Jocelynn L. Cook

Estimating the prevalence of infertility in Canada

BACKGROUND Over the past 10 years, there has been a significant increase in the use of assisted reproductive technologies in Canada, however, little is known about the overall prevalence of infertility in the population. The purpose of the present study was to estimate the prevalence of current infertility in Canada according to three definitions of the risk of conception. METHODS Data from the infertility component of the 2009–2010 Canadian Community Health Survey were analyzed for married and common-law couples with a female partner aged 18–44. The three definitions of the risk of conception were derived sequentially starting with birth control use in the previous 12 months, adding reported sexual intercourse in the previous 12 months, then pregnancy intent. Prevalence and odds ratios of current infertility were estimated by selected characteristics. RESULTS Estimates of the prevalence of current infertility ranged from 11.5% (95% CI 10.2, 12.9) to 15.7% (95% CI 14.2, 17.4). Each estimate represented an increase in current infertility prevalence in Canada when compared with previous national estimates. Couples with lower parity (0 or 1 child) had significantly higher odds of experiencing current infertility when the female partner was aged 35–44 years versus 18–34 years. Lower odds of experiencing current infertility were observed for multiparous couples regardless of age group of the female partner, when compared with nulliparous couples. CONCLUSIONS The present study suggests that the prevalence of current infertility has increased since the last time it was measured in Canada, and is associated with the age of the female partner and parity.

Fetal alcohol spectrum disorder: a guideline for diagnosis across the lifespan

The consequences of prenatal alcohol exposure were first described more than 40 years ago.[1][1],[2][2] The term “fetal alcohol syndrome” (FAS) was first used to describe the cluster of birth defects due to prenatal alcohol exposure (including growth restriction, craniofacial abnormalities and

Pre-Conception Practices Among FamilyPhysicians and Obstetrician-Gynaecologists:Results from a National Survey

OBJECTIVE To determine the pre-conception practices among obstetrician-gynaecologists and family physicians in Canada. METHODS Between October 2001 and May 2002, a survey was mailed to a national random sample of obstetricians and gynaecologists (n = 539) and family physicians (n = 2378) who were current members of the College of Family Physicians of Canada or the Society of Obstetricians and Gynaecologists of Canada. RESULTS Response rates were 41.7% among obstetrician-gynaecologists and 31.1% among family physicians. More than 85% of physicians frequently discussed birth control and Pap testing with women of childbearing age, but fewer than 60% frequently obtained a detailed history of alcohol use. Fewer than 50% of physicians frequently discussed the following with women of childbearing age: weight management, workplace stress, mental health, addiction history, or the risks of substance use during pregnancy. Fewer than 15% enquired about a history of sexual or emotional abuse. Family physicians were significantly more likely than obstetrician-gynaecologists to discuss mental health (41.1% vs. 28.1%), depression (44.5% vs. 29.0%), and history of alcohol use (59.8% vs. 47.9%) with women of childbearing age (all P < 0.05). Obstetrician-gynaecologists were significantly more likely than family physicians to discuss folic acid (57.8% vs. 47.2%), sexual abuse (18.2% vs. 10.8%), smoking (56.0% vs. 46.1%), and drug use (45.8% vs. 35.9%) (all P < 0.05) with women of childbearing age who were not pregnant. CONCLUSION There are missed opportunities in pre-conception screening to identify women with suboptimal reproductive health status who are at risk for adverse conception, pregnancy, and birth outcomes. Physician training in identification of women at risk would allow for increased primary and secondary prevention efforts through referral to appropriate treatment and resources.

Cross-border reproductive care: now and into the future.

OBJECTIVE To introduce the key discussion points from the first International Forum on Cross-Border Reproductive Care (CBRC). SETTING International conference. CONCLUSION(S) A number of similar concerns were raised by the international panel of attendees at the International Forum on CBRC. The primary concerns of health care providers were the lack of reliable and complete information on the numbers of CBRC cases, the types of care being sought, and the outcomes of the treatments or pregnancies. To ensure quality of care on both international and local scales, physicians and fertility clinic staff of outgoing and incoming CBRC patients must be advised on how to best counsel their patients on safety and efficacy.

Assisted Reproductive Technology-Related Multiple Births: Canada in an International Context

OBJECTIVE It has been well-documented that the use of assisted reproductive technology (ART) increases the risk for multiple births, which are associated with sub-optimal outcomes for pregnant women and their offspring. The occurrence of multiple births due to infertility treatments has been recognized as a significant problem globally, and a number of countries have developed approaches, policies, statutes, and regulations geared to decreasing the rates of multiple births as a result of ART. This review was designed to explore Canadas position in the international context of ART-related multiple births and to examine the strategies of other countries intended to decrease rates of multiple pregnancy. METHODS Data were obtained from publicly available data sources from 21 countries, including Canada, and comparisons were made between pregnancy rates, percentages of live births, percentages of multiple births, numbers of embryos transferred, and governing guidelines and policies. RESULTS Canada has one of the highest ART-related multiple-birth rates, and the number of embryos transferred per cycle plays an important role in this. Cooperation among stakeholders in the development of approaches and guidelines is essential for preventing multiple births due to infertility treatments. CONCLUSIONS In order effectively to reduce the multiple-birth rate in Canada, it is important to learn from the experiences of other countries, taking the Canadian context into consideration.

Preterm birth prevention in twin pregnancies with progesterone, pessary, or cerclage: a systematic review and meta-analysis

About half of twin pregnancies deliver preterm, and it is unclear whether any intervention reduces this risk.

Multiple Births Associated With Assisted Human Reproduction in Canada

OBJECTIVE Assisted human reproduction has been associated with increased rates of multiple births. Data suggest that twins and higher order multiple pregnancies are at risk for pre- and postnatal health complications that contribute to stress on both the family and the Canadian health care system. No published Canadian data estimate the contribution of assisted human reproduction to multiple birth rates. This study was designed to determine the contributions of age and assisted human reproduction to multiple birth rates in Canada. METHODS We performed analyses of existing Canadian databases, using a mathematical model from the Centers for Disease Control and Prevention. More specifically, data from the Canadian Vital Statistics: Births and Stillbirths database were combined with data from the Canadian Assisted Reproductive Technologies Register collected by the Canadian Fertility and Andrology Society. Datasets were standardized to age distributions of mothers in 1978. RESULTS RESULTS suggest that in vitro fertilization, ovulation induction, and age each contribute more to the rates of triplets than to twins. As expected, the contribution of natural factors was higher to twins than to triplets. CONCLUSION These are the first Canadian data analyzed to separate and measure the contributions of age and assisted reproductive technologies to multiple birth rates. Our findings are important for guiding physician and patient education and informing the development of treatment protocols that will result in lower-risk pregnancies and improved long-term health for women and their offspring.

Effectiveness of progesterone, cerclage and pessary for preventing preterm birth in singleton pregnancies: a systematic review and network meta‐analysis

Preterm birth (PTB) is the leading cause of infant death, but it is unclear which intervention is best to prevent it.

Caregiver needs and stress in caring for individuals with fetal alcohol spectrum disorder.

OBJECTIVE Individuals with FASD experience neurodevelopmental impairments and adverse outcomes, which can result in stress on the caregiver. However, there is little research on the needs of caregivers supporting individuals with FASD and whether they are associated with caregiver stress. METHOD 125 caregivers of individuals with FASD completed a survey with questions adapted from the Family Caregiver Survey and the Perceived Stress Scale. RESULTS Caregivers reported a range of needs and concerns, and high levels of stress. In many areas of caregiver well-being concerns tended to be higher among caregivers with adolescents and adults compared to those with children. Foster parents reported fewer well-being concerns than biological/kinship and adoptive parents. Caregivers who cared for the individuals for longer periods of time reported the most well-being concerns and lowest satisfaction with supports. Caregivers with the lowest income reported higher levels of stress than those with higher incomes. Higher reported stress was highly correlated with more needs/concerns. CONCLUSIONS Caregivers of individuals with FASD have multiple areas of need and concern, and experience high levels of stress. Reducing demands on caregivers and providing resources may help reduce caregiver needs and stress, particularly for those caring for adolescents and adults, and those with lower incomes.

Are FASD guidelines practical and sustainable

The FASD guidelines[1][1] and accompanying article[2][2] should not be interpreted as implying a “tertiary bias,” as suggested by Keith Goulden. On the contrary, trained and functional FASD diagnostic teams have recently been established in smaller communities throughout Canada and are providing