Although it is clear that infertility leads to heightened stress for patients, the impact of depressed mood and anxiety on treatment outcome is inconsistently reported. The aim of this study was to evaluate the effect of stress, depression and anxiety on in vitro fertilization (IVF) outcomes in Kazakhstani public assisted reproductive technology (ART) clinics. The prospective cohort study was performed between June 2019 and September 2020 using questionnaires to assess psychological stress, depressed mood and anxiety in women referred to IVF clinics in two public clinical centers in Kazakhstan, Nur-Sultan and Aktobe. Our study sample comprised 142 women with the average age of 33.9 ± 4.9 years, and infertility duration 6.0 ± 3.5 years. More than half of respondents had Center for Epidemiological Studies Depression Scale (CES-D) scores higher than 16, indicating their risk of developing clinical depression. Ninety-one percent of women from Aktobe city were at risk for clinical depression (p < 0.001). Aktobe city respondents had higher stress subscale scores and anxiety scale scores (p < 0.001) than Nur-Sultan respondents. Statistical analysis showed that IVF outcome was not significantly associated with depression and stress, while the higher anxiety scale scores were negatively associated with clinical pregnancy after IVF.

An accurate understanding of reproductive facts is essential for appropriate decision making regarding whether, when, and how to conceive. The objective of this study was to investigate women’s knowledge of how age affects fertility and their knowledge about the effectiveness for assisted reproductive technologies for treating fertility. A cross-sectional study was conducted including women seeking fertility treatment at the University Medical Center, Nur-Sultan, Kazakhstan in 2018–2019. Patients were interviewed with a structured questionnaire. Socio-demographic, clinical characteristics, and knowledge and awareness about the implications of aging for fertility (advanced maternal age (AMA)) and pregnancy outcomes using fertility treatments (assisted reproductive technologies ((ART)) and the sum of both scores total knowledge score (TKS). TKS mean was 7.7 (SD = 2.1), AMA was 5.0 (SD = 1.5), and ART was 2.7 (SD = 1.5). No socio-demographic factors correlated with lower knowledge. Fertility knowledge was found to be low. No differences were found associated with socio-economic level, although they were identified in women with certain types of infertility and a history of gynecological problems. Delaying childbearing based on incorrect perceptions of female fertility could lead to involuntary childlessness. Health education regarding fertility has to be part of broader health promotion programs to enhance awareness of the effect of age on fertility.

ObjectivesInfertility rates have been increasing in low-income and middle-income countries, including Kazakhstan. The need for accessible and affordable assisted reproductive technologies has become essential for many subfertile women. We aimed to explore whether the public funding and clinical settings are independently associated with in vitro fertilisation (IVF) clinical pregnancy and to determine whether the relationship between IVF clinical pregnancy and clinical settings is modified by payment type.DesignA prospective cohort study.SettingThree private and two public IVF clinics located in major cities.ParticipantsWomen aged ≥18 seeking first or repeated IVF treatment and agreed to complete a survey were included in the study. Demographical and previous medical history data were collected from a survey, while clinical data from medical records. The total response rate was 14%.Primary and secondary outcome measuresClinical pregnancy was defined as a live intrauterine pregnancy identified by ultrasound scan at 8 gestational weeks. The outcome data were missing for 22% of women.ResultsOut of 446 women in the study, 68.2% attended private clinics. Two-thirds of women attending public clinics and 13% of women attending private clinics were publicly funded. Private clinics retrieved, on average, a higher number of oocytes (11.5±8.4 vs 8.1±7.2, p<0.001) and transferred more embryos (2.2±2.5 vs 1.4±1.1, p<0.001) and had a statistically significantly higher pregnancy rate compared with public clinics (79.0% vs 29.7%, p<0.001). Publicly funded women had on average a higher number of oocytes retrieved and a statistically significantly higher probability of clinical pregnancy (RR=1.23, 95% CI 1.02 to 1.47) than self-paid women, after adjusting for covariates. There was no statistically significant interaction between clinical setting and payment type.ConclusionsPrivate clinics and public funding were independently associated with higher IVF clinical pregnancy rates. There is also a need to further investigate whether the increase in public funding will influence clinical pregnancy rates.

Introduction: Women's intentions to delay attempting a family until later in life is well known all over the world, but their knowledge of this behavior's influence on fertility rate, as well as all the accompanying disadvantages that might appear, has not been systematically investigated. Therefore, the aim of the study was to investigate women's awareness of delayed childbearing age on fertility rate and IVF procedure success in Kazakhstan. Materials and Methods: The investigation was carried out at

Introduction: An increase in a woman's age at her first birth has occurred across all age groups but has been most pronounced in relatively older women, such that one out of every five women in the world has her first child after the age of 35, an 8-fold increase over the previous generation. Objective: What do infertile women in Каzakhstan over the age 40 understand of the relationship between age and fertility?Methods: 82 medical card women over the 40 years old, who had consultation in IVF department of National research Center of Maternity & Child Care, were retrospectively analyzed. The data include responses to the interview questions 'What information did you have about fertility and age before you started trying to get pregnant?' and 'What did you learn once you proceeded with fertility treatment?', as well as any discussion of these topics.Results: 31.7% of women in our cohort first attempted conception at an average age more than 35 and 61% stated that they had some awareness that fertility declined after age 40. Yet 90.2% of women expected their fertility to decline gradually until menopause at around 50 years and 30.5% reported that they expected to get pregnant without difficulty at age 40. When entering into the medical realm, very few participants had considered the possibility that they would need IVF and 53.7% reported being 'shocked' and 'alarmed' to discover that their understandings of the rapidity of age-related reproductive decline were inaccurate.There were 97.6% of women who advocated better fertility education earlier in life so that men and women could make more informed childbearing decisions and 80.5% who indicated that with more information about declining fertility they might have attempted conception at an earlier age.Conclusion: We found that women in our country did not have a clear understanding of the age at which fertility begins to decline. Over half of participants were 'shocked' to discover that the chances of conception at their ages were much lower than they had anticipated. As a result, we conclude that while the failure to appreciate the true biological relationship between aging and fertility may reflect inaccessibility or misinterpretation of information, it is not sufficient to explain the decades-long socio-demographic phenomenon of delayed childbearing.Keywords: age and fertility, delayed childbearing, fertility education. Бүгінгі күнде әрбір бесінші әйел өзінің алғашқы баласын 35 жастан кейін туады, бұрынғы буынмен салыстырғанда бұл көрсеткіш 8 есе жоғары. Казақстандық әйелдердің жүктілігінен саналы түрде бас тарту фактісі бар ма? Әйелдер жүктілікті кейінге қалдыру бедеулік қауіпіне әкелетіндігін түсінеді ме? Осы сұрақтарға жауап іздеу біздің зерттеуімізге бастама болды. Pregnancy after 40 years old -is a realized reality?Зерттеу мақсаты: Қазақстанда 40 жастан асқан бедеу әйелдержас пен ұрықтылық арасындағы өзара байланысты қалай түсінетінін зерттеу.Материалдар және әдістер: Қазақстанның әр аймағынан АБҰҒО (Астана) ЭКҰ бөлімшесінде кеңестенуге келуші 40-49...