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Associations between military service characteristics, female infertility, and delayed conception
DESIGN: Retrospective Cohort. MATERIALS AND METHODS: Patients at a single IVF center from January 2011 to April 2017 who underwent their first IVF cycle were reviewed for this analysis. Patients utilizing preimplantation genetic diagnosis in conjunction with PGS, oocyte cryopreservation, and patients participating in IVF research where PGS was offered at no cost were excluded. Only patients with known insurance status were included. Patients were divided into those with IVF insurance coverage and those without IVF insurance coverage. PGS utilization was compared between the 2 groups. Analysis was performed using chi-squared and student’s t-test where appropriate. Logistic regression was used to account for differences in patient age and antimullerian hormone level (AMH). An alpha error of 0.05 was considered significant. RESULTS: 6537 patients were included in the analysis. Group 1 (those patients with IVF insurance coverage) included 4938 (75.5%) patients and group 2 (those patients without IVF coverage) included 1599 (24.5%) patients. There was no difference in the rate of IVF coverage when patients were stratified by the year they underwent IVF (p¼0.78). Patients without insurance coverage were more likely to utilize PGS (54.1% v. 49.9%, p¼0.003). When adjusting for factors that may influence the decision to utilize PGS (patient age and AMH) the odds of PGS utilization were still lower in patients with IVF coverage (ORadj 0.788 [0.700-0.887], p<0.0001). As expected, sustained implantation rate (number of ongoing gestations at 8 weeks / number of blastocysts transferred) is higher in patients that underwent PGS, p¼0.015. CONCLUSIONS: Patients without insurance coverage are more likely to pursue PGS. We hypothesize that patients who are paying out of pocket for in vitro fertilization opt to utilize PGS to improve their per cycle chance of conception, thereby optimizing the cost-effectiveness of their cycle.
(5%, n¼82) and IVF/ICSI (4.6%, n¼76) occurred less frequent. At the moment of the survey, most couples (93.55%, n¼1,146) undergoing treatment had not conceived successfully. CONCLUSIONS: Among couples of reproductive age in China, the prevalence of infertility was 25%. Almost half of the couples experiencing infertility had not sought medical help. Supported by: This study was supported by Assisted Reproductive Technology Development Cooperation Projects from the Center for international exchanges and cooperation in National Health and Family Planning Commission of the People’s Republic of China (No. (2010) 237), National Key Technology R&D Program in the Twelfth FiveYear Plan (No.2012BAI32B01) and Research Fund of National Health and Family Planning Commission of China (No.201402004). The study funders had no rule in the study design, implementation, analysis, manuscript, preparation, or decision to submit this article for publication.
P-18 Tuesday, October 31, 2017
OBJECTIVE: To evaluate associations between military service characteristics, self-reported infertility, and delayed conception among women who have served in the U.S. military. DESIGN: Cross-sectional data analysis of the Examining Contraceptive Use and Unmet Need (ECUUN) Study, a national telephone survey of randomly sampled women veterans aged 18-44 who received primary care at the Veterans Administration (VA) in the prior 12 months. MATERIALS AND METHODS: Interviews were conducted from April 2014 through January 2016 by trained interviewers using computer-assisted telephone interview technology. Detailed information about women’s military service and pregnancy histories was obtained. Infertility status was determined based on patient self-report of a prior diagnosis by a health-care provider; delayed conception was defined as R1 pregnancies occurring later than desired. Descriptive statistics and chi-square tests were used to examine associations between infertility and deployment history, branch of service (Army, Navy, Air Force, Marines and Coast Guard), era of service (Persian Gulf and Afghanistan/Iraq; data stratified by woman’s age less than or R 30 years to account for confounding between age and era of service), and history of military sexual trauma (MST). Associations between these military service characteristics and delayed conception were also assessed. RESULTS: A total of 2,302 women participated in the ECUUN survey. Mean age was 34.5 5.6 years. Infertility was reported by 8.3%. Among women who conceived, 14.6% reported that R1 pregnancy occurred later than desired. History of MST was reported by 55%. Infertility was more commonly reported by women with a history of MST than those without this history (10.8% vs 5.3%, p<0.001). Among women R 30 years of age, infertility was more common in those who served in the Persian Gulf compared to those who did not (10.1% vs 7.3%, p¼0.04). Delayed conception was also associated with a history of MST (16.4%% vs 12.2%, p¼0.02). Neither infertility nor delayed conception was associated with deployment history or branch of service. CONCLUSIONS: Lack of infertility coverage for military families has become an area of increasing public awareness. To our knowledge, this is the first study specifically examining infertility and delayed conception among women who have served in the U.S. military. Our results suggest that infertility is associated with service era and MST, whereas delayed conception is only associated with MST. Interestingly, branch of service and history of deployment were not associated with either infertility or delayed conception. Supported by: Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, VA Merit Award IIR 12-124 (PI: Sonya Borrero).
PREVALENCE OF INFERTILITY IN CHINA: A POPULATION BASED STUDY. Z. Zhou,a D. Zheng,a H. Wu,a R. Li,a S. Xu,b Y. Kang,c Y. Cao,d X. Chen,e Y. Zhu,f S. Xu,g Z. Chen,h B. W. Mol,i J. Qiao.a aDepartment of Obstetrics and Gynecology, Reproductive Medical Center, Peking University Third Hospital, Beijing, China; bReproductive Medical Center, The Second Hospital of Hebei Medical University, Shijiazhuang, China; cReproductive Medical Center, Maternal and Children’s Health Hospital of Fujian Province, Fuzhou, China; dDepartment of Obstetrics and Gynecology, Reproductive Medical Center, First Affiliated Hospital of Anhui Medical University, Hefei, China; eReproductive Medical Center, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China; fDepartment of Reproductive Endocrinology, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China; gPopulation and Family Planning Research Institute of Heilongjiang Province, Harbin, China; hCenter for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China; iObstetrics & Gynaecology, The University of Adelaide, North Adelaide, Australia. OBJECTIVE: To assess the current prevalence of infertility and the uptake of medical care among couples of reproductive age in China. DESIGN: Population-based cross-sectional study. MATERIALS AND METHODS: A large-scale population-based crosssectional study was conducted from February 2010 to November 2011 in 8 provinces/municipalities in northern and eastern China.Out of 25,270 approached couples, 18,571 (response rate 74%) were interviewed in a face to face interview using a structured questionnaire. RESULTS: Among women ‘at risk’ of pregnancy, the overall prevalence of infertility was 15.5% (2,680/17,275), of which 9.5% was primary infertility and 6.0% was secondary infertility. Among 10,742 women actively attempting to become pregnant, the prevalence of infertility was 25.0% with 2,680/10,742 (primary infertility 15.3%; secondary infertility 9.7%, respectively). Only 55.2% (1,915/3,470) of women who failed to achieve pregnancy in the last 12 months had sought medical help. Most of the couples who sought medical help did so through a general hospital (n¼1,467, 76%), and diagnoses were tubal infertility (n¼451, 24.9%), unexplained infertility (n¼387, 21.4%), male infertility (n¼319, 17.6%), ovulatory disorder (n¼239, 13.2%) and endometriosis (n¼46, 2.5%) while 20.4% (n¼370) had not yet been classified. The majority of couples received non-ART fertility treatment (65.0%, n¼1076), which included ovulation monitoring (23.0%, n¼381), ovulation induction (23.4%, n¼388) and surgery of womb or appendix (18.6%, n¼307), while intrauterine insemination
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P-19 Tuesday, October 31, 2017 ASSOCIATIONS BETWEEN MILITARY SERVICE CHARACTERISTICS, FEMALE INFERTILITY, AND DELAYED CONCEPTION. R. M. Beverley,a S. Borrero,b,c J. A. Harris,a F. E. Sileanu,b M. K. Mor,b,d X. Zhao,b M. N. Menke.a aDepartment of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA; bCenter for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA; cDivision of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA; dDepartment of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA.
Vol. 108, No. 3, Supplement, September 2017
(5%, n¼82) and IVF/ICSI (4.6%, n¼76) occurred less frequent. At the moment of the survey, most couples (93.55%, n¼1,146) undergoing treatment had not conceived successfully. CONCLUSIONS: Among couples of reproductive age in China, the prevalence of infertility was 25%. Almost half of the couples experiencing infertility had not sought medical help. Supported by: This study was supported by Assisted Reproductive Technology Development Cooperation Projects from the Center for international exchanges and cooperation in National Health and Family Planning Commission of the People’s Republic of China (No. (2010) 237), National Key Technology R&D Program in the Twelfth FiveYear Plan (No.2012BAI32B01) and Research Fund of National Health and Family Planning Commission of China (No.201402004). The study funders had no rule in the study design, implementation, analysis, manuscript, preparation, or decision to submit this article for publication.
P-18 Tuesday, October 31, 2017
OBJECTIVE: To evaluate associations between military service characteristics, self-reported infertility, and delayed conception among women who have served in the U.S. military. DESIGN: Cross-sectional data analysis of the Examining Contraceptive Use and Unmet Need (ECUUN) Study, a national telephone survey of randomly sampled women veterans aged 18-44 who received primary care at the Veterans Administration (VA) in the prior 12 months. MATERIALS AND METHODS: Interviews were conducted from April 2014 through January 2016 by trained interviewers using computer-assisted telephone interview technology. Detailed information about women’s military service and pregnancy histories was obtained. Infertility status was determined based on patient self-report of a prior diagnosis by a health-care provider; delayed conception was defined as R1 pregnancies occurring later than desired. Descriptive statistics and chi-square tests were used to examine associations between infertility and deployment history, branch of service (Army, Navy, Air Force, Marines and Coast Guard), era of service (Persian Gulf and Afghanistan/Iraq; data stratified by woman’s age less than or R 30 years to account for confounding between age and era of service), and history of military sexual trauma (MST). Associations between these military service characteristics and delayed conception were also assessed. RESULTS: A total of 2,302 women participated in the ECUUN survey. Mean age was 34.5 5.6 years. Infertility was reported by 8.3%. Among women who conceived, 14.6% reported that R1 pregnancy occurred later than desired. History of MST was reported by 55%. Infertility was more commonly reported by women with a history of MST than those without this history (10.8% vs 5.3%, p<0.001). Among women R 30 years of age, infertility was more common in those who served in the Persian Gulf compared to those who did not (10.1% vs 7.3%, p¼0.04). Delayed conception was also associated with a history of MST (16.4%% vs 12.2%, p¼0.02). Neither infertility nor delayed conception was associated with deployment history or branch of service. CONCLUSIONS: Lack of infertility coverage for military families has become an area of increasing public awareness. To our knowledge, this is the first study specifically examining infertility and delayed conception among women who have served in the U.S. military. Our results suggest that infertility is associated with service era and MST, whereas delayed conception is only associated with MST. Interestingly, branch of service and history of deployment were not associated with either infertility or delayed conception. Supported by: Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, VA Merit Award IIR 12-124 (PI: Sonya Borrero).
PREVALENCE OF INFERTILITY IN CHINA: A POPULATION BASED STUDY. Z. Zhou,a D. Zheng,a H. Wu,a R. Li,a S. Xu,b Y. Kang,c Y. Cao,d X. Chen,e Y. Zhu,f S. Xu,g Z. Chen,h B. W. Mol,i J. Qiao.a aDepartment of Obstetrics and Gynecology, Reproductive Medical Center, Peking University Third Hospital, Beijing, China; bReproductive Medical Center, The Second Hospital of Hebei Medical University, Shijiazhuang, China; cReproductive Medical Center, Maternal and Children’s Health Hospital of Fujian Province, Fuzhou, China; dDepartment of Obstetrics and Gynecology, Reproductive Medical Center, First Affiliated Hospital of Anhui Medical University, Hefei, China; eReproductive Medical Center, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China; fDepartment of Reproductive Endocrinology, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China; gPopulation and Family Planning Research Institute of Heilongjiang Province, Harbin, China; hCenter for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China; iObstetrics & Gynaecology, The University of Adelaide, North Adelaide, Australia. OBJECTIVE: To assess the current prevalence of infertility and the uptake of medical care among couples of reproductive age in China. DESIGN: Population-based cross-sectional study. MATERIALS AND METHODS: A large-scale population-based crosssectional study was conducted from February 2010 to November 2011 in 8 provinces/municipalities in northern and eastern China.Out of 25,270 approached couples, 18,571 (response rate 74%) were interviewed in a face to face interview using a structured questionnaire. RESULTS: Among women ‘at risk’ of pregnancy, the overall prevalence of infertility was 15.5% (2,680/17,275), of which 9.5% was primary infertility and 6.0% was secondary infertility. Among 10,742 women actively attempting to become pregnant, the prevalence of infertility was 25.0% with 2,680/10,742 (primary infertility 15.3%; secondary infertility 9.7%, respectively). Only 55.2% (1,915/3,470) of women who failed to achieve pregnancy in the last 12 months had sought medical help. Most of the couples who sought medical help did so through a general hospital (n¼1,467, 76%), and diagnoses were tubal infertility (n¼451, 24.9%), unexplained infertility (n¼387, 21.4%), male infertility (n¼319, 17.6%), ovulatory disorder (n¼239, 13.2%) and endometriosis (n¼46, 2.5%) while 20.4% (n¼370) had not yet been classified. The majority of couples received non-ART fertility treatment (65.0%, n¼1076), which included ovulation monitoring (23.0%, n¼381), ovulation induction (23.4%, n¼388) and surgery of womb or appendix (18.6%, n¼307), while intrauterine insemination
e114
ASRM Abstracts
P-19 Tuesday, October 31, 2017 ASSOCIATIONS BETWEEN MILITARY SERVICE CHARACTERISTICS, FEMALE INFERTILITY, AND DELAYED CONCEPTION. R. M. Beverley,a S. Borrero,b,c J. A. Harris,a F. E. Sileanu,b M. K. Mor,b,d X. Zhao,b M. N. Menke.a aDepartment of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA; bCenter for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA; cDivision of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA; dDepartment of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA.
Vol. 108, No. 3, Supplement, September 2017