Fertility-related Outcomes Research Articles

P-346 A systematic review of the gonadotoxicity of osteoscarcoma and Ewinǵs sarcoma chemotherapies in postpubertal females and males

Abstract Study question What is the postpubertal gonadotoxicity of osteosarcoma (OS) and Ewing’s sarcoma (ES) chemotherapies to better counsel females and males about the risk of infertility? Summary answer Limited data indicate a risk of infertility in OS in 5.1% of females and 52.2% of males and in ES in 13.0% and 89.5% respectively. What is known already Data on the gonadotoxicity of different chemotherapies are essential to better advise young women and men about the risk of treatment-related infertility and to better assess the need for fertility preservation measures prior to cancer treatment. Such data specific to bone-cancer have not yet been systematically reviewed. This review is part of the FertiTOX project (www.fertitox.com) which aims to close the gap of data regarding gonadotoxicity of cancer therapies to enable more accurate counselling regarding fertility preservation. Study design, size, duration A systematic review was conducted to address the issue of gonadotoxicity of bone-cancer specific chemotherapies. Combined search topics included 1) bone-cancer, 2) cancer therapies and 3) fertility parameters after cancer therapy. All relevant documents published between 09/2000 and 08/2022 from the information sources MEDLINE, Embase, and Cochrane Library were included. Participants/materials, setting, methods Only post-pubertal women and men aged < 40 years without recurrent or metastatic disease were included. Due to the inconsistent description of post-treatment fertility parameters, the parameter “suspected infertility” was introduced to summarise and interpret the results. “Suspected infertility” was defined as follows: in women, any menstrual cycle disorder, gonadotropin or anti-mullerian hormone outside the reference range and a diagnosis of premature ovarian failure; in men, the presence of azoospermia or oligozoospermia. Main results and the role of chance A total of 11 out of 831 trials were included in the review. All studies were registry or observational studies. The rate of suspected infertility varied considerably in both OS and ES. Suspected infertility was found in 10/190 (5.1%, range 0-66%) female patients with OS (6 studies), 24/46 (52.2%, range 46-100%) male patients with OS (3 studies), 18/138 (13.0%, range 3-18%) female patients with ES (3 studies) and 34/38 (89.5%) male patients with ES (1 study). It was not possible to calculate the risk associated with specific chemotherapies. The risk of suspected infertility tended to be higher in ES, where all (100%) patients received alkylating chemotherapy, compared with 40% of women and 90% of men in OS. In both OS and ES, the overall rate of suspected infertility appeared to be higher in men than in women. Limitations, reasons for caution The limited data and heterogeneity of fertility-related outcomes in most trials made it necessary to define the rather vague outcome “suspected infertility”. Wider implications of the findings Our data suggest a moderate to high risk of infertility due to chemotherapies in bone cancer. This appears to be more pronounced in males than in females, although precise information cannot be given due to limited data. However, even though the study emphasizes the importance to consider fertility preservation measures. Trial registration number not applicable

Pharmacogenomic studies of fertility outcomes in pediatric cancer survivors - A systematic review.

For the same age, sex, and dosage, there can be significant variation in fertility outcomes in childhood cancer survivors. Genetics may explain this variation. This study aims to: (i) review the genetic contributions to infertility, (ii) search for pharmacogenomic studies looking at interactions of cancer treatment, genetic predisposition and fertility-related outcomes. Systematic searches in MEDLINE Ovid, Embase Classic+Embase, and PubMed were conducted using the following selection criteria: (i) pediatric, adolescent, and young adult cancer survivors, below 25 years old at the time of diagnosis, (ii) fertility outcome measures after cancer therapy, (iii) genetic considerations. Studies were excluded if they were (i) conducted in animal models, (ii) were not published in English, (iii) editorial letters, (iv) theses. Articles were screened in Covidence by at least two independent reviewers, followed by data extraction and a risk of bias assessment using the Quality in Prognostic Studies tool. Eight articles were reviewed with a total of 29 genes. Outcome measures included sperm concentration, azoospermia, AMH levels, assessment of premature menopause, ever being pregnant or siring a pregnancy. Three studies included replication cohorts, which attempted replication of SNP findings for NPY2R, BRSK1, FANCI, CYP2C19, CYP3A4, and CYP2B6. Six studies were rated with a high risk of bias. Differing methods may explain a lack of replication, and small cohorts may have contributed to few significant findings. Larger, prospective longitudinal studies with an unbiased genome-wide focus will be important to replicate significant results, which can be applied clinically.

Did the Affordable Care Act Promote Racial Equity in Pregnancy-Related Health? A Scoping Review.

In the United States, there are profound and persistent racial and ethnic disparities in pregnancy-related health, emphasizing the need to promote racial health equity through public policy. There is evidence that the Affordable Care Act (ACA) increased health insurance coverage, access to health care, and health care utilization, and may have affected some pregnancy-related health outcomes (eg, preterm delivery). It is unclear, however, whether these impacts on pregnancy-related outcomes were equitably distributed across race and ethnicity. Thus, the objective of this study was to fill that gap by summarizing the peer-reviewed evidence regarding the impact of the ACA on racial and ethnic disparities in pregnancy-related health outcomes. The authors conducted a scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR), using broad search terms to identify relevant peer-reviewed literature in PubMed, Web of Science, and EconLit. The authors identified and reviewed n = 21 studies and found that the current literature suggests that the ACA and its components were differentially associated with contraception-related and fertility-related outcomes by race/ethnicity. Literature regarding pregnancy health, birth outcomes, and postpartum health, however, was sparse and mixed, making it difficult to draw conclusions regarding the impact on racial/ethnic disparities in these outcomes. To inform future health policy that reduces racial disparities, additional work is needed to clarify the impacts of contemporary health policy, like the ACA, on racial disparities in pregnancy health, birth outcomes, and postpartum health.

Is reproductive development adaptively calibrated to early experience? Evidence from a national sample of females.

Many developmental theories have not been sufficiently evaluated using designs that control for unobserved familial confounds. Our long-term goal is to determine the causal structure underlying associations between early environmental conditions and later psychosocial and health outcomes. Our overall objective in this study was to further evaluate predictions derived from applications of life history theory to female reproductive development, key among them that reproductive milestones translate early environmental risk into fertility, health, and behavioral outcomes. To this end, we used female data from the National Longitudinal Survey of Youth 1979 and structural equation modeling to conduct increasingly severe tests, beginning with covariate control and then progressing to sibling control and behavioral genetic designs. After adjusting for confounds varying between sets of siblings, we did not find evidence that age at menarche reflected components of early environment or that any focal outcomes reflected early fragmented family structure (birth to age nine). Although we detected no links between measured environment and individual differences in age at sexual debut, we did find that it reflected both shared and nonshared influences in our behavior genetic models. Interestingly, delayed sexual debut (into young adulthood) reflected identification of parents as the greatest influences and forecasted an array of fertility-related outcomes. Taken together, these findings challenge theories suggesting menarche timing is adaptively calibrated to early environment. They also highlight the need for more research using sibling control and related designs to examine the roles of environments in development. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The impact of dietary interventions on polycystic ovary syndrome patients with a BMI ≥25 kg/m2: A systematic review and meta-analysis of randomized controlled trials.

Dietary interventions, recommended as a primary approach globally, benefit women with polycystic ovary syndrome (PCOS) by inducing weight loss and improving clinical symptoms, metabolism, and pregnancy results. However, the impact of diet on PCOS in individuals with BMI ≥ 25 kg/m2 is unclear. The aim of this review was to offer dietary guidance for these patients. Six databases, CNKI, Wanfang, VIP, PubMed, Cochrane Library, and Web of Science, were searched systematically from inception to December 2023 for clinical randomized controlled trials (RCT) on dietary interventions for PCOS. Two researchers independently screened and extracted data following pre-defined inclusion criteria, with bias assessment using the Cochrane Handbook and Review Manager (version 5.4) software. Nine RCTs with 559 participants were included. Among women with PCOS and obesity, compared to the control group, individuals who underwent dietary interventions experienced improvements in weight-related Indicators, glycolipid metabolism, hormone-related indicators, and fertility-related outcomes. Subgroup analysis indicated that calorie-restricted diets (CRDs) and low-energy-low-carb combined diets had advantages over other dietary interventions. Moreover, the overweight period was the optimal intervention period. Dietary interventions can improve the clinical manifestations of PCOS and pregnancy rates in patients with a BMI ≥ 25 kg/m2. Particularly, CRDs, low-calorie-low-carb combined diets, and low-calorie-extract combined diets are recommended.

Is the mortality–fertility nexus gendered? A research note on sex differences in the impact of sibling mortality on fertility preferences

Research guided by demographic transition theory has shown that exposure to mortality influences women’s fertility preferences and behaviours. Despite the myriad contexts, methodological approaches, and linkages featured in past studies, they have shared a focus on women, leaving questions on the gendered salience of mortality exposures for adults’ fertility-related outcomes unanswered. In this research note, we analyse data from three African countries with distinct fertility profiles (Nigeria, Zambia, and Zimbabwe) to examine associations between sibling mortality exposure and ideal family size among women, men, and couples. We also investigate the stability of these associations over time. The associations between adults’ sibling mortality exposure and their own and their spouses’ ideal family sizes vary across countries. However, the gendered nature of the results in every country and evidence of cross-spousal effects uniformly demonstrate the need to incorporate sex differences into the study of the mortality–fertility link.

Approach to Radical Hysterectomy for Cervical Cancer in Pregnancy: Surgical Pathway and Ethical Considerations.

Cervical cancer is currently the fourth most common cancer in women and in the poorest countries this neoplasia still represents a widespread and potentially lethal disease. We present a rare case of cervical cancer in pregnancy, analyzing the historical changes behind the procedure of radical hysterectomy for cervical cancer and discussing variations in surgical techniques and anatomical definitions that have since been proposed. We present the case of a 33-year-old patient who attended with vaginal bleeding in the second trimester of pregnancy. Examination revealed an abnormal looking cervix, with investigations concluding stage IIb squamous cell carcinoma. Following extensive discussion regarding management options, the patient went on to have a peripartum foetocidal type III nerve sparing radical Wertheim hysterectomy at 18 weeks gestation with conservation and transposition of the ovaries above the level of the pelvic brim. The patient recovered well without significant morbidity and received further input from fertility and psychological medical teams in addition to adjuvant treatment within the department of clinical oncology. This case represents several elements of great interest and learning. Notably, we highlight this both due to the surgical challenges that a gravid uterus presents in the execution of a radical hysterectomy; and regarding the compassionate care demonstrated by the team - not only in supporting the patient and her partner in a period of profound turmoil in terms of the management of their cancer diagnosis and unborn child, but also regarding the uncertainty in consideration of the oncological and fertility related outcomes. This manuscript adds to the growing literature on the appropriate use of radical surgery for cervical cancer, more specifically during pregnancy and in consideration of such ethical dilemma, where management guidelines do not exist to aid clinicians further in their provision of treatment.

How women's empowerment influences fertility-related outcomes and contraceptive practices: A cross-sectional study in Mozambique.

Women's empowerment could be a crucial step for tackling gender inequality and improve women's reproductive health and rights in Mozambique. This study aims to examine how different domains of women's empowerment influence fertility-related outcomes and contraceptive practices in Mozambique. We used the 2015 Demographic Health Survey (DHS) conducted in Mozambique from which a sample of 2072 women aged 15 to 49 years were selected and included in this analysis. A principal component analysis was performed, and the components retained were identified as the domains of empowerment. These were: Beliefs about violence against women, Decision-making, and Control over sexuality and safe sex. A multinomial logistic regression was run to estimate the association between levels of empowerment for each domain and the study outcomes. Crude and adjusted odds ratio (OR) were calculated, with 95% confidence intervals (95% CI). Beliefs about violence against women and Control over sexuality and safe sex were positively associated with having 1 to 4 children. Control over sexuality and safe sex also increased likelihood of women wanting to space childbearing over more than 2 years. Decision-making increased the odds of women not wanting more children. Middle to high empowerment levels for Control over sexuality and safe sex also increased the chances of using any type of contraceptive method and using it for longer periods. All domains, from the middle to high levels of empowerment, decreased the chances of women not wanting to use contraception. Our study confirmed the multidimensional nature of empowerment showing that each domain had a different effect over specific fertility and contraceptive outcomes and reinforced the importance of a domain approach for estimating and understanding empowerment. It also revealed the critical role of Control over sexuality and safe sex domain for improving women's ability to decide over fertility and contraceptive practices in Mozambique.

Fertility decision and its associated factors in Sub-Saharan Africa: a multilevel multinomial logistic regression analysis

BackgroundFertility desire is one of the predictors of contraceptive behavior and fertility-related outcomes. However, information is scarce on individual and community-level factors of women’s fertility decisions in sub-Saharan Africa.ObjectiveTo assess fertility decisions and their associated factors in Sub-Saharan Africa.MethodsThe 35 Sub-Saharan African country’s most recent demographic and health surveys (DHS) data conducted from 2008 to 2020 was used. A total of 284,744 (weighted) married women were used for analysis. The proportion of fertility decisions with their 95%CI was estimated. To assess the factors associated with fertility decisions, both random effect and fixed effect analyses were conducted. In the fixed analysis, particularly in the multivariable analysis, adjusted relative risk ratio (aRRR) with its 95% confidence interval (CI) was reported and variables with a p-value < 0.05 were considered significant predictors of fertility decisions.ResultsIn this study, 64.35% (95%CI: 64.2%, 64.5%) of the study participants had fertility desire. However, 5.4% (95%CI: 5.3, 5.5) of the study participants had undecided fertility behavior. In the multivariable analysis, desire for more children and undecided fertility desire were relatively lower among older women, women with primary, secondary, and higher education, working women, women who currently use contraceptives, women with a higher number of living children, women with higher parity, women from eastern and southern Africa, and women from wealthy households. While, the ideal number of children, women who had decision-making autonomy, and women from the rural residence were all associated with a relatively higher desire for more children and undecided fertility desire. Furthermore, respondents' education and sex of household head were associated with the desire for more children while media exposure was associated with undecided fertility desire.ConclusionIn this study, around two-thirds of women had a desire for more children and only 5.4% of women had undecided fertility desires. Both individual and community-level factors were associated with both desires for more children and undecided fertility desires. As a result, the aforementioned factors should be considered while developing reproductive health programs.

The impact of college education on women’s fertility: evidence from a natural experiment in South Korea

ABSTRACT This study estimates the impact of women’s college education on their fertility-related outcomes by taking advantage of a natural experiment known as the graduation quota program that massively expanded women’s opportunities to attend college in South Korea. After the 1979 military coup, the military regime in South Korea ordered all public and private colleges to expand their college admission levels by 30 per cent in 1981 and 50 per cent in 1982. This study implemented instrumental variable (IV) analysis using the Korean Longitudinal Survey of Women and Families (KLoWF). Specifically, our IV analysis uses the birth cohorts that were differently exposed to this sudden and exogenous policy change as an instrumental variable to identify the longer-term effects of college education on women’s fertility-related outcomes. It is found that college education caused those women who were induced to attend college by the graduation quota program to have fewer children. Furthermore, this study finds that this impact can be partially explained by women being less likely to get married.

Can Nutrition Help in the Treatment of Infertility?

Infertility is defined as the inability to conceive after 12 months of unprotected intercourse or six months for women aged 35 years or older. The physical, emotional, psychological, and financial statuses of infertile couples are tremendously affected especially after undergoing diagnostic and/or curative treatments. Human fertility is influenced by multiple factors including female or male, and modifiable or non-modifiable factors. There is growing evidence that nutri-tion may play an important role in adjusting fertility-related outcomes in both men and women. The objective of our study was to summarize the latest data on nutritional factors (specific food groups, nutrients, and nutritional supplements) that have an impact on female or male sexual and reproductive function. PubMed and Google Scholar platforms were used to collect appropriate articles for the review using several combinations of keywords (infertility, diet, dietary supplements, antioxidants, and beverages). Adherence to a healthy dietary pattern favoring fish, poultry, whole grains, fruits, vegetables, and healthy fats, was related to better fertility in both genders. Despite the multifactorial etiology of sexual infertility, nutrition may affect the sexual/reproductive function in both women and men.

Fertility Status Among Long-Term Childhood Acute Lymphoblastic Leukemia Survivors Enrolled between 1971 and 1998 in the EORTC Children Leukemia Group Trials 58741, 58831/2 and 58881

BackgroundThe survival of childhood acute lymphoblastic leukemia (ALL) has improved significantly over the last decades, with recently reported overall survival rates in Europe of up to 85% in children (<14 years) and 62% in adolescents (15-19 years) (Trama, Lancet Oncol 2016). The increased number of long-term survivors has made the management of side effects an increasingly important issue in pediatric oncology. In this context, the impact on fertility caused by widely employed ALL treatments such as alkylating agents, cranial radiotherapy, total body irradiation and orchiectomy has been an emerging concern over the last years. The aim of this study was to assess fertility among long-term childhood ALL survivors.MethodsBetween 2012 and 2017, a follow-up study was performed among childhood ALL (and acute lymphoblastic lymphoma) survivors enrolled between 1971 and 1998 in EORTC studies (58741, 58831/2, 58881) in France and Belgium. Patients <18 years (yrs) at diagnosis and ≥18 yrs at the time of the follow-up were eligible to fill out a questionnaire that included information about their fertility. The following fertility-related outcomes were evaluated: having menstrual cycles for females, intention to have children, having children, use of reproductive techniques to become pregnant and occurrence of negative pregnancy outcomes (miscarriage, medical abortion, birth defects), separately for males and females.ResultsOut of 1429 eligible patients, 502 (35%) filled out the questionnaire, 862 (60%) were lost to follow-up, and 65 (5%) refused to participate. Disease characteristics and relapse occurrence within one yr after diagnosis were comparable between these 3 groups.Among respondents (275 females, 227 males), approximately 14% were aged 10-17 yrs at diagnosis and almost 30% belonged to the NCI high risk group (Table 1). Approximately 12% received cranial radiotherapy and 6% of females and 8% of males underwent hematopoietic stem cell transplantation. Relapse occurred in 12% and 14% of females and males, respectively. The median time between the diagnosis and the socioeconomic evaluation was 20 yrs (range: 13-42). The median age at follow-up was 25 yrs (range: 18-53).All but 6 females had ever had menstrual cycles. At the time of the fertility evaluation, 93% out of females younger than 45 yrs of age (N=270) either had menstrual cycles, were pregnant, gave breast feeding or continuously used contraceptives. Among females who had tried to become pregnant, 89% had been pregnant, 75% had children and 12% used medical help to become pregnant. One fifth of the ever pregnant females had ever had a miscarriage. The incidences of other negative pregnancy outcomes (e.g. birth defect, medical abortion) were low.The average number of children females had was 0.36 (95% CI: 0.27-0.44). The expected number of children in a population with the same distribution of country, age, and yr of birth of the mothers based on national population registries was 0.55. However, as 52% of the females had a bachelor or master degree and only 3% had no secondary school diploma, this difference could possibly be explained by an overrepresentation of females with a high level of education in our sample.Among males who had tried to have children, 83% made their partner pregnant, 72% had children and 7% used medical help to make their partner pregnant. The incidence of negative pregnancy outcomes other than miscarriage was low.ConclusionsIn this first disease-specific European cohort study, we evaluated fertility among adult survivors of childhood ALL enrolled in EORTC trials, with a median time from the diagnosis of 20 yrs.Most survivors who tried to have children, succeeded (75% of females, 72% of males). However, the average number of children per female seemed to be lower than in the general population. The incidences of birth defects, and medical abortions were low, both among female survivors and the partners of the male survivors.Despite the large number of potentially eligible patients, we could evaluate only 35% of long-term survivors. We were unable to study the effect of specific treatment exposures due to the large variety of treatments that patients received, the association between some treatments (protocol dependent) and age at the fertility evaluation, and the need to stratify the analyses by sex. Improvements in the follow-up of childhood cancer survivors are needed for a better evaluation of the long-term outcomes. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Child marriage and its impact on fertility and fertility-related outcomes in South Asian countries

Although South Asia (SA) is reported as a home of child marriage, the association of child marriage with fertility and fertility-related outcomes in this region is poorly explored. The most recent data of the Demographic and Health Survey of six SA countries – Afghanistan, Bangladesh, India, Maldives, Nepal and Pakistan – have been used in this article. The unit of analysis is 584,213 currently married women aged 20–49. The outcomes of interest are fertility and fertility-outcomes. Quantitatively important and reliable estimates were obtained from the statistical analyses. The results are presented by odds ratios with 95% CIs. Findings reveal that, overall, 42.1% of the respondents were married-off before age 18. The prevalence of child marriage was lowest in the Maldives and highest in Bangladesh at 20.5% and 74.4% respectively. The likelihood of early childbirth and repeated childbirth were significantly ( p &lt; 0.001) lower and that for high fertility, unintended pregnancy, lifetime pregnancy termination and use of a modern contraceptive method was significantly higher in the child married women compared to their adult married counterparts. Reforms should aim to have more girls remain in schooling for both personal and overall societal development and also to reduce adverse reproductive outcomes caused by child marriage.

Child Marriage in Rural Bangladesh and Its Consequences on Reproductive and Maternal Health: An Empirical Study

Despite the high prevalence of child marriage in Bangladesh and the potential adverse effects of child marriage on reproductive and maternal health outcomes, there is relatively little empirical evidence available on this issue, which has impeded efforts to stop child marriage and to initiate improved and effective adolescent health programs. The purpose of this study is to determine the causes of child marriage and its consequences on the reproductive and maternal health of child brides in Bangladesh. Data for the study came from a cross-sectional sample survey and the ultimate sampling units were selected by using a three-stage cluster sampling technique. The results of the study suggest that the dominant driving factors for child marriage are: poverty, lack of education, social and cultural norms, ensuring daughters’ financial security, protection of daughters from sexual harassment and unwelcome sexual advances. There are serious consequences of child marriage on adolescents’ health. It truncates a girl’s childhood, gives rise to severe physical and psychological risks on health, and takes her from internationally accepted human rights. The difference between mean years of marriage and first birth interval indicates that Bangladeshi adolescents hurry to initiate childbearing. They are at high risk of reproductive health. Most of them suffered from various maternal health problems such as gynecological problems before pregnancy, complications during pregnancy, at the time of delivery, and after delivery due to the absence of proper maturity. Child marriage enlarges boundary of vulnerability to adolescents that leads to poor fertility control and fertility-related outcomes, and poor maternal health care issues.

Effect of Educational intervention about Nutrition for Infertile Women on their Knowledge in Preconception Period

Background: Human fertility affected by many factors as nutrition (unbalanced nutrition and unhealthy diet) be together to affect reproduction security in women. Evidence suggests that nutrition can play an important role in altering fertility-related outcomes in both men and women. Aim: this study aims to assess level of knowledge about nutrition that increases fertility in infertile women, and evaluate effect of educational intervention about nutrition on infertile women’s knowledge in preconception period. Methods: Quasi experimental (pre – posttest) research design was carried out in this study. It was conducted at infertility outpatient clinic women’s health Hospitals, Assiut University, Egypt. Sample included 100 infertile women. Structured interview questionnaire was used and included two parts: Sociodemographic data and questions to assess knowledge regarding fertility's nutrition. Results: There are statistical significant differences between pretest and posttest regarding total knowledge of infertile women about nutrition, P-Value is 0.001. Conclusion: Educational program about nutrition that may increase fertility is very important to enhance infertile women’s knowledge regarding nutrition that may increase and decrease fertility. Recommendations: implementing a continuing educational program for women including counseling skills about importance of fertility nutrition during preconception period.

Cognitive Ecology in Humans: The Role of Intelligence in Reproductive Ecology

In the present research, we examined the role of intelligence in reproductive ecology with the hypothesis that intelligence has some characteristics of a slow life-history behavioral trait. We did this by analyzing the associations between intelligence, environmental harshness in childhood (parental investment, family dysfunction and economic poverty), and three fertility-related outcomes: planned and observed age at first reproduction and expected total fertility. Data was collected on a large sample of adults (N = 1475). Nonlinear, quadratic relations between harsh environment and intelligence were detected: the highest intellectual abilities were found in participants who lived in conditions of intermediate harshness. Furthermore, intelligence was positively associated with both planned and observed age at first reproduction and negatively with expected total fertility. Finally, the interactions between environment and intelligence in the prediction of these outcomes were found: individuals with a lower intellectual capacity who grew up in families with decreased maternal investment plan to have their first child earlier in their lifetime; on the other hand, lower intellectual capacities interacted with elevated paternal investment to predict higher expected number of children. Obtained results largely support the hypothesis of intelligence as a trait which contributes to a slow life-history dynamics. However, they imply that the relations between intelligence and childhood environment, especially family relations, may be complex. Study findings reveal the fruitfulness of an evolutionary ecological approach to intelligence in contemporary humans.

Free Primary Education, Timing of Fertility, and Total Fertility

Abstract This study employs a difference-in-differences estimation strategy to study the causal impacts of free primary education (FPE) on women’s schooling and fertility-related outcomes using the 1990s FPE reform of Malawi. The results show that full exposure to FPE at the mean value of the reform’s potential impact led to an 18.5 percentage points increase in the probability of ever enrolling in school and 1.2 years of additional schooling. Furthermore, the reduced form estimates suggest that full exposure to FPE increased age at first marriage and at first childbirth by almost 0.79 and 0.98 years respectively. The study also finds statistically significant reductions at all ages between age 14 and 24 in the total number of children to which women give birth. By age 24, for example, full exposure to FPE at the mean value of the reform’s potential impact led to 0.28 fewer children. In addition, there is evidence showing that exposure to FPE led to increased spacing between the first two births (about six additional months) if the first child is female. The study explores several channels through which FPE may affect fertility-related outcomes. Postponement of marriage and first childbirth, increased contraceptive use, and changes in mate characteristics all play a role.

The Flexibility of Fertility Preferences in a Context of Uncertainty.

The Flexibility of Fertility Preferences in a Context of Uncertainty.

Preserving fertility in pseudomyxoma peritonei, a novel approach.

Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is the gold standard treatment for patients with pseudomyxoma peritonei (PMP) but involves routine bilateral salpingo-oophorectomy. Young women wishing to maintain fertility may be reluctant to pursue this. An alternative strategy in women with low-grade PMP has been explored in the form of laparoscopic evacuation of pelvic and ovarian mucin with resection of the appendiceal tumour. Between January 2012 and January 2015, four young women (aged 28-35 years) with PMP seeking to maintain fertility underwent laparoscopy, appendicectomy and pelvic mucinous evacuation and washout. Data regarding intra-operative and histopathological findings were collected. Endpoints were fertility-related outcomes and oncological follow-up. Infertility was a presenting symptom in three of the four women. All four had significant pelvic mucinous disease on radiological imaging and were offered CRS and HIPEC as definitive treatment, but chose laparoscopy with appendicectomy and copious irrigation and washout of the pelvis with stripping of mucinous disease off the ovarian surfaces. Postoperative histology demonstrated a low-grade appendiceal mucinous neoplasm (LAMN) in all patients with acellular mucin or low-grade mucinous carcinoma peritonei in the peritoneal cavity. All patients successfully conceived subsequently and gave birth to healthy babies. After 12-29 months follow-up, all women are well with no radiological or laparoscopic evidence of disease recurrence. In patients with low-grade PMP, initial therapeutic laparoscopy can restore fertility, whilst providing short- to medium-term disease control. This modality in young women wishing to have children appears to be a feasible alternative to immediate CRS and HIPEC.

Endometriosis: an overview of Cochrane Reviews.

Endometriosis: an overview of Cochrane Reviews.