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Ethnic and racial differences in the prevalence of infertility: national survey of family growth (NSFG)
expulsion rates were 3.7% for both age groups, 1.8% vs 5.0% for nulliparous vs parous women, and 3.1% vs 6.9% in women with BMIs <30 vs R30 kg/ m2. The cumulative 5-year ectopic pregnancy rate was 0.18 per 100 womanyears (range: 0.14-0.28 across all subgroups). Over 5 years, 328 (22.6%) women discontinued due to any adverse event (AE). This rate was 24.2% vs 21.5% in nulliparous vs parous women. Overall, the most frequent AEs that led to discontinuation were vaginal hemorrhage (3.5%), IUS expulsion (3.0%), and pelvic pain (3.0%). CONCLUSIONS: LNG-IUS12 was highly effective over 5 years, regardless of age or parity. LNG-IUS12 was associated with low rates of expulsion and ectopic pregnancy. Overlapping 95% CIs for all groups suggest that no major differences exist between them. LNG-IUS12 offers women a lowerdose 5-year contraceptive option. Supported by: Study and abstract funded by Bayer HealthCare O-16 Monday, October 17, 2016 12:00 PM FERTILITY CONCERNS ARE ASSOCIATED WITH LOWER CONTRACEPTION RATES IN BREAST CANCER SURVIVORS. T. Toloubeydokhti, S. Lederhandler, I. Su. Reproductive Medicine, University of California, San Diego, La Jolla, CA. OBJECTIVE: Contraception rates are lower in reproductive-aged female cancer survivors than in the general population. Longitudinal contraception patterns and factors related to contraceptive use are not known. This study evaluated changes in and factors related to contraceptive use in breast cancer survivors. DESIGN: Prospective cohort MATERIALS AND METHODS: 114 newly diagnosed, premenopausal breast cancer patients, mean age 39.5(SD 4.8), were enrolled at diagnosis and followed for up to 24 months. Contraception use, concern about future fertility, sexual activity were self-reported at enrollment and follow up visits via standardized questionnaires. Participants at risk of unintended pregnancy were categorized as 1) using contraception and 2) using WHO Tiers I/II contraception at enrollment and the first follow up occurring 12-24 months later. Paired data on contraception and use of Tiers I/II methods were compared using McNemar’s test. Participants characteristics and future fertility concern were compared by contraception status via Fisher’s Exact or Student’s t-test. RESULTS: 85 participants were at risk of unintended pregnancy, excluding women who were pregnant, underwent hysterectomy or bilateral salpingoophorectomy, or were not sexually active. The majority was Caucasian (69%), 74% underwent chemotherapy, 20% were nulligravid, and 31% reported future fertility concerns. At diagnosis, 35% were not using contraception. A minority of contracepting participants (41%) used Tier I/II methods. Compared to enrollment, follow up data showed 32% of participants were not using contraception (p¼0.57); use of Tiers I/II methods was reported by 45% of those contracepting (p¼0.41). At follow up, contraception use and use of Tiers I/II methods were not associated with age, race, education, income, cancer characteristics or prior fertility preservation. Nulligravid women had a lower rate of contraception than those with prior pregnancy (RR 0.55, 95%CI 0.31-0.99, p¼0.009). Participants with fertility concerns also had a lower rate of contraception (RR 0.67, 95% CI 0.421.08, p¼0.05). CONCLUSIONS: In the first two years after cancer diagnosis, no significant changes in contraception were seen in reproductive-aged breast cancer survivors. Many reported fertility concerns and were not contracepting effectively, suggesting a need to improve family planning practices in this population. Supported by: NIH HD058799-05, 5R01HD080952-03, HD MRSG-08110-01-CCE O-17 Monday, October 17, 2016 12:15 PM UTILIZATION OF IMMEDIATE POSTPARTUM ETONOGESTREL CONTRACEPTIVE IMPLANT. B. B. Mills, J. Van Deman III, E. C. Heberlein, A. H. Picklesimer. Department of Obstetrics and Gynecology, Greenville Health System, Greenville, SC. OBJECTIVE: To compare utilization of the etonogestrel contraceptive implant before and after a Medicaid payment policy change that allows device, facility and professional reimbursement while the patient is an inpatient postpartum, in addition to a bundled payment for obstetric delivery. DESIGN: Retrospective cohort study
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MATERIALS AND METHODS: Deliveries between January and April 2013, prior to inpatient availability of contraceptive implants, and January to April 2014, after inpatient insertion became available, were compared. Demographic characteristics, prenatal contraception plan, postpartum visit attendance, and utilization of long acting reversible contraception were obtained. Differences were compared using two-tailed independent sample ttests for continuous variables and Chi-square or Fisher’s exact test for categorical variables. RESULTS: 816 women were in the 2013 outpatient cohort and 847 women were in the 2014 inpatient cohort. Implant utilization increased from 4% to 21% (p<0.001) and was independent of parity or mode of delivery. Receipt of long acting reversible contraception increased from 12% to 26% of patients (p<0.001). Postpartum visit attendance was higher in women who received an inpatient implant (60% vs. 50%, p¼0.024). CONCLUSIONS: Improving access to contraceptive implants immediately postpartum via payment reform significantly increased uptake.
O-18 Monday, October 17, 2016 12:30 PM ETHNIC AND RACIAL DIFFERENCES IN THE PREVALENCE OF INFERTILITY: NATIONAL SURVEY OF FAMILY GROWTH (NSFG). J. D. Peck,a A. Janitz,b L. B. Craig.c aDept of Biostatistics and Epidemiology, OU Health Sciences Center, Oklahoma City, OK; bDept of Biostatistics and Epidemiology, OU Health Science Center, Oklahoma City, OK; cSection of REI, Dept of Ob/Gyn, OU Health Science Center, Oklahoma City, OK. OBJECTIVE: Clinical and population-based comparisons of the racial/ ethnic burden of infertility have identified disparities in infertility prevalence. The objective of our study was to estimate the prevalence of infertility in the U.S. population by race/ethnicity in a nationally representative sample of men and women aged 15-44 years. DESIGN: Secondary analysis of existing cross-sectional data from the NSFG, a US population-based survey collecting data on infertility and receipt of infertility services. MATERIALS AND METHODS: We analyzed female respondent data from the pooled NSFG cycles 2002, 2006-2010 and 2011-2013. Racial/ ethnic groups were categorized as 1) Non-Hispanic (NH) white, 2) NH black, 3) NH other, or 4) Hispanic. Infertility was defined as >12 months of intercourse without pregnancy among married or cohabiting respondents in a continuous relationship for R12 months with no use of contraception. Impaired fecundity included women in 3 subgroups of nonsurgically sterile, subfecund, and long (3+ yr) interval without conception. Prevalence proportions and multivariable logistic regression analyses accounted for survey weighting. Prevalence odds ratios (POR) and 95% confidence intervals (CI) were adjusted for age, relationship status, education, poverty level, parity, body mass index, smoking, pelvic inflammatory disease treatment and gynecologic disorders. Power calculations indicated the planned study had 80% power to detect minimum PORs of 1.7 and 1.4 for infertility and impaired fecundity among other race/ethnicity compared to NH whites. RESULTS: In the pooled data (n¼25,523), the prevalence of infertility was 6.4% (95% CI: 5.7%, 7.0%) and the prevalence of impaired fecundity was 34.1% (95% CI: 33.0%, 35.1%). Compared to NH whites, NH blacks had a 43% higher adjusted odds of infertility (95% CI: 1.00, 2.03). Hispanics also had a higher adjusted odds of infertility compared to NH whites (POR: 1.28, 95% CI: 0.95, 1.74), whereas there was little difference for NH other (POR: 0.95, 95% CI: 0.60, 1.49). A significantly lower odds of impaired fecundity was observed among Hispanic (POR: 0.75, 95% CI: 0.65, 0.87) and NH other (POR: 0.74, 95% CI: 0.60, 0.92), with no difference for NH blacks (POR: 1.01, 95% CI: 0.87, 1.17), compared to NH whites. CONCLUSIONS: Prevention of reproductive health disparities requires monitoring race-specific infertility prevalence and related risk factors to guide and monitor effective public health action strategies to safeguard reproductive health. Supported by: This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under 1 R40MC29449-01-00. Support is also provided by Oklahoma Shared Clinical and Translational Resource Institute NIGMS U54 GM104938. The information, content and/or conclusions are those of the authors and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S.
Vol. 106, No. 3, Supplement, September 2016
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ASRM Abstracts
MATERIALS AND METHODS: Deliveries between January and April 2013, prior to inpatient availability of contraceptive implants, and January to April 2014, after inpatient insertion became available, were compared. Demographic characteristics, prenatal contraception plan, postpartum visit attendance, and utilization of long acting reversible contraception were obtained. Differences were compared using two-tailed independent sample ttests for continuous variables and Chi-square or Fisher’s exact test for categorical variables. RESULTS: 816 women were in the 2013 outpatient cohort and 847 women were in the 2014 inpatient cohort. Implant utilization increased from 4% to 21% (p<0.001) and was independent of parity or mode of delivery. Receipt of long acting reversible contraception increased from 12% to 26% of patients (p<0.001). Postpartum visit attendance was higher in women who received an inpatient implant (60% vs. 50%, p¼0.024). CONCLUSIONS: Improving access to contraceptive implants immediately postpartum via payment reform significantly increased uptake.
O-18 Monday, October 17, 2016 12:30 PM ETHNIC AND RACIAL DIFFERENCES IN THE PREVALENCE OF INFERTILITY: NATIONAL SURVEY OF FAMILY GROWTH (NSFG). J. D. Peck,a A. Janitz,b L. B. Craig.c aDept of Biostatistics and Epidemiology, OU Health Sciences Center, Oklahoma City, OK; bDept of Biostatistics and Epidemiology, OU Health Science Center, Oklahoma City, OK; cSection of REI, Dept of Ob/Gyn, OU Health Science Center, Oklahoma City, OK. OBJECTIVE: Clinical and population-based comparisons of the racial/ ethnic burden of infertility have identified disparities in infertility prevalence. The objective of our study was to estimate the prevalence of infertility in the U.S. population by race/ethnicity in a nationally representative sample of men and women aged 15-44 years. DESIGN: Secondary analysis of existing cross-sectional data from the NSFG, a US population-based survey collecting data on infertility and receipt of infertility services. MATERIALS AND METHODS: We analyzed female respondent data from the pooled NSFG cycles 2002, 2006-2010 and 2011-2013. Racial/ ethnic groups were categorized as 1) Non-Hispanic (NH) white, 2) NH black, 3) NH other, or 4) Hispanic. Infertility was defined as >12 months of intercourse without pregnancy among married or cohabiting respondents in a continuous relationship for R12 months with no use of contraception. Impaired fecundity included women in 3 subgroups of nonsurgically sterile, subfecund, and long (3+ yr) interval without conception. Prevalence proportions and multivariable logistic regression analyses accounted for survey weighting. Prevalence odds ratios (POR) and 95% confidence intervals (CI) were adjusted for age, relationship status, education, poverty level, parity, body mass index, smoking, pelvic inflammatory disease treatment and gynecologic disorders. Power calculations indicated the planned study had 80% power to detect minimum PORs of 1.7 and 1.4 for infertility and impaired fecundity among other race/ethnicity compared to NH whites. RESULTS: In the pooled data (n¼25,523), the prevalence of infertility was 6.4% (95% CI: 5.7%, 7.0%) and the prevalence of impaired fecundity was 34.1% (95% CI: 33.0%, 35.1%). Compared to NH whites, NH blacks had a 43% higher adjusted odds of infertility (95% CI: 1.00, 2.03). Hispanics also had a higher adjusted odds of infertility compared to NH whites (POR: 1.28, 95% CI: 0.95, 1.74), whereas there was little difference for NH other (POR: 0.95, 95% CI: 0.60, 1.49). A significantly lower odds of impaired fecundity was observed among Hispanic (POR: 0.75, 95% CI: 0.65, 0.87) and NH other (POR: 0.74, 95% CI: 0.60, 0.92), with no difference for NH blacks (POR: 1.01, 95% CI: 0.87, 1.17), compared to NH whites. CONCLUSIONS: Prevention of reproductive health disparities requires monitoring race-specific infertility prevalence and related risk factors to guide and monitor effective public health action strategies to safeguard reproductive health. Supported by: This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under 1 R40MC29449-01-00. Support is also provided by Oklahoma Shared Clinical and Translational Resource Institute NIGMS U54 GM104938. The information, content and/or conclusions are those of the authors and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S.
Vol. 106, No. 3, Supplement, September 2016