Objective
To estimate the prevalence of pelvic pain and model associations with potential demographic, obstetric, gynaecological and psychosocial determinants.
Design, setting and sample
A cohort ...study of women born between 1972 and 1973 in Dunedin, New Zealand, most recently assessed when aged 38 years (95% of survivors retained); 429 women were eligible for analysis.
Methods
Women self‐completed reproductive health questionnaires at ages 21, 26, 32 and 38 years, with questions on dysmenorrhoea at ages 13 and 15, and on all pelvic pain at age 38. Prevalence and 95% confidence intervals (CI) were calculated and Poisson regression used to model associations.
Main outcome measures
The prevalence of pain and adjusted relative risks (ARR) for potential explanatory factors.
Results
Over half (54.5%, 95% CI 49.7–59.3%) of women experienced pelvic pain in the past 12 months at age 38. Dysmenorrhoea was reported by 46.2% (41.3–51.3%), dyspareunia by 11.6% (8.7–15.2%) and other pelvic pain (OPP) by 17.3% (13.8–21.2%). After adjusting for multiple factors, pregnancy (ARR 0.60, 95% CI 0.32–1.13) and childbirth (ARR 0.52, 95% CI 0.25–1.09) were borderline protective for dyspareunia and OPP, respectively. However, childbirth was not associated with dysmenorrhoea (ARR 0.97, 95% CI 0.74–1.28). Dysmenorrhoea and dyspareunia were strongly associated, and both were associated with endometriosis.
Conclusions
Our data confirm that female pelvic pain is common, and suggest common gynaecological and obstetric causal pathways, but there was no strong evidence supporting a benefit of childbirth for dysmenorrhoea. Further research on obstetric events and pelvic pain is needed, with both being common experiences.
Tweetable
Pelvic pain was common at age 38, especially dysmenorrhoea (46.2%), and no improvement was detected following childbirth.
Tweetable
Pelvic pain was common at age 38, especially dysmenorrhoea (46.2%), and no improvement was detected following childbirth.
BACKGROUND
Tensions and anxieties surround secrecy within families in the context of gamete donation and family building. This paper presents the views of parents who had kept their use of donor ...insemination a secret from their offspring. A sub-set of these parents said that they wished to tell their now-adult offspring, and discussed the questions and issues this secrecy raised to them.
METHODS
In-depth interviews were undertaken with heterosexual parents (of 44 families) who had given birth to children conceived via donor insemination between 1983 and 1987. These interviews comprised a follow-up study, with the first interviews being undertaken when the children were aged up to seven. In this paper, qualitative data relating to a sub-set of 12 parents (from seven families) who now wished to tell their offspring are presented.
RESULTS
The parents describe the pressures that the secret-keeping had created for them as well as the impact of those pressures. They report on the reasons they now want to share the family building history and the associated fears and anxieties about doing so. The parents all say that they wish they had told their offspring much earlier. In five of the seven families, parents describe how the offspring had raised questions concerning a perceived genetic disconnection between them and their parents.
CONCLUSIONS
Keeping the use of donor insemination a secret from offspring created considerable pressure for these parents. Despite the secrecy, offspring can become aware of the genetic disconnection.
Abstract
STUDY QUESTION
What is the rate of natural conception leading to ongoing pregnancy or livebirth over 6–12 months for infertile women of age ≥35 years?
SUMMARY ANSWER
Natural conception rates ...were still clinically relevant in women aged 35 years and above and were significantly higher in women with unexplained infertility compared to those with other diagnoses.
WHAT IS KNOWN ALREADY
In recent years, increasing numbers of women have attempted to conceive at a later age, resulting in a commensurate increase in the need for ART. However, there is a lack of data on natural fertility outcomes (i.e. no interventions) in women with increasing age.
STUDY DESIGN, SIZE, DURATION
A systematic review with individual participant data (IPD) meta-analysis was carried out. PubMed, MEDLINE, EMBASE, the Cochrane Library, clinicaltrials.gov were searched until 1 July 2018 including search terms ‘fertility service’, ‘waiting list’, ‘treatment-independent’ and ‘spontaneous conception’. Language restrictions were not imposed.
PARTICIPANTS/MATERIALS, SETTING, METHODS
Inclusion criteria were studies (at least partly) reporting on infertile couples with female partner of age ≥35 years who attended fertility services, underwent fertility workup (e.g. history, semen analysis, tubal status and ovulation status) and were exposed to natural conception (e.g. independent of treatment such as IVF, ovulation induction and tubal surgery). Studies that exclusively studied only one infertility diagnosis, without including other women presenting to infertility services for other causes of infertility, were excluded. For studies that met the inclusion criteria, study authors were contacted to provide IPD, after which fertility outcomes for women of age ≥35 years were retrieved. Time to pregnancy or livebirth and the effect of increasing age on fertility outcomes after adjustment for other prognostic factors were analysed. Quality of studies was graded with the Newcastle–Ottawa Scale (non-randomised controlled trials (RCTs)) or the Cochrane Risk of Bias tool (for RCTs).
MAIN RESULTS AND THE ROLE OF CHANCE
We included nine studies (seven cohort studies and two RCTs) (n = 4379 women of at least age 35 years), with the observed composite primary outcome of ongoing pregnancy or livebirth occurring in 429 women (9.8%) over a median follow-up of 5 months (25th to 75th percentile: 2.5–8.5 months). Studies were of moderate to high quality. The probability of natural conception significantly decreased with any diagnosis of infertility, when compared with unexplained infertility. We found non-linear effects of female age and duration of infertility on ongoing pregnancy and tabulated the predicted probabilities for unexplained infertile women aged 35–42 years with either primary or secondary infertility and with a duration of infertility from 1 to 6 years. For a 35-year-old woman with 2 years of primary unexplained infertility, the predicted probability of natural conception leading to ongoing pregnancy or livebirth was 0.15 (95% CI 0.11–0.19) after 6 months and 0.24 (95% CI 0.17–0.30) after 12 months. For a 42-year-old woman, this decreased to 0.08 (95% CI 0.04–0.11) after 6 months and 0.13 (95% CI 0.07–0.18) after 12 months.
LIMITATIONS, REASONS FOR CAUTION
In the studies selected, there were different study designs, recruitment strategies in different centres, protocols and countries and different methods of assessment of infertility. Data were limited for women above the age of 40 years.
WIDER IMPLICATIONS OF THE FINDINGS
Women attending fertility services should be encouraged to pursue natural conception while waiting for treatment to commence and after treatment if it is unsuccessful. Our results may aid in counselling women, and, in particular, for those with unexplained infertility.
STUDY FUNDING/COMPETING INTEREST(S)
S.J.C. received funding from the University of Adelaide Summer Research Scholarship. B.W.M. is supported by a NHMRC Investigator grant (GNT1176437), B.W.M. reports consultancy for ObsEva, Merck, Merck KGaA, iGenomix and Guerbet. B.W.M. reports research support by Merck and Guerbet.
PROSPERO REGISTRATION NUMBER
CRD42018096552.
Abstract
STUDY QUESTION
How common were children among infertile couples?
SUMMARY ANSWER
A total of 61.7% of infertile couples presenting for care subsequently had live born children 13.1 years after ...first being clinically assessed, with a mean of 1.7 children among those who had at least one.
WHAT IS KNOWN ALREADY
While the prognoses for infertile couples undertaking specific treatments have been well described, less is known about those not undergoing these treatments or the total number of children. This information is necessary for decision-making in many individual cases; not knowing this has been cited by patients and clinicians as impeding implementation of care.
STUDY DESIGN, SIZE, DURATION
The sole provider of specialist fertility care for the two southern-most regions in New Zealand enroled 1386 infertile couples from 1998 to 2005 in a longitudinal study with follow-up on all births until the end of 2014. Couples were followed in care for a median of 1.1 years and median follow-up for births was 13.1 years.
PARTICIPANTS/MATERIALS, SETTING, METHODS
Clinic-collected data were linked to national maternity data to extend follow-up past the end of clinical contact. The primary outcome was the total number of live born children. Hurdle regression was used to investigate factors associated with resolving infertility and the total number of children.
MAIN RESULTS AND THE ROLE OF CHANCE
Infertility was resolved with a live birth by 61.7% (95% CI 59.1–64.2%) of couples; just over half of all first births were treatment-dependent. Among couples who resolved their infertility, 55.6% (52.2–58.9%) had at least one additional child and the mean number of children was 1.7. While female age strongly influenced outcomes, one-third of women aged 40–41 years had a child, not significantly less than those in their late 30s. The lowest levels of resolution occurred in women aged ≥42 years, couples who were infertile for >4 years and women with a BMI ≥ 35 kg/m2. Moderate obesity did not affect outcomes.
LIMITATIONS, REASONS FOR CAUTION
The main limitation of this study was insufficient data to investigate male factor infertility outcomes. It is also possible that treatment-dependent resolution could be higher in more recent cohorts with the increased use of ART.
WIDER IMPLICATIONS OF THE FINDINGS
Outcomes in these couples are comparable to those seen in other studies in high-income countries despite the relatively low contribution of ART. The prognosis for most infertile couples is positive and suggests many will not require treatment. Further research is needed to inform best practice for women in their early forties or with moderate obesity, and to develop prediction models that are more relevant for the initial management of infertility.
STUDY FUNDING/COMPETING INTEREST(S)
This study was co-funded by a University of Otago PhD Scholarship and the Department of Women's and Children's Health, University of Otago. There were no competing interests to declare.
The effect of clinical priority access criteria for access to infertility treatment was examined for women outside the body mass index (BMI) range of 18–32 kg/m2. Treatments and outcomes were ...analysed from 1280 cases referred from 1998 to May 2005. Sixteen percent of women had a BMI of >32 kg/m2. Overall, 38% of these women had a birth from conceiving a treatment‐related pregnancy or spontaneous pregnancy, compared with 52% of women with BMI < 32 kg/m2. Weight loss allowed women in the BMI group >32<35 kg/m2 to access treatment, but women in higher BMI groups were less successful.
The effect of clinical priority access criteria for access to infertility treatment was examined for women outside the body mass index (BMI) range of 18-32 kg/m2. Treatments and outcomes were ...analysed from 1280 cases referred from 1998 to May 2005. Sixteen percent of women had a BMI of >32 kg/m2. Overall, 38% of these women had a birth from conceiving a treatment-related pregnancy or spontaneous pregnancy, compared with 52% of women with BMI < 32 kg/m2. Weight loss allowed women in the BMI group >32<35 kg/m2 to access treatment, but women in higher BMI groups were less successful. PUBLICATION ABSTRACT
An existing Ferm type passive sampler technique has been further developed to measure concentrations of formaldehyde gas in indoor air. Formaldehyde forms a derivative after reaction with a filter ...coated with 2,4-dinitrophenylhydrazine (2,4-DNPH). The formaldehyde 2,4-dinitrophenylhydrazine derivative (formaldehyde-2,4-DNPH) is extracted from the filter, and the concentration is determined by high performance liquid chromatography. The technique has been validated against an active sampling method, and the agreement is close when the appropriate laminar boundary layer depth is applied to the passive measurement. For this technique an exposure period of 3 days is equivalent to a limit of detection of formaldehyde of 3.4 ppbv and a limit of quantification of 7.6 ppbv. To test the performance of the passive samplers ambient formaldehyde measurements were carried out inside homes and in a range of workplace environments.
This study characterized indoor volatile organic compounds (VOCs) and investigated the effects of the dwelling characteristics, building materials, occupant activities, and environmental conditions ...on indoor VOC concentrations in 40 dwellings located in Melbourne, Australia, in 2008 and 2009. A total of 97 VOCs were identified. Nine VOCs, n‐butane, 2‐methylbutane, toluene, formaldehyde, acetaldehyde, d‐limonene, ethanol, 2‐propanol, and acetic acid, accounted for 68% of the sum of all VOCs. The median indoor concentrations of all VOCs were greater than those measured outdoors. The occupant density was positively associated with indoor VOC concentrations via occupant activities, including respiration and combustion. Terpenes were associated with the use of household cleaning and laundry products. A petroleum‐like indoor VOC signature of alkanes and aromatics was associated with the proximity of major roads. The indoor VOC concentrations were negatively correlated (P < 0.05) with ventilation. Levels of VOCs in these Australian dwellings were lower than those from previous studies in North America and Europe, probably due to a combination of an ongoing temporal decrease in indoor VOC concentrations and the leakier nature of Australian dwellings.
A study has been conducted in Launceston, Australia, to determine within households with wood heaters the effect of leakage from the heater and flue on the indoor air concentrations of the ...pollutants: benzene, toluene, ethylbenzene and xylene (BTEX). The study involved three classes: 28 households without wood heaters, 19 households with wood heaters compliant with the relevant Australian Standard and 30 households with non-compliant wood heaters. Outdoor and indoor BTEX concentrations were measured in each household for 7 days during summer when there was little or no wood heater usage, and for 7 days during winter when there was widespread wood heater usage. Each participant kept a household activity diary throughout their sampling periods. For wintertime, there were no significant differences of the indoor BTEX concentrations between the three classes of households. Also there were no significant relationships between BTEX indoor concentrations within houses and several measures of the amount of wood heater use within these houses. For the households sampled in this study, the use of a wood heater within a house did not lead to BTEX release within that house and had no direct detectable influence on the concentrations of BTEX within the house. We propose that the pressure differences associated with the both the leakiness or permeability of the building envelope and the draught of the wood heater have key roles in determining whether there will be backflow of smoke from the wood heater into the house. For a leaky house with a well maintained wood heater there should be no backflow of smoke from the wood heater into the house. However backflow of smoke may occur in well sealed houses.
The study also found that wood heater emissions raise the outdoor concentrations of BTEX in winter in Launceston and through the mixing of outdoor air through the building envelopes into the houses, these emissions contribute to increases in the indoor concentrations of BTEX in winter in all houses in Launceston.
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