An investigation into infertility in Otago and Southland; the prevalence, service use and understanding amongst women

Introduction: Infertility is an important global public health issue. For individuals it can result in grief, depression and deteriorating relationships, and, for societies, generate a costly burden and possibly impact on population growth. Findings from high-income countries, although variable, have suggested approximately a fifth of women had experienced infertility (defined as ever trying unsuccessfully to conceive for at least 12 months), with around half of these seeking medical help, and up to a third receiving treatment. Despite the common occurrence of infertility, surveys generally have reported poor knowledge. While New Zealand demographic data highlight delayed childbearing and high proportions of childless women over 40 years, potentially indicating substantial infertility, there has been only limited information about infertility here. This thesis aims to extend current knowledge by estimating the prevalence of infertility, assessing service use and outcomes for infertile women in southern New Zealand, and evaluating fertility knowledge and behaviours. Methods: To meet this overall aim three studies were conducted: A population-based survey of women living in southern New Zealand aged 25–50 years to determine the proportion having: a) experienced infertility; b) sought help; and c) resolved their infertility, and to assess their fertility knowledge; an analysis of Otago Fertility Service patient data to determine the prevalence and predictors service outcomes; and national hospital discharge data on infertility, and also pelvic inflammatory disease and ectopic pregnancies (both causes of tubal factor infertility), were explored to determine their feasibility for monitoring infertility and the potential generalisability of the southern data nationally. Results: The survey had 1,125 participants, representing a response rate of 60.1%. Overall, 21.7% (95% CI 19.1–24.4%) had tried unsuccessfully to conceive for at least 12 months, increasing to 25.3% (95% CI 22.6–28.1%) when the definition included women who sought medical help to conceive. The majority (70.6%) of infertile women sought medical help, and 37.9% reported receiving treatment. Amongst fertility clinic patients, receiving treatment was associated with low parity, younger age, not smoking and having a healthy body mass index. Three-quarters of survey participants and half of the clinic patients resolved their infertility with a live birth. Resolution was associated with a younger age at onset of infertility, being in a heterosexual relationship, being less deprived, having less severe diagnoses and receiving treatment. Knowledge amongst survey participants was particularly poor regarding identifying women’s fertile period, although a third reported engaging in ovulation monitoring. Interpretation of national data on hospitalisations for infertility, pelvic inflammatory disease and ectopic pregnancies was substantially hindered by the unknown, but likely substantial, proportion of cases not managed as publicly funded inpatients. Overall this analysis showed that it is not currently feasible to monitor infertility in New Zealand using hospitalisation data. Discussion: Most findings were consistent with the literature identified from other high-income countries, although survey results suggest infertility could be more common than previously estimated. These data provide insights into infertility in New Zealand and highlight the need for national data on infertility care and outcomes, primary prevention strategies, and improved fertility education.

Evaluation of a PGP3 ELISA for surveillance of the burden of <i>Chlamydia </i>infection in women from Australia and Samoa

© FEMS 2019. Serological assays can be used to investigate the population burden of infection and potentially sequelae from Chlamydia. We investigated the PGP3 ELISA as a sero-epidemiological tool for infection or sub-fertility in Australian and Samoan women. The PGP3 ELISA absorbance levels were compared between groups of women with infertility, fertile, and current chlamydial infections. In the Australian groups, women with chlamydial tubal factor infertility had significantly higher absorbance levels in the PGP3 ELISA compared to fertile women (P < 0.0001), but not when compared to women with current chlamydial infection (P = 0.44). In the Samoan study, where the prevalence of chlamydial infections is much higher there were significant differences in the PGP3 ELISA absorbance levels between chlamydial sub-fertile women and fertile women (P = 0.003). There was no difference between chlamydial sub-fertile women and women with a current infection (P = 0.829). The results support that the PGP3 assay is effective for sero-epidemiological analysis of burden of infection, but not for evaluation of chlamydial pathological sequelae such as infertility

An investigation into infertility in Otago and Southland; the prevalence, service use and understanding amongst women

Introduction: Infertility is an important global public health issue. For individuals it can result in grief, depression and deteriorating relationships, and, for societies, generate a costly burden and possibly impact on population growth. Findings from high-income countries, although variable, have suggested approximately a fifth of women had experienced infertility (defined as ever trying unsuccessfully to conceive for at least 12 months), with around half of these seeking medical help, and up to a third receiving treatment. Despite the common occurrence of infertility, surveys generally have reported poor knowledge. While New Zealand demographic data highlight delayed childbearing and high proportions of childless women over 40 years, potentially indicating substantial infertility, there has been only limited information about infertility here. This thesis aims to extend current knowledge by estimating the prevalence of infertility, assessing service use and outcomes for infertile women in southern New Zealand, and evaluating fertility knowledge and behaviours. Methods: To meet this overall aim three studies were conducted: A population-based survey of women living in southern New Zealand aged 25–50 years to determine the proportion having: a) experienced infertility; b) sought help; and c) resolved their infertility, and to assess their fertility knowledge; an analysis of Otago Fertility Service patient data to determine the prevalence and predictors service outcomes; and national hospital discharge data on infertility, and also pelvic inflammatory disease and ectopic pregnancies (both causes of tubal factor infertility), were explored to determine their feasibility for monitoring infertility and the potential generalisability of the southern data nationally. Results: The survey had 1,125 participants, representing a response rate of 60.1%. Overall, 21.7% (95% CI 19.1–24.4%) had tried unsuccessfully to conceive for at least 12 months, increasing to 25.3% (95% CI 22.6–28.1%) when the definition included women who sought medical help to conceive. The majority (70.6%) of infertile women sought medical help, and 37.9% reported receiving treatment. Amongst fertility clinic patients, receiving treatment was associated with low parity, younger age, not smoking and having a healthy body mass index. Three-quarters of survey participants and half of the clinic patients resolved their infertility with a live birth. Resolution was associated with a younger age at onset of infertility, being in a heterosexual relationship, being less deprived, having less severe diagnoses and receiving treatment. Knowledge amongst survey participants was particularly poor regarding identifying women’s fertile period, although a third reported engaging in ovulation monitoring. Interpretation of national data on hospitalisations for infertility, pelvic inflammatory disease and ectopic pregnancies was substantially hindered by the unknown, but likely substantial, proportion of cases not managed as publicly funded inpatients. Overall this analysis showed that it is not currently feasible to monitor infertility in New Zealand using hospitalisation data. Discussion: Most findings were consistent with the literature identified from other high-income countries, although survey results suggest infertility could be more common than previously estimated. These data provide insights into infertility in New Zealand and highlight the need for national data on infertility care and outcomes, primary prevention strategies, and improved fertility education.

Prevalence of Chlamydia trachomatis infection in Samoan women aged 18 to 29 and assessment of possible risk factors: a community-based study

Background Knowledge about genital Chlamydia trachomatis (CT) infections in the Pacific is limited. In this study we investigated CT infection in Samoan women. Methods We recruited women having unprotected sex aged 18 to 29 years from 41 Samoan villages. They completed a questionnaire and provided a urine sample for CT testing by PCR. Associations between CT infection and possible risk factors were explored using logistic regression. Results Altogether, 239 women were recruited; 86 (36.0%; weighted estimate of prevalence: 41.9%; 95% CI: 33.4–50.5%) were positive for CT infection. A higher proportion of women aged 18 to 24 were positive (54/145; 37.2%) than those aged 25 to 29 (32/94; 34.0%; p=0.20). Being single (OR 1.92; 95% CI: 1.02–3.63) and having two or more lifetime sexual partners (OR 3.02; 95% CI: 1.19–7.67) were associated with CT infection; 27.6% of those with one lifetime partner were positive. Participants who had a previous pregnancy were less likely to be positive (OR 0.49; 95% CI: 0.27–0.87). Primiparous and multiparous women were less likely to be positive than nulliparous women (OR 0.54; 95% CI: 0.30–0.99 and OR 0.46; 95% CI: 0.24–0.89, respectively). Conclusions The prevalence of CT infection in these Samoan women is very high. Further studies, including investigating the prevalence of CT infection in men, and strategies for sustainable control are needed

Sensitivity of the Ct antibody assays according to gender.

<p>Sensitivity of the Ct antibody assays according to gender.</p

The Relationship between Ct Pgp3 antibody positivity and self-reported Ct, number of sexual partners, number of sexual partners of those who had not reported Ct infection and age of first coitus by age 26, 32 and 38 years. Women.

<p>The Relationship between Ct Pgp3 antibody positivity and self-reported Ct, number of sexual partners, number of sexual partners of those who had not reported Ct infection and age of first coitus by age 26, 32 and 38 years. Women.</p

Flowchart showing the history of detectable Pgp3 antibody in women and men at age 26, 32 and 38 years.

<p>The number of women and men testing Pgp3 antibody positive at age 26 is given. Shown at age 32 and 38 are the numbers of these positive individuals who: i) maintained Pgp3 seropositivity with no self-report of re-exposure to Ct, ii) remained Pgp3 positive, but also reported a re-infection with Ct, iii) had become seronegative, and iv) were missing at that time point. Finally, the numbers of women and men who became Pgp3 seropositive between age 26 and 32 together with their subsequent antibody status and infection history by age 38 are shown.</p

Comparison of ROC analysis AUCs across the different assays.

<p>Comparison of ROC analysis AUCs across the different assays.</p

Disparities in the pace of biological aging among midlife adults of the same chronological age have implications for future frailty risk and policy

Some humans age faster than others. Variation in biological aging can be measured in midlife, but the implications of this variation are poorly understood. We tested associations between midlife biological aging and indicators of future frailty-risk in the Dunedin cohort of 1037 infants born the same year and followed to age 45. Participants’ Pace of Aging was quantified by tracking declining function in 19 biomarkers indexing the cardiovascular, metabolic, renal, immune, dental, and pulmonary systems across ages 26, 32, 38, and 45 years. At age 45 in 2019, participants with faster Pace of Aging had more cognitive difficulties, signs of advanced brain aging, diminished sensory-motor functions, older appearance, and more pessimistic perceptions of aging. People who are aging more rapidly than same-age peers in midlife may prematurely need supports to sustain independence that are usually reserved for older adults. Chronological age does not adequately identify need for such supports