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1.
Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med ; 30(2): 185-194, 2022 Mar.
Article in Russian | MEDLINE | ID: covidwho-1791310

ABSTRACT

The article presents current trends in reproductive demographic process economically developed countries. Today, the total fertility rate in all European countries is below the minimum required to ensure population reproduction in long term - 2.1 children per woman during her life. According statistic data, 4.167 million children were born in the EU in 2019 that corresponds to 9.3 births per 1000 of population. In the EU, 1.53 children went to one woman in 2019 (in 2018 - 1.54). The lowest total fertility rates in 2019 were registered in Malta (1.14), Spain (1.23) and Italy (1.27). In the United States, fall of rate of childless women with higher education disputes well-established observation of positive relationship between education and childlessness. The infertility affects approximately 8-12% of couples worldwide, at that in developed countries, up to 15% of all couples are infertile. In connection with the problem of birth rate reduction in developed countries, researchers highlight such problems as increasing of average age of mothers at delivery (30-35 years and older) and intervals between labors, development of subsidiary reproductive technologies, pregnancy outcomes, newborns health in short and long perspective. The global COVID-19 pandemic resulted in resources deficiency, complexities with medical services support related to reproductive health, risks for maternal and perinatal outcomes in pregnant women with COVID-19. However, actually still there is no complete picture of pandemic impact on global indices of reproductive demographic process.


Subject(s)
COVID-19 , Adult , Birth Rate , COVID-19/epidemiology , Child , Developed Countries , Female , Humans , Infant, Newborn , Pandemics , Pregnancy , Reproductive Techniques, Assisted , United States
3.
Hum Reprod ; 37(5): 947-953, 2022 05 03.
Article in English | MEDLINE | ID: covidwho-1713663

ABSTRACT

STUDY QUESTION: Does prior severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection in women undergoing fertility treatments affect the outcomes of fresh ART cycles? SUMMARY ANSWER: SARS-CoV-2 infection does not affect fresh ART treatment outcomes, except for a possible long-term negative effect on oocyte yield (>180 days postinfection). WHAT IS KNOWN ALREADY: A single previous study suggested no evidence that a history of asymptomatic or mild SARS-CoV-2 infection in females caused impairment of fresh ART treatment outcomes. STUDY DESIGN, SIZE, DURATION: Retrospective cohort study, including all SARS-CoV-2 infected women who underwent fresh ART cycles within a year from infection (the first cycle postinfection), between October 2020 and June 2021, matched to non-diagnosed controls. PARTICIPANTS/MATERIALS, SETTING, METHODS: Patients from two large IVF units in Israel who were infected with SARS-CoV-2 and later underwent fresh ART cycles were matched by age to non-diagnosed, non-vaccinated controls. Demographics, cycle characteristics and cycle outcomes, including oocyte yield, maturation rate, fertilization rate, number of frozen embryos per cycle and clinical pregnancy rates, were compared between groups. MAIN RESULTS AND THE ROLE OF CHANCE: One hundred and twenty-one infected patients and 121 controls who underwent fresh ART cycles were included. Oocyte yield (12.50 versus 11.29; P = 0.169) and mature oocyte rate (78% versus 82%; P = 0.144) in all fresh cycles were similar between groups, as were fertilization rates, number of frozen embryos per cycle and clinical pregnancy rates (43% versus 40%; P = 0.737) in fresh cycles with an embryo transfer. In a logistic regression model, SARS-CoV-2 infection more than 180 days prior to retrieval had a negative effect on oocyte yield (P = 0.018, Slope = -4.08, 95% CI -7.41 to -0.75), although the sample size was small. LIMITATIONS, REASONS FOR CAUTION: A retrospective study with data that was not uniformly generated under a study protocol, no antibody testing for the control group. WIDER IMPLICATIONS OF THE FINDINGS: The study findings suggest that SARS-CoV-2 infection does not affect treatment outcomes, including oocyte yield, fertilization and maturation rate, number of good quality embryos and clinical pregnancy rates, in fresh ART cycles, except for a possible long-term negative effect on oocyte yield when retrieval occurs >180 days post-SARS-CoV-2 infection. Further studies are warranted to support these findings. STUDY FUNDING/COMPETING INTEREST(S): None. TRIAL REGISTRATION NUMBER: 0010-21-HMC, 0094-21-ASF.


Subject(s)
COVID-19 , Fertilization in Vitro , Birth Rate , COVID-19/therapy , Female , Fertilization in Vitro/methods , Humans , Live Birth , Pregnancy , Pregnancy Rate , Retrospective Studies , SARS-CoV-2 , Treatment Outcome
4.
Hum Reprod ; 37(4): 822-827, 2022 04 01.
Article in English | MEDLINE | ID: covidwho-1684692

ABSTRACT

STUDY QUESTION: How did the coronavirus disease 2019 (COVID-19) pandemic affect live birth numbers in Europe? SUMMARY ANSWER: In 14 European countries with validated datasets on live birth numbers during the ongoing COVID-19 pandemic, excess mortality was inversely correlated with live birth numbers. WHAT IS KNOWN ALREADY: Since March 2020, in order to minimize spread of severe acute respiratory syndrome coronavirus 2 and reducing strain on the health care systems, many national authorities have imposed containments and restricted both indoor and outdoor recreational activities. Historical events, such as electricity blackouts, have repeatedly been shown to exert incremental effects on birth numbers. STUDY DESIGN, SIZE, DURATION: We evaluated the effect of the COVID-19 pandemic and the containments on reproduction and birth numbers in 14 European countries with complete and validated datasets, until March 2021. PARTICIPANTS/MATERIALS, SETTING, METHODS: The national demographic offices of 20 European countries were requested to provide the monthly birth numbers from 2015 to March 2021. Among them, 14 countries provided those data. Taking into account seasonal variations, the live birth numbers were compared with excess mortality at two different time intervals during the pandemic. MAIN RESULTS AND THE ROLE OF CHANCE: At 9 months after the initiation of containments in many European countries, 11 of 14 European countries (78.5%) experienced a decline in live birth numbers, ranging between -0.5% and -11.4%. The decline in live birth numbers was most pronounced in eight European countries with the highest degree of excess mortality. From January to March 2021, live birth numbers continued to decline in 5 of 8 European countries with high excess mortality, whereas live births started to recover in 8 of 14 countries (57.1%). LIMITATIONS, REASONS FOR CAUTION: The live birth numbers of some key European countries were not available. WIDER IMPLICATIONS OF THE FINDINGS: The demographic changes linked to the COVID-19 pandemic may add to the overall socio-economic consequences, most particularly in those countries with pre-existing reduced reproduction rates. STUDY FUNDING/COMPETING INTEREST(S): This study did not receive specific funding. The authors have no conflicts of interest to declare. TRIAL REGISTRATION NUMBER: N/A.


Subject(s)
COVID-19 , Birth Rate , Europe/epidemiology , Female , Fertilization in Vitro , Humans , Live Birth/epidemiology , Pandemics , Pregnancy
7.
Front Public Health ; 9: 729795, 2021.
Article in English | MEDLINE | ID: covidwho-1448820

ABSTRACT

This paper aims to evaluate the performance of multiple non-linear regression techniques, such as support-vector regression (SVR), k-nearest neighbor (KNN), Random Forest Regressor, Gradient Boosting, and XGBOOST for COVID-19 reproduction rate prediction and to study the impact of feature selection algorithms and hyperparameter tuning on prediction. Sixteen features (for example, Total_cases_per_million and Total_deaths_per_million) related to significant factors, such as testing, death, positivity rate, active cases, stringency index, and population density are considered for the COVID-19 reproduction rate prediction. These 16 features are ranked using Random Forest, Gradient Boosting, and XGBOOST feature selection algorithms. Seven features are selected from the 16 features according to the ranks assigned by most of the above mentioned feature-selection algorithms. Predictions by historical statistical models are based solely on the predicted feature and the assumption that future instances resemble past occurrences. However, techniques, such as Random Forest, XGBOOST, Gradient Boosting, KNN, and SVR considered the influence of other significant features for predicting the result. The performance of reproduction rate prediction is measured by mean absolute error (MAE), mean squared error (MSE), root mean squared error (RMSE), R-Squared, relative absolute error (RAE), and root relative squared error (RRSE) metrics. The performances of algorithms with and without feature selection are similar, but a remarkable difference is seen with hyperparameter tuning. The results suggest that the reproduction rate is highly dependent on many features, and the prediction should not be based solely upon past values. In the case without hyperparameter tuning, the minimum value of RAE is 0.117315935 with feature selection and 0.0968989 without feature selection, respectively. The KNN attains a low MAE value of 0.0008 and performs well without feature selection and with hyperparameter tuning. The results show that predictions performed using all features and hyperparameter tuning is more accurate than predictions performed using selected features.


Subject(s)
COVID-19 , Birth Rate , Cluster Analysis , Humans , Reproduction , SARS-CoV-2
9.
Proc Natl Acad Sci U S A ; 118(36)2021 09 07.
Article in English | MEDLINE | ID: covidwho-1379373

ABSTRACT

Drawing on past pandemics, scholars have suggested that the COVID-19 pandemic will bring about fertility decline. Evidence from actual birth data has so far been scarce. This brief report uses data on vital statistics from a selection of high-income countries, including the United States. The pandemic has been accompanied by a significant drop in crude birth rates beyond that predicted by past trends in 7 out of the 22 countries considered, with particularly strong declines in southern Europe: Italy (-9.1%), Spain (-8.4%), and Portugal (-6.6%). Substantial heterogeneities are, however, observed.


Subject(s)
Birth Rate , Pandemics/statistics & numerical data , COVID-19/epidemiology , Europe/epidemiology , Female , Humans , Male , Pandemics/economics , Population Growth , Pregnancy , United States/epidemiology
10.
Am J Obstet Gynecol MFM ; 3(6): 100476, 2021 11.
Article in English | MEDLINE | ID: covidwho-1377645

ABSTRACT

OBJECTIVE: Recent analyses have suggested that the number of births in the United States may decrease substantially in the wake of the COVID-19 pandemic.1 Some of this decline may be attributable to economic disruptions that are often linked to lowered birth rates.1 However to the best of our knowledge, empirical data to validate these projections and to look more specifically at the consequences of "lockdowns," have not yet been published. The objective of our study was to compare the birth rates in New York City and Long Island hospitals during the 9 months after the lockdown, to the birth rates during the same time frames in previous years. STUDY DESIGN: This was a multicenter, retrospective study of live births from hospitals in the New York City Maternal-Fetal Medicine Research Consortium, an ongoing collaboration at several hospitals in New York City and Long Island. This consortium captures approximately one-third of the births in New York City (eg, of the 117,013 births recorded in 2017, 42,680 [36.6%] were from this consortium). To evaluate whether the lockdown in New York City (the first in the United States) between March 2020 and June 2020 resulted in a change in the number of births after the lockdown, we calculated the total live births 9 months after the lockdown (between December 2020 and February 2021) and compared the number with the total in the same 3 months during the previous 4 years. Fourteen hospitals with a total of greater than 55,000 annualized live births were included. Time series regression was performed to test the birth trends and to determine whether any change was a part of an ongoing trend. RESULTS: Figure 1 shows the total live births in the different time frames. There were 12,099 live births that occurred between December 2020 and February 2021. This is 2994 (19.8%) less live births than the previous year. In addition, the average number of live births in the 4 years before the study period was 15,101 births. This decrease was seen in all the hospitals included in the cohort. The hospitals located within New York City (N=10) had a larger drop in birth rate in the last 2 years (-1947, 18.9%) than in the hospitals located in Long Island (N=4) (-581, 13.4%). Figure 2 represents the total live births by individual hospitals in the different time frames. Among the entire cohort, the largest drop in birth rate in the previous years was only 4.9%. In addition, there was no significant trend in the number of births in the previous years (P=.586). Furthermore, no significant trend was identified in the hospitals located in New York City or Long Island (P=.831 and P=.178, respectively). Hospitals with large numbers of Medicaid-funded births showed the same trend as hospitals with smaller numbers of such births. CONCLUSION: Nine months after the lockdown was implemented, we observed a nearly 20% decrease in live births than the previous year. Although these data demonstrate a decline that is even greater than previously projected by analysts,1 there are several issues that should be considered. Firstly, the relationship between lockdowns and preterm birth is unclear, because we did not evaluate the birth outcomes, and thus, we cannot comment on preterm birth. However, most data do not suggest a major effect in the direction of more preterm births.2-4 We are unable to comment on the outmigration of pregnant women to other hospitals, the 3 accredited free-standing birth centers in New York City, or other geographic areas. However, the estimates on the outmigration data were less than the decrease we found. Using anonymized smartphone location data of approximately 140,000 New York City residents, a company specializing in geospatial analysis found that approximately 5% of New York City residents left New York City between March and May, with the majority moving to surrounding locations in the Northeast and to South Florida.5 The steeper decrease in live births in hospitals located in New York City than in those located in Long Island may be related to the population density and the recommended social distancing practices. The population density is higher in New York City than in Long Island (27,000 people per square mile vs 2360 people per square mile). Thus, the lockdown may have had a reduced effect on the number of live births in areas with a lower population density. In addition, most of the New York City residents outmigrated to surrounding locations including Long Island, which may have diminished the decrease in live births. Our data clearly demonstrate that there were significant changes in the number of births in the 9 months after the nation's first lockdown. Although we cannot definitively determine the contributions of migration, family choice, or other factors to those changes, these preliminary findings should provide direction to future studies. That work should consider zip codes, parities, and other factors that might exaggerate or mitigate the trends we report here.


Subject(s)
COVID-19 , Premature Birth , Birth Rate , Communicable Disease Control , Female , Humans , Infant, Low Birth Weight , Infant, Newborn , Infant, Premature , New York City/epidemiology , Pandemics , Population Surveillance , Pregnancy , Pregnancy Outcome , Pregnancy, Multiple , Premature Birth/epidemiology , Reproductive Techniques, Assisted , Retrospective Studies , SARS-CoV-2 , United States
11.
J Perinat Med ; 50(1): 42-45, 2022 Jan 27.
Article in English | MEDLINE | ID: covidwho-1357448

ABSTRACT

OBJECTIVES: Decreasing fertility implies considerable public health, societal, political, and international consequences. Induced abortion (IA) and the recent COVID-19 pandemic can be contributing factors to it but these have not been adequately studied so far. The purpose of this paper is to explore the relation of IA incidence and the COVID-19 pandemic to declining rates of delivery, as per our Sardinian experience. METHODS: We analyzed the registered data from the official Italian statistics surveys of deliveries and IA in the last 10 years from 2011 to 2020 in Sardinia. RESULTS: A total of 106,557 deliveries occurred and a progressive decrease in the birth rate has been observed. A total of 18,250 IA occurred and a progressive decline has been observed here as well. The ratio between IA and deliveries remained constant over the decade. Between 2011 and 2019 a variation of -4.32% was observed for IA while in the last year, during the COVID-19 pandemic the decrease of the procedures was equal to -12.30%. For the deliveries, a mean variation of the -4.8% was observed between the 2011 and the 2019 while in the last year, during the COVID-19 pandemic the decrease was about -9%. Considering the about 30% reduction of live births between 2011 and 2020, there is an almost proportional reduction in IA. CONCLUSIONS: Public policy responses to decreasing fertility, especially pronatalist ones, would be provided with evidence base about trends in delivery and IA and women's decision making.


Subject(s)
Abortion, Induced/statistics & numerical data , Birth Rate/trends , COVID-19 , Female , Humans , Italy , Pregnancy , Retrospective Studies
12.
BMJ Glob Health ; 6(8)2021 08.
Article in English | MEDLINE | ID: covidwho-1356933

ABSTRACT

OBJECTIVE: Preterm birth is the leading cause of child morbidity and mortality globally. We aimed to determine the impact of the COVID-19 mitigation measures implemented in China on 23 January 2020 on the incidence of preterm birth in our institution. DESIGN: Logistic regression analysis was used to investigate the association between the national COVID-19 mitigation measures implemented in China and the incidence of preterm birth. SETTING: Shanghai First Maternity and Infant Hospital, Shanghai China. PARTICIPANTS: All singleton deliveries abstracted from electronic medical record between 1 January 2014 to 31 December 2020. MAIN OUTCOME MEASURES: Preterm birth rate. RESULTS: Data on 164 107 singleton deliveries were available. COVID-19 mitigation measures were consistently associated with significant reductions in preterm birth in the 2-month, 3-month, 4-month, 5-month time windows after implementation (+2 months, OR 0.80, 95% CI 0.69 to 0.94; +3 months, OR 0.83, 95% CI 0.73 to 0.94; +4 months, OR 0.82, 95% CI 0.73 to 0.92; +5 months, OR 0.84, 95% CI 0.76 to 0.93). These reductions in preterm birth were obvious across various degrees of prematurity, but were statistically significant only in moderate-to-late preterm birth (32 complete weeks to 36 weeks and 6 days) subgroup. The preterm birth difference disappeared gradually after various restrictions were removed (7th-12th month of 2020, OR 1.02, 95% CI 0.94 to 1.11). There was no difference in stillbirth rate across the study time window. CONCLUSION: Substantial decreases in preterm birth rates were observed following implementation of the national COVID-19 mitigation measures in China. Further study is warranted to explore the underlying mechanisms associated with this observation.


Subject(s)
COVID-19 , Premature Birth , Birth Rate , Child , China/epidemiology , Female , Humans , Infant , Infant, Newborn , Pregnancy , Premature Birth/epidemiology , Premature Birth/prevention & control , SARS-CoV-2
13.
Public Health ; 198: 35-36, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1343344

ABSTRACT

OBJECTIVES: The COVID-19 pandemic has led to major changes in the lives of people worldwide, including changes in personal and social habits. Faced with this global health emergency, governments have imposed strict mitigation measures. Within this context, and considering data from previous epidemics, it has been proposed that birth rates may have been negatively impacted. This study aimed to assess the trends in birth rates in three main industrial cities in Northern Italy during the COVID-19 pandemic. STUDY DESIGN: This was a retrospective and observational study. METHODS: Data on birth rates were collected and compared for the cities of Milan, Genoa and Turin from November 2019 to January 2020 (i.e. before the COVID-19 pandemic) and during the same period of the following year (i.e. during the COVID-19 pandemic). RESULTS: Birth rates in the cities of Milan, Genoa and Turin decreased by 55%, 12% and 33%, respectively. CONCLUSIONS: The decrease in birth rates during the COVID-19 pandemic in these three industrialised cities is in line with the demographic effects of previous pandemics. The negative impact of COVID-19 on conception may be a result of various underlying factors. Further studies are required to verify how social and demographic factors may influence birth rates during pandemics.


Subject(s)
COVID-19 , Pandemics , Birth Rate , Cities , Humans , Italy/epidemiology , Retrospective Studies , SARS-CoV-2
14.
Reprod Biomed Online ; 43(4): 765-767, 2021 10.
Article in English | MEDLINE | ID: covidwho-1331174

ABSTRACT

RESEARCH QUESTION: What effects did the early phase of the COVID-19 pandemic have on natural and assisted reproductive technology (ART)-mediated birth rates? DESIGN: Regional registries were consulted with permission from the Health Authorities of Lombardy Region, Northern Italy, an area particularly affected by the early phase of the epidemic. Deliveries occurring in the area between 1 January 2019 and 31 December 2020 from women beneficiaries of the National Health System and resident in Lombardy were identified. Comparisons mainly focused on December 2020, when women who conceived after 8 March (the start of the stringent lockdown imposed by the authorities) were expected to deliver. RESULTS: When comparing the periods January to November in 2019 and 2020, a 5.1% reduction of monthly general birth rate (from 5732 in 2019 to 5438 in 2020) was observed. The contribution of ART births was similar in 2019 and 2020, being 4.4% and 4.5%, respectively. In December 2020, a notable drop in natural (-17.8%), ART-mediated (-86.6%) and overall (-21.0%) births was observed compared with December 2019. After adjusting for the expected 5.1% reduction, the inferred effect of the COVID-19 crisis corresponded to a 16.7% reduction in birth rate, of which 76% was related to natural (707 births) and 24% to ART (218 births) conceptions. CONCLUSIONS: This is the first study providing population-based evidence on the effects of COVID-19 and its related stringent restrictions on birth rates. The birth rate was dramatically reduced following the critical period, and the closure of ART centres played only a marginal role (24%) in the overall detrimental effect.


Subject(s)
COVID-19/epidemiology , Pregnancy, Multiple/statistics & numerical data , Reproductive Techniques, Assisted/statistics & numerical data , Birth Rate , Communicable Disease Control , Female , Humans , Italy/epidemiology , Pregnancy , Pregnancy Outcome , Registries
16.
Reprod Biomed Online ; 43(4): 663-669, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1275668

ABSTRACT

RESEARCH QUESTION: Does intrauterine administration of HCG before embryo transfer improve live birth rate during IVF cycles? DESIGN: A parallel, randomized controlled trial conducted between July 2018 and February 2020. Infertile women (n = 181) scheduled for fresh or vitrified-warmed embryo transfer after IVF carried out for any indication were randomized in a 1:1 ratio to receive either HCG (500 IU in 0.1 ml of tissue culture media) or culture media (0.1 ml of tissue culture media) via intrauterine injection 4 min before embryo transfer. In both groups, an intrauterine insemination catheter was used for administering the medication. Primary outcome was live birth, with ongoing pregnancy and clinical pregnancy as secondary outcomes. Analysis was based on intention-to-treat principle. RESULTS: Baseline and cycle characteristics were comparable between the two groups. In the control group, one woman with a confirmed clinical pregnancy was lost to follow-up. Live birth rates were 24% (22/90) in the HCG group versus 19% (17/90) in the control group (RR 1.29, 95% CI 0.74 to 2.27). Clinical pregnancy and ongoing pregnancy rates were 34% versus 26% (RR 1.31, 95% CI 0.84 to 2.04) and 24% versus 19% (RR 1.29, 95% CI 0.74 to 2.27) in the HCG and the control groups, respectively. CONCLUSION: Intrauterine injection of HCG before embryo transfer did not improve live birth rates in women undergoing IVF. As the study was designed to detect a 20% difference between groups, a smaller, clinically important difference could not be ruled out. Treatment outcomes were lower than expected in the control group.


Subject(s)
Chorionic Gonadotropin/administration & dosage , Embryo Transfer/statistics & numerical data , Reproductive Control Agents/administration & dosage , Adult , Birth Rate , Double-Blind Method , Female , Humans , Pregnancy
17.
JAMA Netw Open ; 4(6): e2111621, 2021 06 01.
Article in English | MEDLINE | ID: covidwho-1251879

ABSTRACT

Importance: The influence of the COVID-19 pandemic on fertility rates has been suggested in the lay press and anticipated based on documented decreases in fertility and pregnancy rates during previous major societal and economic shifts. Anticipatory planning for birth rates is important for health care systems and government agencies to accurately estimate size of economy and model working and/or aging populations. Objective: To use projection modeling based on electronic health care records in a large US university medical center to estimate changes in pregnancy and birth rates prior to and after the COVID-19 pandemic societal lockdowns. Design, Setting, and Participants: This cohort study included all pregnancy episodes within a single US academic health care system retrospectively from 2017 and modeled prospectively to 2021. Data were analyzed September 2021. Exposures: Pre- and post-COVID-19 pandemic societal shutdown measures. Main Outcomes and Measures: The primary outcome was number of new pregnancy episodes initiated within the health care system and use of those episodes to project birth volumes. Interrupted time series analysis was used to assess the degree to which COVID-19 societal changes may have factored into pregnancy episode volume. Potential reasons for the changes in volumes were compared with historical pregnancy volumes, including delays in starting prenatal care, interruptions in reproductive endocrinology and infertility services, and preterm birth rates. Results: This cohort study documented a steadily increasing number of pregnancy episodes over the study period, from 4100 pregnancies in 2017 to 4620 in 2020 (28 284 total pregnancies; median maternal [interquartile range] age, 30 [27-34] years; 18 728 [66.2%] White women, 3794 [13.4%] Black women; 2177 [7.7%] Asian women). A 14% reduction in pregnancy episode initiation was observed after the societal shutdown of the COVID-19 pandemic (risk ratio, 0.86; 95% CI, 0.79-0.92; P < .001). This decrease appeared to be due to a decrease in conceptions that followed the March 15 mandated COVID-19 pandemic societal shutdown. Prospective modeling of pregnancies currently suggests that a birth volume surge can be anticipated in summer 2021. Conclusions and Relevance: This cohort study using electronic medical record surveillance found an initial decline in births associated with the COVID-19 pandemic societal changes and an anticipated increase in birth volume. Future studies can further explore how pregnancy episode volume changes can be monitored and birth rates projected in real-time during major societal events.


Subject(s)
Birth Rate , COVID-19 , Pandemics , Physical Distancing , Social Isolation , Academic Medical Centers , Adult , Birth Rate/trends , COVID-19/prevention & control , Electronic Health Records , Female , Fertility , Forecasting , Humans , Interrupted Time Series Analysis , Pregnancy , Prospective Studies , Retrospective Studies , SARS-CoV-2 , United States , Universities
19.
Reprod Biomed Online ; 42(6): 1087-1096, 2021 06.
Article in English | MEDLINE | ID: covidwho-1208380

ABSTRACT

RESEARCH QUESTION: The economic and reproductive medicine response to the coronavirus disease 2019 (COVID-19) pandemic in the USA has reduced the affordability and accessibility of fertility care. What is the impact of the 2008 financial recession and the COVID-19 recession on fertility treatments and cumulative live births? DESIGN: The study examined annual US natality, Centers for Disease Control and Prevention IVF cycle activity and live birth data from 1999 to 2018 encompassing 3,286,349 treatment cycles, to estimate the age-stratified reduction in IVF cycles undertaken after the 2008 financial recession, with forward quantitative modelling of IVF cycle activity and cumulative live births for 2020 to 2023. RESULTS: The financial recession of 2008 caused a 4-year plateau in fertility treatments with a predicted 53,026 (95% confidence interval [CI] 49,581 to 56,471) fewer IVF cycles and 16,872 (95% CI 16,713 to 17,031) fewer live births. A similar scale of economic recession would cause 67,386 (95% CI 61,686 to 73,086) fewer IVF cycles between 2020 and 2023, with women younger than 35 years overall undertaking 22,504 (95% CI 14,320 to 30,690) fewer cycles, compared with 4445 (95% CI 3144 to 5749) fewer cycles in women over the age of 40 years. This equates to overall 25,143 (95% CI 22,408 to 27,877) fewer predicted live births from IVF, of which only 490 (95% CI 381 to 601) are anticipated to occur in women over the age of 40 years. CONCLUSIONS: The COVID-19 recession could have a profound impact on US IVF live birth rates in young women, further aggravating pre-existing declines in total fertility rates.


Subject(s)
COVID-19/economics , Fertility/physiology , Live Birth , Reproductive Techniques, Assisted/economics , Adult , Birth Rate , Female , Humans , Pandemics , Pregnancy
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