Prevalence of infertility in the United States as estimated by the current duration approach and a traditional constructed approach

Marie E Thoma; Alexander C McLain; Jean Fredo Louis; Rosalind B King; Ann C Trumble; Rajeshwari Sundaram; Germaine M Buck Louis

doi:10.1016/j.fertnstert.2012.11.037

Infertility Evaluation

Prevalence of infertility in the United States as estimated by the current duration approach and a traditional constructed approach

Thoma ME, McLain AC, Louis JF, King RB, Trumble AC, Sundaram R, Buck Louis GM

Published April 2013 Fertility and sterility

DOI 10.1016/j.fertnstert.2012.11.037 PMID 23290741 PMC PMC3615032

RRM Academy Synopsis

US infertility is about twofold higher by trying-time estimates

Infertility prevalence was about twofold higher by the current duration approach in the authors' analysis of a 2002 national survey of US women aged 15 to 44. It gave 15.5 out of 100 women trying to conceive. The traditional constructed measure gave 7.0 out of 100 married or cohabiting women.

Key Findings

The current duration approach estimated infertility prevalence at 15.5% (95% CI: 8.6, 27.5), based on 270 women. The constructed measure estimated 7.0% (95% CI: 6.2, 7.8), based on 3,812 women.
Among women with no prior births, the current duration approach gave 24.3% (95% CI: 12.4, 43.5) and the constructed measure gave 13.2% (95% CI: 11.2, 15.2).
Excluding women who started infertility treatment, estimates were 12.6% (95% CI: 7.6, 21.4) for the current duration approach and 6.6% (95% CI: 5.8, 7.5) for the constructed measure.
Both approaches linked infertility to increasing age, lower education, no prior births and gynecologic disorders. Race/ethnic identification and poverty level showed opposing patterns.

Interpretation

The authors analyzed the 2002 National Survey of Family Growth, a nationally representative survey taken at one point in time. The current duration approach asks sexually active women who are not using contraception and want to become pregnant how long they have been trying. It then estimates total time to pregnancy statistically. The constructed measure infers infertility from answers about contraception, sexual activity and pregnancy. The authors note that the current duration sample covered only women who reported trying to conceive. The authors call their 15.5% estimate consistent with the 12 to 18% range from US cohorts that enrolled women before conception.

RRM Context

Restorative reproductive medicine starts from the cause of delayed conception in each couple. A population estimate shows how common the problem is, and the cause still needs a full evaluation of both partners. The 2013 study shows that the count itself depends on how infertility is defined and measured.

Our editorial summary of this paper, not the article's abstract.

Abstract

Objective

To estimate the prevalence of infertility using a current duration approach for comparison with a traditional constructed measure.

Design

Cross-sectional survey.

Setting

Not applicable.

Patients

A nationally representative sample of females aged 15-44 years.

Interventions

None.

Main Outcome Measures

Infertility prevalence estimated by two approaches: [1] a constructed measure derived from questions on sexual activity, contraception, relationship status, and pregnancy, and [2] a measure based on estimated time to pregnancy derived from the respondents' current duration of pregnancy attempt (i.e., current duration approach). Associations with self-reported descriptive characteristics using weighted logistic regression or parametric survival models for each respective approach.

Results

Infertility prevalence was approximately twofold higher using the current duration approach (15.5%; 95% confidence interval 8.6%-27.5%) vs. the constructed measure (7.0%; 95% confidence interval 6.2%-7.8%). Both methods identified similar patterns of increasing age, lower education, nulliparity, and history of gynecologic disorders as being associated with measures of impaired fecundity, whereas opposing patterns were seen for racial/ethnic identification and poverty status.

Conclusions

Infertility prevalence based on a current duration approach was consistent with other US prospective cohort studies with preconception enrollment. These findings underscore the importance of definition and methodologic approach for estimating the prevalence of infertility.

Topics

Infertility › Evaluation › Prevalence and Incidence · Research Methods › Measurement and Statistics › Outcome Definitions

Marie E Thoma, Alexander C McLain, Jean Fredo Louis, Rosalind B King, Ann C Trumble, Rajeshwari Sundaram, Germaine M Buck Louis

M Thoma, Alex McLain, A McLain, J Louis, R King, A Trumble, R Sundaram, G Louis

PMID 23290741 23290741 DOI 10.1016/j.fertnstert.2012.11.037 10.1016/j.fertnstert.2012.11.037 Thoma et al. 2013, Thoma 2013

Prevalence of infertility in the United States as estimated by the current duration approach and a traditional constructed approach

US infertility is about twofold higher by trying-time estimates

Key Findings

Interpretation

RRM Context

Abstract

Topics

By this author

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