Medical Treatment For Infertility Research Articles

Traditional Methods Known and Practiced by Infertile Women for Infertility:A Descriptive Study

Aim: This study aims to determine the traditional methods known and practiced by infertile women for infertility. Desing: This study was designed as descriptive and cross-sectional type. Materials and method: The study sample consisted of 153 infertile women who visited the in vitro fertilization (IVF) center of a public hospital. The data were collected using a questionnaire to determine the infertile women’s socio-demographic characteristics, duration of infertility, medical treatment for infertility, family support, feelings about having children in the future, and the traditional methods they knew and used for infertility. Results: Among the traditional methods they knew and utilized for infertility, almost all the infertile women reported praying, 52.9% reported drinking herbal remedies, nearly half of them reported drinking onion juice and consuming fig puree, and 46.4% reported drinking carob juice. Considering the relationship between the duration of infertility and traditional practices known by infertile women regarding infertility, there was a significant difference between longer periods of infertility and the status of knowing traditional practices such as drinking onion juice, visiting holy tombs, consulting a hodja/Muslim preacher, going to thermal springs, and using heat plaster on the back (p<0.05). Consclusion: The fact that infertile women knew and used at least one traditional method for infertility in our study shows that their fertility is at risk. In this regard, nurses need to take careful patient histories at every stage of treatment, provide psychological and social support during the long and difficult treatment process, and offer counseling services. Furthermore, comprehensive studies are needed to examine the effects of traditional methods used in infertility treatment.

Psychological Aspects of Infertility - Results from an Actor-Partner Interdependence Analysis.

Introduction For some patients, undergoing medical treatment for infertility is a cause of major emotional stress which the couple needs to deal with together; it can be said that infertility is a shared stressor. From the literature it is known that a subjectively perceived sense of self-efficacy supports the patient's ability to cope adaptively with an illness. As the basis for this study, we assumed that high levels of self-efficacy are associated with low psychological risk scores (e.g., for anxiety or depressiveness), both in the patient themselves and in their partner. Accordingly, in infertility patients, targeted support to promote helpful self-efficacy expectations could represent a new counselling strategy that could enable psychologically vulnerable patients to better cope with the treatment procedure and treatment failures of medically assisted reproduction, making these patients less at risk with regard to psychosocial factors. Methods 721 women and men attending five fertility centers in Germany (Heidelberg, Berlin), Austria (Innsbruck), and Switzerland (St. Gallen, Basel) completed the SCREENIVF-R questionnaire to identify psychological risk factors for amplified emotional problems, as well as the ISE scale to measure self-efficacy. Using paired t-tests and the actor-partner interdependence model, we analyzed the data of 320 couples. Results Considering the study participants as couples, women had a higher risk score than men for four out of five risk factors (depressiveness, anxiety, lack of acceptance, helplessness). In all of the risk areas, it was possible to identify a protective effect from self-efficacy on the patient's own risk factors (actor effect). There was a negative correlation between the men's self-efficacy level and the women's feelings of depressiveness and helplessness (partner effect, man → woman). The women's self-efficacy levels had a positive correlation with acceptance and access to social support in the men (partner effect, woman → man). Conclusion Because infertility is generally something that a couple has to deal with together, future studies should focus on couples as the unit of analysis instead of just analyzing the men and women separately. In addition, couples therapy should be the gold standard in psychotherapy for infertility patients.

Novel Genetic Risk and Metabolic Signatures of Insulin Signaling and Androgenesis in the Anovulation of Polycystic Ovary Syndrome

Ovulation induction is a first-line medical treatment for infertility in polycystic ovary syndrome (PCOS). Poor ovulation responses are assumed to be due to insulin resistance and hyperandrogenism. In a prospective cohort (PCOSAct) of 1000 infertile patients with PCOS, whole-exome plus targeted single-nucleotide polymorphism (SNP) sequencing and comprehensive metabolomic profiling were conducted. Significant genome-wide common variants and rare mutations associated with anovulation were identified, and a prediction model was built using machine learning. Common variants in zinc-finger protein 438 gene ( ZNF438 ) indexed by rs2994652 ( p = 2.47 × 10 –8 ) and a rare functional mutation in REC114 (rs182542888, p = 5.79 × 10 –6 ) were significantly associated with failure of ovulation induction. Women carrying the A allele of rs2994652 and REC114 p.Val101Leu (rs182542888) had lower ovulation (odds ratio (OR) = 1.96, 95% confidence interval (95%CI) = 1.55–2.49; OR = 11.52, 95%CI = 3.08–43.05, respectively) and prolonged time to ovulation (mean = 56.7 versus (vs) 49.0 days, p < 0.001; 78.1 vs 68.6 days, p = 0.014, respectively). L -phenylalanine was found to be increased and correlated with the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) index ( r = 0.22, p = 0.050) and fasting glucose ( r = 0.33, p = 0.003) for rs2994652, while arachidonic acid metabolism was found to be decreased and associated with increased anti-Müllerian hormone (AMH; r = –0.51, p = 0.01) and total testosterone (TT; r = –0.71, p = 0.02) for rs182542888. A combined model of genetic variants, metabolites, and clinical features increased the prediction of ovulation (area under the curve (AUC) = 76.7%). Common variants in ZNF438 and rare functional mutations in REC114 , associated with phenylalanine and arachidonic acid metabolites, contributed to the failure of infertility treatment in women with PCOS.

Inequity of Access: Scoping the Barriers to Assisted Reproductive Technologies.

Infertility impacts millions of people of reproductive age worldwide, with approximately 10-15% of couples affected. When infertility is present, there are many potential barriers to treatment, leading to inequity of access. Assisted reproductive technologies (ART) are the mainstay of medical treatment for infertility and include procedures such as in vitro fertilisation. This scoping review aims to explore the barriers to accessing assisted reproductive technologies to highlight a potential role for the pharmacist in addressing these barriers. Five databases, including CINAHL, Emcare, Medline, Scopus, and Web of Science, were searched using keywords that resulted in 19 studies that explored barriers to initially accessing or continuing ART. Studies identified more than one barrier to accessing ART, with the most mentioned barrier being the geographic location of the patient, with others themed as psychological, financial, minority groups, educational level, and the age of the patient. Recommendations were made to address barriers to accessing ART, which included changes to government regulations to increase health education and promotion of infertility. Pharmacists' accessibility, even in geographically remote locations, places them in an ideal position to address many of the challenges experienced by people accessing infertility treatment to improve outcomes for these people.

Awareness, knowledge, and psycho-emotional aspect of infertility among women seeking fertility assistance at a tertiary care hospital in Chhattisgarh, a cross-sectional study.

The lack of fundamental knowledge and awareness about the biological process of reproduction is low worldwide but has reportedly higher incidence rates in under-developed countries. Infertility can have a tremendous effect on a woman's psychological and social well-being, pushing her toward mental stress, anxiety, depression self-blame, self-isolation, feeling of worthlessness, and lack of interest in life. The present study was conducted to determine the level of knowledge and awareness regarding factors affecting fertility and also to ascertain the emotional status of females visiting the Obstetrics and Gynecology out-patient department for fertility assistance. A cross-sectional study was performed by using a questionnaire which had two parts; the first part had questions about awareness and knowledge of the subject of infertility, and the second part had 12 questions that assessed the psychological and emotional status of the participants, and it also explored prevailing myths about infertility based on a validated questionnaire. There was a significant difference in mean knowledge score; those who were more educated had better knowledge of various aspects of infertility. The overall adequacy for knowledge and awareness revealed that only 62 (47.7%) of the participants had adequate knowledge (score >6) regarding female infertility. The mean score for knowledge among all the respondents was 6.61 ± 1.48. The overall emotional and psychological score suggested that 30 (23%) of the respondents were disturbed because of stress because of infertility. Infertility can have a serious impact on the psychological well-being of females, and social pressure and stigma associated with childlessness can further worsen the physical and emotional well-being of couples, which needs to be addressed before starting treatment of infertility for a better response to treatment. The limited knowledge and prevailing mis-conceptions regarding infertility need to be sincerely dealt with to complement the medical treatment of infertility.

Psycho-emotional stress, folliculogenesis, and reproductive technologies: clinical and experimental data.

Modern life, especially in large cities, exposes people to a high level of noise, high density of population, disrupted sleeping, large amount of excessive and controversial information as well as to other negative factors; all this may cause chronic psycho-emotional stress. The latest publications often use the term “Syndrome of megalopolis”, which means disruption of sleeping, high anxiety, and altered reproductive function. Medical treatment of infertility may also be considered as a stress factor, especially when infertility lasts for years and is aggravated with emotional frustration. Long-lasting distress may worsen health in general and suppress reproductive function, in particular. The review presents the data on the effects of maternal stress on folliculogenesis, especially when assisted reproductive technologies (ARTs) are used. Clinical data are presented alongside data from laboratory animal experiments. Different maternal stress models are taken into account in respect of their inf luence on oocyte maturation and embryo development. The interfering of psycho-emotional stress and reproductive function is the focus of the review. In these situations, exogenous hormones compensate for the stress-related disruption of the hypothalamic-pituitary-gonadal axis. When ARTs are implemented, stress-induced disruption of oogenesis is realized not via a decrease in hypothalamic and pituitary hormones, but by other ways, which involve paracrine mechanisms described in this review. Based on the literature analysis, one may conclude that stress negatively affects oocyte maturation in the ovary and suppresses subsequent embryo development. The role of some ovarian paracrine factors, such as BDNF, GDF-9, HB-EGF, TNF-α, and some others has been elucidated

Psychic consequences of infertility on couples: A short commentary

AbstractInfertility is a reproductive system condition defined by the failure to carry a clinical pregnancy following a period of 12 months or more of unprotected regular intercourse. Despite the fact that infertility is not a life-threatening condition, it is still a stressful life event for couples or people owing to the high value placed on having a child by individuals or society in general. Infertile couples are dealing with a variety of emotional issues in addition to a medical ailment. Infertile couples’ emotions, feelings, and beliefs frequently alter as a result of their infertility diagnosis. Due to the extreme seclusion of the subject, infertile couples may resort to hiding the problem if they are under a lot of societal pressure. The inability to conceive has been regarded as a stressful situation for both the person and the couple. The news of infertility elicits the same emotional responses as a death or catastrophic sickness. The medical treatment of infertility causes anxiety and pain, and this suffering and anxiety can have an impact on the treatment’s outcomes. Failed attempts result in major narcissistic injuries, which are frequently compounded by sexuality issues and relationship difficulties.

The Infertility-Abortion Nexus: Does Having Had an Abortion Influence Distress and Help-Seeking for Infertility?

To determine whether a history of abortion is associated with the experience of infertility among women, 2,199 women who ever met medical criteria for infertility were studied. Data for the study come from the National Survey of Fertility Barriers (NSFB), a nationally representative telephone survey of US women aged 25–45. Linear and logistic regression analysis revealed that a history of induced abortion was not statistically associated with fertility-specific distress, talking to a doctor about fertility, or seeking medical treatment for infertility. Having had an induced abortion may increase women’s confidence in their ability to get pregnant in the future.

Procreative rights denied? Access to assisted reproduction technologies by single women in China

The Chinese regulatory framework on access to assisted reproduction technologies (hereafter ART) is relatively restrictive, limiting ART exclusively to heterosexual married couples as a medical treatment for infertility. ART clinics across China are prohibited from providing ART services for single women. This creates significant regulatory barrier for single women to exercise their procreative rights. The restriction finds its root in the population and family planning law under which reproduction is tied to marriage and childbirth outside marriage are deemed as illegitimate with punishing consequences. It essentially denies the procreative rights of single women which are recognized by Chinese law. A welcoming development is that in seven out of 10 cases the court is willing to grant exceptions by allowing posthumous implantation procedure for widowed women after the sudden and unexpected death of the husband.

Evaluation of a serum 17-hydroxyprogesterone as a predictor of semen parameter improvement in men undergoing medical treatment for infertility.

The goal of medical therapy for infertile men with testosterone deficiency (TD) is to improve intratesticular testosterone (ITT). There is a gap in knowledge to identify those who will respond with semen parameter(s) improvement. We hypothesized that serum 17-hydroxyprogesterone (17-OHP) - a marker of ITT - can be used to predict improvement of semen parameter(s). Between July 2018 and January 2020, we conducted a prospective study of 31 men with primary infertility, TD, and secondary hypogonadism receiving clomiphene citrate (CC) and/or human chorionic gonadotropin (hCG) for three months. We assessed baseline and followup hormones, including testosterone, 17-OHP, semen parameter(s), and demographics. Semen quality upgrading was based on assisted reproduction eligibility: in-vitro fertilization (<5 million), intrauterine insemination (IUI) (5-9 million), and natural pregnancy (>9 million). Variables were compared using the Mann-Whitney U or Wilcoxon rank test. Twenty-one men received CC and 10 received CC/hCG. Median followup was 3.7 (3.3-5.1) months. Sixteen men upgraded semen quality. Six of 10 men with baseline total motile sperm count (TMSC) of 0 had motile sperm after treatment, and 11/20 men with TMSC <5 upgraded semen quality into TMSC >5 range. Low 17-OHP was the only factor that predicted semen quality upgrading. Men with 17-OHP ≤55 ng/dL upgraded semen quality and improved hormones, whereas men with 17-OHP >55 ng/dL did not upgrade semen quality. Medical therapy for infertile men with TD resulted in the improvement of sperm concentration, TMSC, testosterone, and 17-OHP. Semen quality upgrading appears to be more significant in patients with low 17-OHP, suggesting that ITT can be used as a biomarker to predict semen parameter(s) improvement.

Culturally adapted depression intervention to manage depression among women with infertility in Ghana.

This study tested the feasibility of a culturally adapted depression intervention among women with infertility. Women who were seeking medical treatment for infertility were randomized into treatment and control groups. Data were collected at baseline, 6 weeks, 12 weeks, and 3 months post intervention. General linear mixed model using empirical Bayesian estimates for repeated measures was used. The findings indicate an improvement in the women's psychosocial health in the treatment group as compared with the controls. These findings strongly suggest that the management of these psychosocial problems should be an integral part of the management of infertility.

Exposure to traumatic events, emotion regulation, and traumatic stress among infertility patients: a moderation analysis

Exposure to traumatic events and emotion regulation were examined as predictors of posttraumatic stress symptoms (PTSS) among women seeking medical treatment for infertility. Emotion regulation difficulties were hypothesized to moderate the association between traumatic events and PTSS severity. Sixty-six participants completed the Trauma History Questionnaire, Posttraumatic Check List for DSM-5, and Difficulties in Emotion Regulation Scale. Regression analyses were conducted. Emotion regulation difficulties predicted PTSS. The interaction between lifetime exposure to traumatic events and emotion regulation significantly predicted PTSS (b = 0.02, p = 0.002) and the model accounted for 31% of the variance in symptoms. Among women pursuing medical fertility treatment with past exposure to traumatic events, brief interventions that enhance emotional regulation skills may decrease PTSS.

Traditional Practices Used by Infertile Women in El Mansoura City

Background: Traditional practices are not new concepts, they have always been an integral part of all human cultures and they are transmitted from generation to generation through taboos or written documents. They constitute a major influence on the health of the individuals. The aim: This study was aimed to assess the traditional practices used by infertile women and assess the factors affecting it. Setting: The present study was carried out at gynecologic outpatient clinic and inpatient department affiliated to three governmental hospitals (El-Gamalia, Meet Salsil and El-Manzala). Study design usingexploratory descriptive design on 200 infertile women. Tool: An interview schedule it entailed seven parts; Socio-demographic characteristics, medical and surgical and Reproductive history, diagnostic methods, causes of infertility and traditional practices. The results of study finding that, more than one third of infertile women used “herbal and shock” (37.0% & 37.5%) respectively as a traditional practices for infertility treatment, while more than two fifths were used “belonging to another women, ritual and remedies” (42.5%, 40.5% and 46.5%) respectively and only (4.5%) used magic and Quranic verses. The most causes of using traditional methods reported by studied women were “positive previous experience, family desire, cheap and available”. Conclusion: most common traditional practices used by infertile women were remedies. Recommendations: Outreach health education programs should be developed for infertile women to increase their awareness about the medical treatment of infertility and the adverse effects of harmful traditional practices on their health.

Association between Organochlorine Pesticide Levels in Breast Milk and Their Effects on Female Reproduction in a Taiwanese Population

Only few studies have focused on organochlorine pesticides (OCPs) in breast milk and the related health risks for women in Taiwan. Our goal is to examine breast milk OCPs and their associations with female reproductive function (infertility, gynecological diseases, and menstruation characteristics) as well as their correlation with sociodemographic parameters (age, pre-pregnant body mass index (BMI), annual incomes, population, birth year, and parity) and dietary habit. The breast milk samples were collected in southern Taiwan (n = 68) from 2013 to 2016 and the OCP residues were analyzed using high resolution gas chromatography with low resolution mass spectrometry (HRGC/LRMS). The results show that the most abundant OCP residues in the breast milk was ΣDDT with the geometric mean ± standard deviation of 9.81 ± 7.52 ng−1 lipid−1 followed by ΣHCH (0.539 ± 0.557 ng−1·lipid−1). In the principal component analysis, cis-chlordane (cis-CHL) and γ-HCH were found to be related to participants who received medical treatment for infertility, and 4,4′-DDT was associated with those who received gynecological surgery. The logistic regression showed that the odds ratio (OR) of log γ-hexachlorocyclohexane (γ-HCH) was higher for mothers who had received medical treatment for infertility than for the normal group (OR = 25.6, p = 0.035) after adjustments for age, pre-pregnant BMI, annual income, population (i.e., native-born Taiwanese), birth year, and parity. Cow milk and beef consumption as well as menstruation characteristics such as average menstrual period (>5 days), shortest menstrual period (<3 days), and women who had taken hormonal drugs were significantly associated to several OCP residues in the breast milk. In addition, ΣHCH including β-HCH and γ-HCH was correlated with annual family income and gravidity as well as cow milk and beef consumptions. Overall, γ-HCH exhibited a probable association with the infertility diseases of Taiwanese women, and dietary habit might play an important role in the female Taiwanese exposure to OCPs.

Assisted reproduction technology in Nigeria: Challenges and the way forward

The challenges associated with infertility have necessitated different healthcare-seeking behaviors ranging from spiritual, traditional/alternative health care to orthodox medical types including biotechnological devices such as assisted reproductive technology (ART). ART is the highest breakthrough in the medical treatment of infertility in the whole world. Its evolution has presented multitudinous ethical, legal, and social challenges resulting in a tectonic shift in the way clinicians and the general population perceive infertility and ethics. Hence, there is a urgent need for stakeholders (fertility specialists, clients, professional organizations, religious bodies, bioethicists, and government) to formulate cultural and context-specific guidelines to help address some of these ethical dilemmas.

'Just because a doctor says something, doesn't mean that [it] will happen': self-perception as having a Fertility Problem among Infertility Patients.

Only some individuals who have the medically defined condition 'infertility' adopt a self-definition as having a fertility problem, which has implications for social and behavioural responses, yet there is no clear consensus on why some people and not others adopt a medical label. We use interview data from 28 women and men who sought medical infertility treatment to understand variations in self-identification. Results highlight the importance of identity disruption for understanding the dialectical relationship between medical contact and self-identification, as well as how diagnosis acts both as a category and a process. Simultaneously integrating new medical knowledge from testing and treatment with previous fertility self-perceptions created difficulty for settling on an infertility self-perception. Four response categories emerged for adopting a self-perception of having a fertility problem: (i) the non-adopters - never adopting the self-perception pre- or post-medical contact; (ii) uncertain - not being fully committed to the self-perception pre- or post-medical contact; (iii) assuming the label - not having prior fertility concerns but adopting the self-perception post-medical contact; and (iv) solidifying a tentative identity - not being fully committed to a self-perception pre-medical contact, but fully committed post-medical contact. (A virtual abstract of this paper can be viewed at: https://www.youtube.com/channel/UC_979cmCmR9rLrKuD7z0ycA).

Effect of the previous reproductive outcomes in subfertile women after in vitro fertilization (IVF) and/or intracytoplasmic sperm injection (ICSI) treatments on perinatal anxious and depressive symptomatology

Introduction: The present study aims to investigate the effects of previous reproductive outcomes on the levels of depression, anxiety and perceived social support in subfertile women who conceived after in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) treatment.Methods: A prospective cohort study was developed. Data were collected on subfertile patients who conceived after IVF/ICSI treatment. All demographic and clinical data were recorded. The Edinburgh Postnatal Depression Scale, the State-Trait Anxiety Inventory-Y and the Multidimensional Scale of Perceived Social Support at 22 and 32 weeks of gestation and 15 days after delivery were completed. Data were analyzed comparing patients who conceived at their first IVF/ICSI cycle, after one unsuccessful ARTs cycle, and after multiple unsuccessful IVF/ICSI cycles.Results: A significant increase in state anxiety and depression scores from 22 gestational weeks of gestation to 15 days after delivery was observed in patients who received multiple unsuccessful IVF/ICSI cycles compared with other groups. No significant difference in perceived social support was detected among groups. The differences in depression and anxiety scores remained consistent after controlling for perceived social support.Discussion: A history of unsuccessful IVF/ICSI treatments seems to leave women more vulnerable in facing the duties of the new parental role. Such possibility underlies the importance of the availability of a psychological support for these women, even after a successful medical treatment for infertility.

Correlation between oocyte morphology and the embryo aneuploidy rate in IVF cycles

Aneuploidy is the main genetic cause of miscarriages and congenital birth defects following both natural conception and in vitro fertilization (IVF). The oocyte aneuploidy rate varies over a wide range, but there is a close correlation between advancing maternal age and the increasing aneuploidy rate. Controlled ovarian stimulation additionally complicates this problem because it leads to the maturation of oocytes that would naturally undergo apoptosis. A large proportion of oocytes recovered from exogenous gonadotropin-stimulated cycles exhibit different morphological abnormalities (dysmorphisms). The purpose of the study was to evaluate the aneuploidy rates of chromosomes 13, 18, 21, X and Y in embryos from patients with different oocyte morphotypes. Materials and methods: This prospective study included 84 patients treated with IVF at a single academic center. The patients were divided into the following groups: group 1 consisted of women with cytoplasmic dysmorphisms (n = 28), group 2 consisted of women with extracytoplasmic dysmorphisms (n = 28), and group 3 consisted of women with morphologically normal oocytes (n = 28). One blastomere from each embryo was analyzed for aneuploidies of chromosomes 13, 18, 21, X, and Y results. In total we sampled 368 embryos on day 3 (98 from group 1, 126 from group 2 and 144 from group 3). In group 1, there were 67 aneuploid embryos (68.4%); in group 2, there were 49 aneuploid embryos (38.9%); and in group 3, there were 45 (31.3%) (p < 0.0001). To identify the factors that influenced the appearance of aneuploidy in the embryo, we compared the groups with euploid (group A, n = 161) and aneuploid embryos (group B, n = 207). The aneuploidy rate was related to some of the female baseline characteristics, specifically, body mass index (BMI) and the basal AMH level. The women in group B were more likely to have histories of chlamydia infection. The summary dose of gonadotropins was higher in group B. Sperm quality (from the fertile or subfertile males) did not influence the embryo aneuploidy rate. The adjusted odds ratio (OR) for an aneuploid embryo in cases of cytoplasmic dysmorphisms was 3.6 (95% CI = 1.8; 7.2) after adjusting for the confounders. The adjusted OR for an aneuploid embryo in cases of extracytoplasmic dysmorphisms was 1.3 (95% CI = 0.7; 2.1) after considering the confounders. The highest percentage of aneuploid embryos occurred in the subgroup of oocytes with vacuoles (100%) followed by the oocytes with dark cytoplasm (73.1%), centrally located granular cytoplasm (66.7%) and SERc (65.2%) (Table 1). The most frequent type of aneuploidy was chromosomal polysomy. The prevalence of all of the types of polysomies was much higher in the group of women with cytoplasmic dysmorphisms. Discussion: Aneuploidies of the gametes are not only the limiting factors for human fertility but are also for the medical treatment of infertility. Morphological assessments of oocytes are the most common method for evaluating oocyte quality in routine practice. Oocyte dysmorphisms are correlated with impaired embryo quality and thus poor clinical outcomes, which may be related to high aneuploidy rates in oocytes with dysmorphisms. We recommend that woman with oocyte dysmorphisms, especially a centrally located granular cytoplasm, SERc and a dark cytoplasm, be subjected to additional genetic counseling to improve the effectiveness of IVF cycles and reduce the risk of giving birth to children with congenital defects.

Improved Fecundity in Northern China: A Secular Trend from 1980 to 2003.

ObjectiveThis study aimed to assess the trend of human fecundity over time in China.MethodsThis retrospective study was conducted in Tongliao, China. Couples who were married during the time period between January 1, 1981 and December 31, 2003 were considered eligible for this study. A total of 27,413 individuals provided valid information via house-to-house interviews. The 12-month cumulative pregnancy rate (CPR) and annual percentage change were used as the outcome measurements.ResultsThere was a significant increase in the CPR over the five successive time groups. A break point in 1988 divided the entire study period into two distinct segments: 1981–1988, during which the CPR increased from 72.2% to 84.2%, and 1988–2003, during which the CPR increased from 84.2% to 87.2%.ConclusionsThe findings were unlikely to be the result of biases, and could not be explained by increased medical treatment for infertility and changes in the prevalence of sexually transmitted diseases. Dramatic societal and behavioral changes due to the unique family planning policy and economic reform policies in China might have been the plausible reason for the results.

Barnes, L.W.Conceiving Masculinity: Male Infertility, Medicine, and Identity. Philadelphia, PA: Temple University Press. 2014. 228 pp $29.95 (pbk) ISBN 978‐1‐4399‐1042‐9

Barnes, L.W.Conceiving Masculinity: Male Infertility, Medicine, and Identity. Philadelphia, PA: Temple University Press. 2014. 228 pp $29.95 (pbk) ISBN 978‐1‐4399‐1042‐9