Infertility: addressing its causes and providing treatment

South Korea's total fertility rate (TFR) in 2009 was 1.15, the lowest in the world (as known so far. The South Korean government has invested a total of 19.7 trillion won (US$ 18 billion) of public funds from 2006 to 2010 to deal with the problem. This paper aims to analyze the “National Supporting Program for Infertility Couples” (hereinafter the “Program”), started in 2006 as one of the measures taken by the South Korean government to deal with low fertility in Korea. Specifically, this study is to clarify the following research questions:
First, did the “Program” start with a comprehensive consideration for women's health? Or rather, has the “Program” caused the concept of women's health to change or deteriorate?
Second, can the “Program” be an effective measure to deal with low fertility? And does this “Program” not cause internal contradictions with other low fertility policies?
Third, does the “Program” live up to its name and actually really help infertile couples?
This study attempts to answer these questions by analyzing the documents published by government regarding the "Program" and low fertility. In addition, it will analyze how national policy deals with women's health in conjunction with the amendments of the “Maternal and Child Health Act”, and previous analysis on the “Maternal and Child Health Service”.

Like other Western-industrialized countries, Australians who wish to have reproductive treatment for sex selection purposes must travel overseas to access them as there are legal barriers prohibiting the treatment in Australia. This raises the question about how Australian get their information on services and care to make informed decisions about this form of “reproductive tourism”. Our paper uses Grounded Theory Method to analyse data collected from Australian medical providers, overseas clinic websites, and Australian internet forums and discussion boards. We find that some Australian clinics advise their clients to go overseas for procedures which are illegal in Australia. In turn, overseas fertility specialists actively market their services for residents in countries such as Australia where the procedures are not allowed. The analysis of the forum and discussion boards provides considerable detail on the reasons and approach that people take. The main topics that arise on the internet forums are being able to speak freely and safely, anonymity, telling others, interactions with doctors, travel logistics, quality of service and cost.

Short postponement of entry to motherhood has occurred from 1990 onwards in Iran. There is some evidence of an increase in childlessness due to delay of childbearing. Using data from the 2000 Iran Demographic and Health Survey (IDHS) and the 1991-2003 survey of Socio-Economic Characteristics of Household in Iran (SECHI), this paper estimates the level and trend of childlessness across time in Iran. Our results show that childlessness in five-year age-groups between ages 15 and 39 increased during 1991-2003. In contracts, the proportion of childlessness in the last years of the reproductive life which can considered as permanent childlessness has reduced from 3.8 per cent to 2.2 per cent. Increased proportion of women with zero parity in Iran seems to be due to tempo effects resulted from short postponement of first birth. Reduction in lifetime childlessness may be due to more access to the assisted reproductive technologies in the country. The IDHS data allowed us to distinguish between voluntary and involuntary childlessness. Among ever-married women aged 15-49 voluntary and involuntary childlessness were 8.5 and 2.0 per cent, respectively. Provincial estimates show that most provinces with a low level of socio- economic development experienced the highest involuntary childlessness as compared with other provinces.

Infertility problem has been a neglected research area in developing countries so far. The main focus has been given on different health issues rather than levels and determinants of infertility in India. Infertility can be categorized in two types, i.e. primary and secondary infertility. Preventive and curative services for infertility have not yet been a priority in India. Hence, it requires an in-depth study in India to unmask this problem. Therefore an attempt has been made to understand the socio-economic and demographic factors, exaggerating situation of infertility in India and treatment seeking behaviour. To carry out this study DLHS-III data have been used. Bivariate and Multivariate models have been prepared to understand the effect of socio-economic and demographic factors for infertility problem and treatment seeking. To focus spatial variation of infertility problem and treatment seeking behaviour. GIS has been used. Rich-poor gap is visible in case of preferred treatment for infertility. Type of occupation is coming significant and those who are engaged in primary sector are more likely to suffer infertility problem than those who are working in secondary and tertiary sector. Recognizing the importance of education and prevention, infertility treatment in India requires greater attention at National levels.

Parenthood is one of the major transitions in adult life for both men and women. Couples experience stigma, sense of loss, and diminished self-esteem in the setting of their infertility. Also postponement of childbearing in young generation couples may be one of the reasons of infertility which dramatically increased the number of couples seeking treatment for infertility now-a-days due to more awareness of available services and latest and more successful techniques.
In this study an attempt have been made to estimate infertility indirectly from the information on childlessness and health seeking behaviour in Uttar Pradesh using the DLHS-III survey data collected in 2007-08. Infertility is perceived as a problem across virtually all cultures and societies and has an estimate about 11 percent of females of reproductive age 20-49, whose marital duration is more than two years. Among those respondents who reported problem of lifetime infertility, more than three-fourth suffered from primary infertility. The estimates of childlessness and current primary infertility are 4.1 percent and 2.0 percent respectively. Also percentage of women seeking treatment for lifetime primary and current primary infertility is about 84.0 percent.

Although Assisted Reproduction Technologies (ART) represent a very small proportion of overall infertility service use in the United States, they drive much of the public’s perception about access to and use of medical services to have a child. We examine trends and individual-level correlates for use of medical services to have a child, using data from two sources. The first data source is the 1995, 2002, and 2006-10 National Surveys of Family Growth (NSFG), each a U.S.-nationally representative, cross-sectional survey of women 15-44 years of age. The second source is fertility clinic data collected by the United States Centers for Disease Control and Prevention/Society for Assisted Reproductive Technology; we analyze clinic data from 1999-2010. This mixed-data approach allows us to determine trends in the demand for infertility services at the national level and to explore diagnoses, medical treatment and outcomes at the clinic level. Preliminary findings from the two data sources indicate an increase in the utilization of ART over this time period, and a decrease in tubal factor and endometriosis as patient diagnoses.

In Europe, there are legal and medical disparities regarding assisted reproductive technologies (ART) which lead to cross-border fertility care. This new social and medical phenomenon concerns French nationals, but studies have not yet enabled us to estimate their number, to identify their sociodemographic characteristics or to understand their histories and motivations. The main purpose here is to present, through a case study based on interviews and self-administrated questionnaires, the first empirical evidence on this (new) phenomenon involving French residents, in four selected European countries (Belgium, Denmark, Greece and Spain): Who are these French patients? Why do they cross borders? How do they organize/manage transnational medical care? Compare these data with other available data on use of ART in France will allow to highlight the specificity (or not) of cross-border French patients. We will conclude that the majority of them crossed borders because of their unsatisfied needs and the inadequacies of French fertility care; that cross-border fertility care is organized into transnational paths, and it relies on medical and associative networks.

The aim of this paper is to study the prevalence and risk factors of pregnancy loss due to miscarriage and stillbirth among mothers aged 15 to 49 years in Malaysia. The data used was obtained from the Fourth Malaysian Population and Family Survey (MPFS-4), which was carried out in 2004. This paper analysed 13,312 pregnancies among 3,534 mothers that ended in live birth or stillbirth and miscarriage which has been grouped together as non-live birth. Multivariate logistic regression model was used to compare risks of non-live births relative to the live births. The results showed that mothers’ birth cohort, age at first marriage, pregnancy order, and previous non-live births have significant effects on the incidence of non-live births among them. It was found that the likelihood of non-live births increased with age at first marriage, pregnancy order, and previous non-live births. In addition, those born in 1970 or later have more risk of non-live births as compared to those were born before. Little has been known about the causes of pregnancy loss due to miscarriage and stillbirth in Malaysia. It is time to start understand the true nature of this condition. Through the provision of cause-oriented treatment by the medical doctors, it is hoped that many couples will be able to achieve intended live births.

Infertility in many South-East-Asian countries, has been relatively a neglected field of social science research as these countries still focus on high fertility and its control and not on the dynamics of infertility. Data from various countries have shown that infertility is affecting a large number of couples even in the highly fertile India. On the contrary, this paper shows that the infertility in India is relatively low although the levels have increased over the years. A regional variation in infertility has also been observed wherein the Southern Regions exhibited higher levels of infertility over that of the other. A logistic regression run has shown that the infertility in India is mainly determined by biological and life-style related factors rather than by the socio-economic factors. Infertility also affects the quality and well-being of women’s life adversely by having greater marital instability, higher exposure to domestic violence and by lowered autonomy.

Treatment seeking behaviour for infertility is affected by community’s socio-cultural norms. Using DLHS-3 data this study examines prevalence of infertility among currently married women of 8 EAG states of India that accounts for 45 percent of India’s population. Eight percent Indian and 51 percent EAG states women had infertility problems. The leading states were Bihar, Chhattisgarh and Uttar Pradesh. A significant proportion of women were Hindu, illiterates, aged 20-29 years, had rural background and age at consummation of marriage was less than 18 years. More than two fifth had taken treatment for infertility. Larger proportions of women were rich, Christian, hailed from other backward classes and had higher level of education. Around half Uttarakhand, Chhattisgarh and Orissa women had allopathic treatment but Rajasthan, Jharkhand and Bihar women had religious/traditional treatment. Multivariate analysis indicated that treatment seeking was affected educational and economic status. Allopathic treatment seeking was determined by knowledge factor and treatment cost. Infertility was highest in Bihar but highest proportion of UP women took treatment for infertility. More Bihar women had responded to infertility treatment. There is a need to look at infertility problems as an issue in domain of reproductive health research.