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Perspectives in Global Fertility and Infertility: 

Perspectives in Global Fertility and Infertility Catherine L. Haggerty, PhD, MPH Assistant Professor of Reproductive Epidemiology University of Pittsburgh

Outline: 

Outline Global Reproductive Health Programs, Population Growth, & Fertility Trends Role of Sexually Transmitted Diseases (STDs) in Unintentional Infertility Intentional Control of Fertility

Traditional Global Reproductive Health: 

Traditional Global Reproductive Health Family planning Maternal and child health programs STD prevention programs

Reproductive Health: A Holistic Approach: 

Reproductive Health: A Holistic Approach 1994 United Nations sponsored 3rd International Conference on Population Development, Cairo Safe sex life Capability and freedom to reproduce Access to safe, effective, affordable, and acceptable family planning Access to prenatal and obstetric care Sexual health: enhanced life and personal relations

Slide6: 

Total World Population by Country Income Group, 1980, 1998, 2015 http://www.worldbank.org/depweb/english/modules/social/pgr/chart1.html

Slide7: 

Average Annual Growth Rates by Country Income Group, 1980-2015 http://www.worldbank.org/depweb/english/modules/social/pgr/chart2.html

Demographic Transition: 

Demographic Transition From: Wikipedia.com

Discussion Question:What might explain general declines in birth rates?: 

Discussion Question: What might explain general declines in birth rates? Declining infant mortality rates in rural areas means less births are needed to result in the same number of children Increases in urban living raises the cost of dependent children Changes in the role of women in societies Improvements in contraceptive technology and availability

Slide10: 

Life Expectancy World Rates

Slide12: 

Fertility Rate World Map From: wikipedia.com

Discussion Question: Why are Total Fertility Rates Higher in Developing Countries?: 

Discussion Question: Why are Total Fertility Rates Higher in Developing Countries? Developed Countries Birth control easily accessible Start families later in life More children = more education, clothing, and feeding costs Developing Countries Children assist with labor and elderly care Lack of access to contraceptives

Maternal age and fertility rates: 

Maternal age and fertility rates

Pathogenesis of pelvic inflammatory disease: 

Pathogenesis of pelvic inflammatory disease

Slide16: 

PID 8% U.S. 15% Sweden 32% Northern Territory, Australia

Pathogenesis of Reproductive Morbidity Following PID: 

Pathogenesis of Reproductive Morbidity Following PID

Healthy Fallopian Tube: 

From: Mårdh P, Möller B, Paavonen J, Weström L, Krieger J, Rein M. Atlas of Infectious Diseases: Sexually Transmitted Diseases. Edited by Gerald Mandell (series editor), Michael F. Rein. ©1996 Current Medicine, Inc. Healthy Fallopian Tube

Slide19: 

From: Mårdh P et al. Atlas of Infectious Diseases: Sexually Transmitted Diseases. Ed. Mandell & Rein. 1996 Current Medicine, Inc.

Slide20: 

Pollack, JD. Trends Microbiol. 1997; 5:413-419

Prevalence of M. genitalium: 

Prevalence of M. genitalium Adapted from CL Haggerty, PA Totten, S Astete, S Hoferka and RB Ness. The role of Mycoplasma genitalium in pelvic inflammatory disease. International Journal of STD & AIDS 2006; Vol. 17, Supplement 1:p. 9, SY5-3, and symposium presentation at the 2006 IUSTI meeting, Paris, France.

Relationship between M. genitalium Measured in the Endometrium at Baseline & Endometritis Assessed at Baseline and 30 Days Post Treatment: 

Relationship between M. genitalium Measured in the Endometrium at Baseline & Endometritis Assessed at Baseline and 30 Days Post Treatment OR=3.4 OR=3.7 *p<0.05 for all comparisons Adapted from CL Haggerty, PA Totten, S Astete, S Hoferka and RB Ness. The role of Mycoplasma genitalium in pelvic inflammatory disease. International Journal of STD & AIDS 2006; Vol. 17, Supplement 1:p. 9, SY5-3, and symposium presentation at the 2006 IUSTI meeting, Paris, France.

Relationship between Endometrial M. genitalium & Endometritis among women without N. gonorrhoeae or C. trachomatis: 

Relationship between Endometrial M. genitalium & Endometritis among women without N. gonorrhoeae or C. trachomatis OR=2.4 OR=6.6 *p<0.05 for all comparisons Adapted from CL Haggerty, PA Totten, S Astete, S Hoferka and RB Ness. The role of Mycoplasma genitalium in pelvic inflammatory disease. International Journal of STD & AIDS 2006; Vol. 17, Supplement 1:p. 9, SY5-3, and symposium presentation at the 2006 IUSTI meeting, Paris, France.

Prevalence of M. genitalium among Women presenting with Signs and Symptoms of PID: 

Prevalence of M. genitalium among Women presenting with Signs and Symptoms of PID

Slide25: 

Frequency of cervical pathogens among 826 West African sex workers Adapted from: Pepin J et al. Mycoplasma genitalium: an organism commonly associated with cervicitis among west African sex workers. Sexually Transmitted Infections. 81(1):67-72, 2005

Prevalence of M. genitalium among HIV Seropositive and Seronegative Women in the US and Kenya: 

Prevalence of M. genitalium among HIV Seropositive and Seronegative Women in the US and Kenya Adapted from: Irwin KL et al. Influence of human immunodeficiency virus infection on pelvic inflammatory disease. Obstetr & Gyn 2000. 95(4):525-34 and Cohen CR et al. Detection of Mycoplasma genitalium in women with laparoscopically diagnosed acute salpingitis. STI 2005. 81(6):463-6.

Slide27: 

Svenstrup, H. F. et al. Hum. Reprod. 2003 18:2103-2109; doi:10.1093/humrep/deg392 Nomarski microscopy (x100 objective) of sperm incubated in vitro with M.genitalium

M. genitalium & Infertility: 

M. genitalium & Infertility Clausen HF et al, 2001 TFI patients: Mg seropositive 22.0% Patients with normal tubes: Mg seropositive 6.3%

Slide29: 

Copyright restrictions may apply. Larsen, U. Int. J. Epidemiol. 2000 29:285-291; doi:10.1093/ije/29.2.285 Percentage with primary infertility in selected sub-Saharan African countries

Slide30: 

Copyright restrictions may apply. Larsen, U. Int. J. Epidemiol. 2000 29:285-291; doi:10.1093/ije/29.2.285 Percentage with secondary infertility in selected sub-Saharan African countries

Total Infertility Rates (Primary and Secondary) in U.S. and in Regions with High Rates of STDs and Low Access to Care: 

Total Infertility Rates (Primary and Secondary) in U.S. and in Regions with High Rates of STDs and Low Access to Care

Primary vs. Secondary Infertility in the U.S. and in Regions with High Rates of STDs and Low Access to Care: 

Primary vs. Secondary Infertility in the U.S. and in Regions with High Rates of STDs and Low Access to Care

Effective Reproductive Span: 

Effective Reproductive Span Biological Reproductive Span Bounded by menarche and menopause Social Reproductive Span Marked by intervals of sexual activity and/or marriage

Family Planning Programs: 

Family Planning Programs Breastfeeding Contraception Abortion

Birth Interval: 

Birth Interval Postpartum period Breastfeeding Time to conception Spontaneous abortion

Worldwide Breastfeeding Rates : 

Worldwide Breastfeeding Rates Developed from http://www.lalecheleague.org/cbi/bfstats03.html

Deliberate Control of Fertility: 

Deliberate Control of Fertility Postponement/interruption of marriage/sexual relationship Sterilization Contraceptive use Induced abortion

Global Contraceptive Rates among Married Couples, 2000: 

Global Contraceptive Rates among Married Couples, 2000

Unintended Pregnancy: 

Unintended Pregnancy 20% in low to middle income countries Ranges from 3% in Niger, sub-Saharan Africa, to 45% in Latin American Bolivia Consequences Increased lifetime risk of maternal mortality Unsafe abortion Poor infant health Lower investment in the child

Final Discussion Question: What are the barriers to family planning services, particularly in developing countries?: 

Final Discussion Question: What are the barriers to family planning services, particularly in developing countries? Lack of well-run family planning programs Economic cost of access to services Transportation costs Supply costs Social costs Travel by women limited Psychic costs Societies may offer little social of familial support for low fertility