unmet clinical need of preventing infertility in women with endometriosis.

Current fertility desire and its associated factors among currently married eligible couples in urban and rural area of Puducherry, south India

Background: There are paucity of studies on current fertility desire at community level. Objective: To assess current fertility desire and its associated factors among eligible couples of reproductive age group in Puducherry, India. Methods: A community-based cross-sectional study from 2016 to 2017 among 2228 currently married eligible couples assessed socio-demographic and fertility-related factors associated with fertility desire. Data were collected based on the National Family Health Survey questionnaire. Association of fertility desire was assessed by univariate and generalised linear regression analysis. Results: Out of 1979 respondents, current fertility desire within two years was 13.7% (95% CI, 12.3%-15.3%). Mean number of children (SD) currently living and preferred was 1.77(0.851) and 2.11 (0.528) respectively. After adjusting for confounders, the significant factors positively associated with fertility desire include woman's age of 18–24 (APR = 2.91), 25-29 years (APR=2.48), 30-34 (APR=2.47), 35-39(APR=2.06), high socioeconomic status (APR=2.02), those without child (APR=52.35) and those with one child (APR=35.60). Conclusion: The fertility desire is comparatively lesser than other areas. Those without or with a single child and high so- cio-economic status group had comparatively more fertility desire. Keywords: Fertility desire; eligible couples; India.

An exploratory, cross-cultural study on perception of putative cyclical changes in facial fertility cues

Although many researchers have argued that facial traits evolved as honest cues to women’s current fertility (possibly via changes in facial femininity), evidence that women’s facial attractiveness is significantly, positively related to probability of conception throughout menstrual cycle is mixed. These mixed results could reflect differences among studies in the methods used to assess facial attractiveness (i.e., forced choice versus rating-scale methods), differences in how fertility was assessed, differences in perceiver characteristics (e.g., their own attractiveness), and facial preferences possibly being moderated by the characteristics of the living environment. Consequently, the current study investigated the putative effect of cyclical changes in fertility on women’s facial attractiveness and femininity (1) using forced choice and rating-scale method, (2) conducting both ovulation tests and repeated daily measures of estradiol assessing the conception probability, (3) based on a culturally diverse sample of perceivers, while (4) controlling for inter-individual variation. Although we found some limited evidence that women’s faces became more attractive when conception probability increased, these effects differed depending on the methods used to assess both attractiveness and fertility. Moreover, where statistically significant effects were observed, the effect sizes were extremely small. Similarly, there was little robust evidence that perceivers’ characteristics reliably predicted preferences for fertility cues. Collectively, these results suggest that mixed results in previous studies examining cyclical fluctuation in women’s facial attractiveness are unlikely to reflect inter-cultural differences and are more likely to reflect differences in the methods used to assess facial attractiveness and fertility.

Current Fertility Status Does Not Predict Sociosexual Attitudes and Desires in Normally Ovulating Women

Previous research has found that women at peak fertility show greater interest in extra-pair sex. However, recent replications have failed to detect this effect. In this study, we add to this ongoing debate by testing whether sociosexuality (the willingness to have sex in the absence of commitment) is higher in women who are at peak fertility. A sample of normally ovulating women ( N = 773) completed a measure of sociosexuality and had their current fertility status estimated using the backward counting method. Contrary to our hypothesis, current fertility was unrelated to sociosexual attitudes and desires, even when relationship status was included as a moderator. These findings raise further doubts about the association between fertility and desire for extra-pair sex.

Retrospective Study of Investigation of Possible Predictors for Total Fertility Rate in India

Total fertility rate (TFR) is the most acceptable and widely used measure of current fertility. Since TFR is based on age-specific fertility rate which required the total number of births in different age groups as well as age of female. When the population is illiterate or older then the information on age may have some recall bias, misreporting digit preference etc., thus in this situation TFR may departed from the actual. Therefore, need some indirect methodology which enables us to have an idea about the estimation of TFR. In this study an attempt has been made to identify some predictors that the explain TFR and try to suggest the best combination of predictors to get estimate of TFR. The methodology used in this study is essentially based on the regression technique. The identification and acceptance of possible predictors are based on the coefficient of determination. The data for the major states of India from National Family Health Survey (NFHS 4) is used for the analysis.

Fertility transition in selected sub-Saharan African countries: the role of family planning programs

Background: Change in fertility rate across societies is a complex process that involves changes in the demand for children, the diffusion of new attitudes about family planning and greater accessibility to contraception. Scholars have concentrated on a range of factors associated with fertility majorly at the national scale. However, considerably less attention has been paid to fertility preference - a pathway through which various variables act on fertility. It is understood that women have inherent fertility preferences which each they seek to achieve over her reproductive cycle. However, the service delivery enhancement levels and capacity across countries as integral pathways to this goal accomplishment stand on their way towards eventual outcomes. Precisely, the Sub-Saharan African countries’ disparities amid similarities in their population policies is a cause of concern. Methods: Using Bongaarts reformulation of Easterlin conceptual scheme of 1985 on DHS data, the understanding of the current fertility transition in general would provide explanations to the observed fertility dynamics. This study therefore is an attempt to explain the current fertility transition through women’s fertility preference. Results: Results reveal that fertility transition is diverse across sub-Saharan Africa; generally, on a decline course in most of the countries. The huge disparities in fertility preferences among women of reproductive age and its non-significant change in the implementation indices points at the service delivery performance underneath regarding the proportion of demand to family planning commodities satisfied. Service delivery indicators are integral to fertility preference achievement within households as well as a country’s overall positioning regarding fertility transition at the macroscale. Conclusions: It is therefore plausible to conclude that the improvement of service delivery in general; precisely touching on the availability and the uptake of quality birth control technologies is one of the most feasible means through which countries can fast track their fertility transitions.

Equilibrium and -efficient fertility with increasing returns to population and endogenous mortality

A general equilibrium model that characterizes the gap between optimal and equilibrium fertility and investment in human capital is developed. The aggregate production function exhibits increasing returns to population arising from specialization, but households face a quantity–quality trade-off when choosing their fertility and how much education these children receive. We show that equilibrium fertility is too low and investment per child is too high, in contrast to a current planner who internalizes the externality of current fertility on the next generation's productivity. We next introduce mortality of young adults in the model and assume that households have a precautionary demand for children. Human capital investment lowers next generation mortality. This model endogenously generates a demographic transition but, since households do not internalize the negative effects of human capital on mortality, the equilibrium demographic transition takes place many years later than the efficient solution. We show that ${\rm {\cal A}}$-efficient fertility and human capital investment pair can switch; in high-mortality regimes, ${\rm {\cal A}}$-efficient fertility is lower than equilibrium fertility, and ${\rm {\cal A}}$-efficient human capital investment is higher than equilibrium investment. In the zero mortality regime, however, ${\rm {\cal A}}$-efficient fertility exceeds equilibrium fertility, and ${\rm {\cal A}}$-efficient human capital investment is lower than the equilibrium choice.

THE EMOTIONAL IMPACT OF THE ASRM GUIDELINES ON FERTILITY PATIENTS DURING THE COVID-19 PANDEMIC

ABSTRACTObjectiveTo survey fertility patients’ agreement with ASRM recommendations during the COVID-19 pandemic and the emotional impact on them.DesignAn online survey was sent to current fertility patientsSettingNew York City academic fertility practice at the epicenter of the COVID-19 pandemicPatient(s)Fertility patients seen within the last yearIntervention(s)NoneMain Outcome Measures(s)Patient agreement with the ASRM recommendations during the COVID-19 pandemic and the emotional impact rated on a Likert scale.Result(s)A total of 518 patients completed the survey for a response rate of 17%. Fifty percent of respondents had a cycle canceled due to the COVID-19 pandemic. Of those who had a cycle cancelled, 85% of respondents found it to be moderately to extremely upsetting with 22% rating it to be equivalent to the loss of a child. There was no difference on the emotional impact based on the type of cycle cancelled. Fifty-five percent of patients agreed that diagnostic procedures such as hysterosalpingograms should be cancelled while 36% of patients agreed all fertility cycles should be cancelled. Patients were slightly more likely to agree with the ASRM guidelines if they have an upcoming cycle cancelled (p = 0.041). Of all respondents 82% would have preferred to have the option to start a treatment cycle in consultation with their doctor.Conclusion(s)Given the severity of the COVID-19 pandemic, the physical, financial and emotional impact of this unprecedented threat cannot be underestimated in our fertility patients.