Age at Puberty of Girls and Boys in France Measurements from a Survey on Adolescent Sexuality

International audienceLife tables of male and female puberty were constructed using the Analysis of Sexual Behaviour of Young People (ACSJ) survey conducted in France in 1994 on the 1975-1978 generations, at that time aged between 15 and 18. Puberty in girls is identified by the onset of menstruation, at a median age of 13.1. Using this indicator, a long-term decline in age at puberty has been established for the developed countries as a whole. This historical change seems to be continuing in France though it has stabilized in several countries. Puberty in boys is harder to identify and there is continuing debate over the choice of a suitable indicator. Using the ACSJ survey, three possible indicators can be suggested: the breaking of the voice (median age 14.8), the maximum growth rate (median age 16) and the first masturbation (median age 14.2). Of these three indicators, the breaking of the voice appears to be the most satisfactory for identifying male puberty

Paternal age: are the risks of infecundity and miscarriage higher when the man is aged 40 years or over?

International audienceBACKGROUND: Maternal age of 35 years or over is a well-known risk factor for human reproduction that has been extensively investigated by demographers and epidemiologists. However, the possibility of a paternal age effect has rarely been considered. We carried out review of the literature to investigate the effect of paternal age on the risks of infecundity and miscarriage.METHODS: We carried out a MEDLINE search and checked the exhaustiveness of our reference list.RESULTS: We identified 19 articles analysing the effect of paternal age. Epidemiological studies provided evidence that paternal age older than 35-40 years affects infecundity. However, the few studies based on data from assisted reproductive techniques (especially IVF with ovum donation) do not confirm this finding. All studies analysing the effect of paternal age on the risk of miscarriage showed an increased risk in men aged 35-40 years or over. Other studies have shown some evidence for a paternal age effect on late foetal deaths.CONCLUSION: The risks of infecundity and miscarriage increase with paternal age. Two main hypotheses can be considered. First, these risks increase after the age of 35-40 years. However, a later paternal age effect (after 45-50 years) cannot be excluded. Second, due to the interaction of the ages of the two partners, the risks of infecundity and miscarriage may be higher when both partners are older (woman aged 35 years or over and man aged 40 years or over)

Mesure de l’âge à la puberté : une approche démographique

International audienceLes distributions de l’âge à la puberté des filles et des garçons ont été estimées dans la population française. Cette analyse a été menée à partir des données de l’enquête rétrospective ‘Analyse du Comportement Sexuel des Jeunes’ (ACSJ) conduite en 1994 auprès des générations 1975-1978, alors âgées de 15-18 ans (n = 6 175). L’âge à la puberté a été mesuré par l’âge aux premières règles chez les filles et par l’âge à la mue de la voix chez les garçons. Afin de prendre en compte les censures, les distributions de l’âge à la puberté ont été estimées selon la méthode des quotients. L’âge médian à la puberté est de 13,1 ans pour les filles et de 14,8 ans pour les garçons. Les trois-quarts des filles sont pubères entre 12 et 14 ans et les trois-quarts des garçons entre 13 et 15 ans. Ces estimations reposent sur les données d’une enquête socio-démographique et nous conduisent à nous interroger sur la qualité des déclarations faites par les adolescents, en particulier pour les garçons

L’infécondité en Europe : et si on parlait un peu des hommes ?

International audienceLes femmes ont longtemps porté seules le poids de l’infécondité. Mais depuis peu, la recherche s’intéresse au rôle de l’homme qui, dans plus de la moitié des cas, est impliqué dans l’infécondité du couple. En outre, on s’interroge sur une possible diminution du nombre et de la qualité des spermatozoïdes dans les pays développés. Les techniques d’assistance médicale à la procréation ont de beaux jours devant elles

Des enfants toujours plus tard ?

International audienc

Age paternel et AMP

International audienceINTRODUCTION. In natural and medical assisted reproduction, the negative effect of maternal age is well known. On the opposite, the paternal age effect have been little investigated.MATERIAL AND METHODS. Our study was on 131,557 attempts of IVF collected in FIVNAT between 1995 and 1999. To analyse paternal age, we then restricted our study to attempts realised on women aged 30 to 34 year old (n = 49 661 attempts).RESULTS. In ART, one man out of four was >= 40 year old whereas one woman out of ten was >= 40 year old. Among IVF without ICSI realised on women aged 30-34 year old, we observed with high paternal age a moderate but significant decrease in fecundation and pregnancy rates. The take home baby rate declined from 20% when the man was 30-34 year old to 15% when the man was >= 45 year in the studied population. No paternal age effect could be showed on success rates in IVF with ICSI.DISCUSSION AND CONCLUSION. This study showed a paternal age effect on success rates in IVF without ICSI. This effect is moderate in comparison with the maternal age one. However >= 40 year old men are much more numerous than >= 40 year old women and we wondered about the paternal age effect in term of public health.INTRODUCTION. En reproduction naturelle et médicalement assistée, les effets délétères de l’âge maternel sont bien connus. A l’opposé, les effets de l’âge paternel ont été peu explorés.MATÉRIEL ET MÉTHODES. Notre étude porte sur 131 557 tentatives de FIV enregistrées dans FIVNAT entre 1995 et 1999. Pour analyser l’âge paternel, nous avons dans un deuxième temps restreint notre étude aux partenaires de femmes âgées de 30 à 34 ans (n= 49 661 tentatives).RÉSULTATS. En AMP, un homme sur quatre est >= 40 ans alors que pour les femmes, cette proportion est de une sur dix. Parmi les FIV classiques réalisées sur des femmes âgées de 30-34 ans, nous observons avec l’élévation de l’âge paternel une baisse modérée mais significative du taux de fécondation et du taux de grossesses. Le pourcentage de tentatives se terminant par « au moins un bébé rentrant à la maison » passe de 20% lorsque l’homme est âgé de 30-34 ans à 15% lorsque l’homme est >= 45 ans dans le groupe étudié. Aucun effet de l’âge paternel n’a pu être mis en évidence sur les taux de succès en ICSI.DISCUSSION ET CONCLUSION. Cette étude montre un effet de l’âge paternel sur les taux de succès en FIV classiques. Si cet effet reste modéré, en particulier en comparaison de l’effet de l’âge maternel, il faut néanmoins s’interroger sur son impact en terme de santé publique quand on considère qu’un homme sur quatre est >= 40 ans

Devenir à long terme de couples traités par fécondation in vitro dans la cohorte DAIFI

Les études sur les couples traités par fécondation in vitro (FIV) ont jusqu à présent porté essentiellement sur l évaluation du succès en FIV. Très peu de données sont disponibles sur le devenir à long terme de couples traités par FIV. L objectif de ce travail était d estimer la fréquence de réalisation du projet parental à long terme, et d étudier les facteurs associés aux interruptions précoces des traitements et aux naissances naturelles.L enquête DAIFI-2009 a inclus 6 507 couples ayant débuté un programme de FIV en 2000-2002 dans l un des 8 centres de FIV participant à l étude. Les données médicales des couples et leur parcours dans le centre ont été obtenus à partir des dossiers médicaux des centres de FIV pour tous les couples. L information sur le devenir des couples après le départ du centre a été obtenue par questionnaire postal auprès des couples en 2008-2009 (38% de participation 7 à 9 ans après l initiation des FIV). L étude des facteurs associés à la participation à l enquête postale suggérait que la fréquence de réalisation du projet parental estimée sur les répondants seulement pourrait être biaisée. Les différentes méthodes mises en œuvre pour corriger la non réponse (pondération, imputation multiple) n ont pas modifié l estimation de la fréquence de réalisation du projet parental. Au total, 7 à 9 ans après l initiation des FIV, 60% des couples ont réalisé leur projet parental de façon biologique, suite à un traitement ou suite à une conception naturelle. Lorsque les adoptions sont aussi prises en compte, 71% des couples ont réalisé leur projet parental. Après l échec d une première tentative de FIV, un couple sur 4 (26%) a interrompu les FIV dans le centre d inclusion. Globalement, les couples avec de mauvais facteurs pronostiques ont un plus grand risque d interrompre les FIV. Cependant, la proportion plus importante d interruption parmi les couples avec une origine inexpliquée de l infécondité pourrait s expliquer par la survenue plus fréquente de naissance naturelle dans ce sous-groupe de couples. Parmi les couples n ayant pas eu d enfant suite aux traitements, 24% ont ensuite conçu naturellement en médiane 28 mois après l initiation des FIV. Parmi les couples ayant eu un enfant suite aux traitements, 17% ont ensuite conçu naturellement en médiane 33 mois après la naissance de l enfant conçu par AMP. Les facteurs associés aux naissances naturelles sont des indicateurs d un meilleur pronostic de fertilité, particulièrement chez les couples sans enfant AMP.L enquête DAIFI-2009 a permis d apporter des informations sur le parcours à long terme des couples traités par FIV qui n avait jusqu à présent été que peu étudié, souvent sur de faibles effectifs et avec un suivi plus court. Ces résultats doivent apporter de l espoir aux couples inféconds, puisque la majorité d entre eux ont finalement réalisé leur projet parental, même si cela peut prendre de nombreuses années.Until now, most studies of couples treated by in vitro fertilization (IVF) have been centered on IVF success. Very few data are available on the long-term outcome of these couples, including spontaneous conception and adoptions. This work aimed to estimate the long-term cumulative parenthood rate, and to study factors associated with early IVF discontinuation and with spontaneous live births.The DAIFI study is a retrospective cohort including 6,507 couples who began IVF in 2000-2002 in one of the eight participating French IVF centres. Medical data on all couples were obtained from centre databases. Information on long-term outcome after leaving the IVF center was collected by postal questionnaire sent to couples in 2008-2010 (7 to 9 years after IVF initiation, participation rate 38%). Study of factors associated with participation in the postal survey suggested that the cumulative parenthood rate estimated only in participants might be biased. The different methods used to correct for non-response bias (inverse probability weighting, multiple imputation) did not modify the estimation of the cumulative parenthood rate obtained with the complete case approach. Finally, 7 to 9 years after IVF initiation, the cumulative parenthood rate was estimated at 60%, including live births following IVF, other treatment or spontaneous conception. When adoptions were also considered, the cumulative parenthood rate reached 71%. After a first failed IVF cycle, just over one couple out of four (26%) discontinued IVF treatment. Globally, couples with poor prognostic factors had a higher risk of early discontinuation of IVF treatment. However, the higher proportion of early discontinuation observed among couples with unexplained infertility could be linked to a higher chance of spontaneous pregnancy in this subpopulation. Among couples who remained childless after treatment, 24% later had a spontaneous live birth (SLB), at a median of 28 months after the first IVF attempt. Among couples who had had a child during medical treatment, 17% later had an SLB, at a median of 33 months after the birth following medical treatment. Regarding factors associated with SLB, they can be viewed as indicators of a better fertility prognosis, especially among unsuccessfully treated couples.The DAIFI study has provided information on the long-term outcome of couples treated by IVF, which has until now been little studied, often on small samples and with a shorter duration of follow-up. These results should give hope to infertile couples as nearly three couples out of four finally became parents, even if it may take many years.PARIS11-SCD-Bib. électronique (914719901) / SudocSudocFranceF

Cumulative parenthood rates in 6,507 couples treated by in vitro fertilization

International audienceStudy question. This study aimed to estimate cumulative parenthood rates (PR) 7 to 9 years after IVF initiation, including various paths to parenthood (treatment, spontaneous conception and adoption).Summary answer. Seventy-one percent of couples had achieved parenthood 7 to 9 years after IVF initiation: 48% following IVF or another treatment (in the inclusion centre or elsewhere at a later date), 12% following spontaneous conception and 11% through adoption.What is known already. Many studies have investigated cumulative live-birth rates following IVF treatment, but few have examined long-term cumulative parenthood rates among IVF-treated couples, including spontaneous live births. Even fewer studies have considered adoption as a path to parenthood.Study design, size, duration. The DAIFI study is a retrospective cohort including 6,507 couples who began IVF in 2000-2002 in eight French IVF centres. Medical data on all couples were obtained from centre databases, and information on long-term outcome was available for the 2,321 participants in the 2008-2010 postal survey.Participants/materials, setting, methods. Of the 6,507 couples, 2,691 achieved parenthood during IVF treatment in the inclusion centre. Of the 3,816 unsuccessfully treated couples, 1,100 participated in the postal survey. Parenthood outcome was unknown for 2,716 couples. Different missing data methods were used to estimate cumulative PR among all unsuccessfully treated couples.Main results and the role of chance. Only very slight differences were observed in the cumulative PR estimated using the different methods (inverse probability weighting, multiple imputation and a combination of both) and with the complete case approach. In unsuccessfully treated couples, cumulative PR ranged from 32% to 33% when adoptions were not included, vs 50% to 51% when adoptions were included. For all 6,507 couples, the global cumulative parenthood rate was estimated at 71%, including 48% following IVF or another treatment, 12% following spontaneous conception and 11% through adoption.Limitations, reason for caution. The Hosmer-Lemeshow tests and areas under the ROC curves showed satisfactory goodness of fit for the prediction models used for participation and parenthood achievement. However, we cannot rule out that some unmeasured factors might impact on achieving parenthood, especially sociodemographic and psychological factors.Wider implications of the findings. This study provides a complete longitudinal overview of paths to parenthood among couples successfully and unsuccessfully treated by IVF. These results should give hope to infertile couples as nearly three couples out of four finally became parents 7 to 9 years after initiation of IVF treatment. However, IVF is not the only path to parenthood and couples should be informed of the other possible avenues.Study funding/competing interest(s). This project was supported by the Agence Nationale de la Recherche [n°ANR-06-BLAN-0221-01]. None of the authors have any competing interest.Trial registration number. Not applicable

To return or not to return for STI-HIV tests results: A study among 214 patients screened positive in a free center in Paris offering SMS reminders to reduce failure to return

International audienceINTRODUCTION. Sexually transmitted infections (STI) are a major challenge in public health as nearly one million people become infected every day in the world with chlamydia, gonorrhoea, syphilis or trichomoniasis. Moreover, 2 millions of people become infected every year with HIV in the world. Despite progress in treatment and screening, incidence of STI continues to increase. To decrease the spread of STI, it is needed not only to focus on screening access but also to reduce the high proportion, 15–20%, of patients screened positive for at least one STI and who do not come back for their results generating delay in their medical care and risks of STI transmitting to their partners. In our free testing center for STI in Paris (France), in order to reduce failure to return, patients are offered the possibility of being notified by SMS after testing. If at least one of the STI results is positive, the SMS invites the patient to come back to the center to obtain his/her results. However, even when informed by up to three SMS, a part of patients still fails to return. To target improvement actions, it is needed to define their profile. This study aimed to explore factors associated with failure to return within 30 days after testing (FTR30) among patient screened positive for STI.METHODS. Between October 2016 and May 2017, all patients with at least one positive result for STI testing (HIV, HBV, HVC, syphilis, gonorrhea and chlamydia) and who accepted to participate in the study were included (n = 214). Data were collected from the consultation database and a self-administered questionnaire. The FTR30 was measured based on information in the consultation database. This database also includes data on STI tested and results of the screenings performed. The self-questionnaire included sociodemographic factors, sexual behavior and factors related to the center visit. Factors associated with FTR30 were assessed using logistic regression models. The choice of the final multivariate model was based on the result of a backward stepwise selection with a 0.2 significance level for removal from the model.RESULTS. More than two-thirds of patients were men (72%), and the median age of patients was 27 years. Most patients were born in metropolitan France (56%) or in sub-Saharan Africa (25%). Men having sex with men represented 30% of the study population. The FTR30 rate was 14% (95% CI [10% > 19%]). Even if non-significant, FTR30 tend to be lower among the 72% of patients who accepted to be notified by SMS than among patients who did not (12% vs. 20%, P 0.10). In multivariate analysis, patients aged 25 or under were more likely to not return than patients older than 25 (aOR: 2.84; 95% CI: 1.09–7.41). A lower self-perceived risk of HIV infection was significantly associated with FTR30 (aOR: 3.05; 95% CI: 1.17–7.94), as well as not being tested for chlamydia and gonorrhea using self-swabbing (aOR: 5.98; 95% CI: 2.03–17.6). Probability of FTR30 was higher for patients coming with someone (aOR: 3.73; 95% CI: 1.41–9.88) compared to patients coming alone.CONCLUSIONS. The SMS program was well accepted but had a limited impact on FTR30 in our study population. To reduce the risk of failure in delivering STI screening results, systematic phone call after testing might also be proposed to patients. Moreover, no self-swabbing for chlamydia and gonorrhea testing and a lower self-perceived risk of HIV infection were associated with a higher probability of FTR30. Thus, improving STI/HIV knowledge and level of health literacy to empower patients would be an efficient way to decrease failure to return for results.DISCLOSURE OF INTEREST. The authors declare that they have no competing interest