Practical Difficulties in Estimating The Prevalence of Primary Infertility in Iran.

BACKGROUND: According to the World Health Organization (WHO)'s clinical, epidemiological and demographic definitions, infertility is an inability to become pregnant within one, two or five years of exposure to pregnancy, respectively. Inconsistent infertility-related definitions and various methodological approaches make it difficult to compare quantitative data in this regard and consequently, have negatively influenced estimating the prevalence of infertility. The present study reviewed the results of a large population-based survey on how the clinical, epidemiological and demographic definitions of infertility produce different results in terms of infertility prevalence in Iran and subsequently, compared the findings in order to find the right time of treatment-seeking by couples. MATERIALS AND METHODS: This community-based, cross-sectional study was carried out by Avicenna Research Institute in the urban and rural parts of Iran between 2010 and 2011. Using cluster sampling, the reproductive history of 17,187 married women aged 20-40 years, was recorded. Totally, 1011 clusters were randomly selected according to post office codes, proportional to the population of the province. Descriptive and inferential statistical analysis of the data was carried out by SPSS statistical software. RESULTS: The prevalence of primary infertility based on the WHO's clinical, epidemiological and demographic definitions were 20.2, 12.8 and 9.2%, respectively. In addition, secondary infertility rate was 4.9%. CONCLUSION: Infertility estimates over a two-year exposure period made a 50% decrease in infertility rate; however, increasing exposure period to five years made no significant difference in infertility rate. The findings showed that most of the couples will get pregnant within two years of unprotected sexual intercourse and thus, need no treatment. Due to practical difficulties in estimating the prevalence of primary infertility, the reference limit for time to pregnancy, should be reconsidered and giving more time to younger women to become pregnant, seems reasonable.

Attitudes about Sex Selection and Sex Preference in Iranian Couples Referred for Sex Selection Technology.

BACKGROUND: Gender preference is prevalent in some communities and using medical techniques to choose the baby's sex may cause the gender discrimination and gender imbalance in communities. Therefore, evaluating the gender preferences and attitudes towards using sex selection technologies seems to be necessary. METHODS: This cross-sectional study was conducted in Avicenna Fertility Center. Participants were 100 women with one child who were referred for sex selection. Data were collected through self-developed questionnaires. The questions were designed by the researchers at the experts' panel. To determine the validity of the questionnaire, the viewpoints of professors specialized in these issues were obtained. The statistical analysis of the data was performed using SPSS software (Version 11.5), and p < 0.05 was considered significant. RESULTS: Tendency toward the male was more than female sex (55.5% male, 15.5% female and 28.5% no tendency). Majority of participants agreed with sex selection with medical reason and sex selection in order to balance the family. Women's level of education had positive effect on agreements to fetal sex selection with medical and non-medical reasons (p < 0.001). CONCLUSION: Although gender preferences were toward the male sex but this preference was not very strong. Most participants agreed with non-medical sex selection for balancing the sex composition of their children. It doesn't seem that non-medical sex selection for family balancing causes severe sex imbalance in Iran.

Fertility behaviour of Iranian women: a community-based, cross-sectional study.

BACKGROUND: The fertility behavior of Iranian women and their reproductive needs is changing and consequently, for providing good services, it is critical to monitor their reproductive behavior at a national level.  METHODS: This study was carried out by Avicenna Research Institute in the urban and rural parts of Iran between 2010 and 2011. Using cluster sampling, the reproductive history of 17,187 married women aged 20 - 40 years were recorded. The statistical analysis of the data was performed using SPSS software (Version 11.5), and P < 0.05 was considered significant.  RESULTS: The common methods of contraception at the time of interview were natural methods (29.8%). The first pregnancy was unwanted in 20.6% of the women. The average number of childbirth per 35 - 40 years woman was 2.4. The mean age of women at marriage date and the mean age at the first childbirth both have increased with time (p< 0.001).  CONCLUSION: Although the fertility rate has declined in Iran, the most important reproductive issues like unwanted pregnancy and use of non-reliable methods of contraception are not resolved yet. Increased mean age at first Childbirth and elevated numbers of couples with no childbirth, because of voluntarily childlessness or Infertility should be noticed more by policy makers. Then allocating enough resources for reproductive health services is vital in new family planning policies.

Prevalence of Primary Infertility in Iran in 2010.

BACKGROUND: Infertility is one of the most significant medical, as well as social problems that affect psychological health of families and societies. Determining the prevalence of infertility is important for evaluating the potential of fertility. There are different reports on the prevalence of infertility in Iran, but the current research employs fertility history in order to provide an unbiased estimation of primary infertility. METHODS: Data from a national survey of Iranian women aged 20-40 years was used in this study in year 2011. Totally, 1011 clusters were randomly selected according to post office codes, proportional to the population of the province. We evaluated the history of fertility as the basis for gathering information. Accordingly, we designed a questionnaire. Subsequently, we recruited and trained nurses and obstetricians to call on married women to fill the questionnaires. Primary infertility refers to a condition in which couples have not been able to conceive a child after one year of un-protected intercourse. RESULTS: In this research, we questioned 17187 women in 1011 clusters. The mean age of the women at the time of their marriage was 20.1, and that of their husbands was 25.4 years. The mean age of women at the time of their first pregnancy was 21.1. This research revealed the prevalence of primary infertility to be 20.2% in Iran. CONCLUSION: The prevalence of primary infertility in Iran seems to be higher than the world average. Therefore, it is crucially important to support the large number of couples who face this problem.