Objective
To examine the characteristics of women seeking infertility evaluation and treatment.
Design
Cross-sectional survey based on in-person interviews, followed by two-step hurdle analysis.
Participants
4,558 married or cohabitating women ages 25–44
Setting
U.S. household population of women based on the 2006–2010 National Survey of Family Growth
Intervention
None
Main Outcome Measure(s)
Likelihood of seeking preliminary infertility evaluation. Likelihood of seeking infertility treatment once evaluated. Treatment type provided.
Results
623 women (13.7%) reported seeking infertility evaluation, of which 328 reported undergoing subsequent infertility treatment. Age at marriage, marital status, education, health insurance status, race/ethnicity, and religion were associated with the likelihood of seeking infertility evaluation. For example, the predicted probability that a non-White woman who married at 25 will seek evaluation was 12%. This probability increased to 34% for White women with a graduate degree who married at age 30. Among women who are evaluated, income, employment status, and ethnicity correlated strongly with the likelihood of seeking infertility treatment. Infertility drug therapy was the most frequent treatment used. Reproductive surgery and in vitro fertilization (IVF) were used the least.
Conclusions
The use of infertility services is not random and understanding the socio-demographic factors correlated with use may assist new couples with family planning. Roughly 50% of the women evaluated for infertility progressed to treatment, and only a small proportion were treated with more advanced assisted reproductive technologies (ARTs) such as IVF therapy. Future research aimed at improving access to effective healthcare treatments within the boundaries of affordability is warranted.
We analysed 381 consecutive cycles of homologous intrauterine insemination (IUI) in 215 infertile couples, resulting in 48 pregnancies (12.6%/cycle, 22.3%/patient). Cycle fecundity ranged from 0.11 to 0.14 in women aged 25-39 years, falling to 0.04 beyond age 40 years. Of the 48 pregnancies, 43 occurred in the first three treatment cycles, in which fecundity was 0.14, 0.16 and 0.10 respectively. Beyond three cycles, fecundity was 0.07 (P = 0.05 versus first two cycles). The occurrence of pregnancy varied with diagnosis (P = 0.04). Fecundity was significantly greater for women with ovulatory dysfunction (0.30) than for endometriosis, male factor, tubal factor, idiopathic infertility or multifactorial (0.08-0.14). Ovulation induction using menopausal gonadotrophins offered significant advantage over natural cycles or cycles using clomiphene citrate without gonadotrophins (0.15 versus 0.03, P = 0.01). Cycles in which pre-ovulatory surges were either induced or supported with human chorionic gonadotrophin (HCG) were superior to spontaneous luteinizing hormone surges (0.13 versus 0.03, P = 0.05). Recruitment of at least two mature (> 1.6 cm) follicles was critical. Only one pregnancy occurred in 64 cycles characterized by one mature follicle, compared with a pregnancy rate of 0.15 in cycles characterized by two or more mature follicles (P = 0.006). IUI is not beneficial to women > 40 years old, and has the best chance of success within three cycles. Multiple follicle recruitment using gonadotrophin-based stimulation protocols and mid-cycle HCG are necessary to achieve an acceptable pregnancy rate.
We investigate the most general notion of a private quantum code, which involves the encoding of qubits into quantum subsystems and subspaces. We contribute to the structure theory for private quantum codes by deriving testable conditions for private quantum subsystems in terms of Kraus operators for channels, establishing an analogue of the Knill-Laflamme conditions in this setting. For a large class of naturally arising quantum channels, we show that private subsystems can exist even in the absence of private subspaces. In doing so, we also discover the first examples of private subsystems that are not complemented by operator quantum error correcting codes, implying that the complementarity of private codes and quantum error correcting codes fails for the general notion of private quantum subsystems.
In recent years, several measures have been proposed for characterizing the
coherence of a given quantum state. We derive several results that illuminate
how these measures behave when restricted to pure states. Notably, we present
an explicit characterization of the closest incoherent state to a given pure
state under the trace distance measure of coherence. We then use this result to
show that the states maximizing the trace distance of coherence are exactly the
maximally coherent states. We define the trace distance of entanglement and
show that it coincides with the trace distance of coherence for pure states.
Finally, we give an alternate proof to a recent result that the $\ell_1$
measure of coherence of a pure state is never smaller than its relative entropy
of coherence.Comment: 11 pages, trace distance of entanglement is new in v
Early integration of assessment and counseling regarding fertility preservation is part of the multidisciplinary approach in the care of the premenopausal breast cancer patient and is key to optimizing both cancer treatment and fertility plans for the future. Because of the many ongoing biological, practical, and ethical controversies surrounding oncofertility, eligible patients should be strongly encouraged to participate in clinical trials and studies to further increase our knowledge in this growing field.
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