Elsevier

Fertility and Sterility

Volume 99, Issue 5, April 2013, Pages 1324-1331.e1
Fertility and Sterility

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

Presented at the 25th Annual Meeting of the Society for Pediatric and Perinatal Epidemiologic Research, Minneapolis, MN, June 25-27, 2012; and the National Institutes of Health Research Festival, Bethesda, MD, October 9-12, 2012.
https://doi.org/10.1016/j.fertnstert.2012.11.037Get rights and content

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.

Patient(s)

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

Intervention(s)

None.

Main Outcome Measure(s)

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.

Result(s)

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.

Conclusion(s)

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.

Section snippets

Design and Study Population

The study population comprises 7,643 females aged 15–44 years who participated in the 2002 cycle of the NSFG (29). The target population for the study population was all reproductive-aged women in the United States; thus, respondents were selected on the basis of a multistage area probability sample from 120 areas across the country. Teenagers and black and Hispanic adults were oversampled in this survey. The overall response rate for females aged 15–44 years was 80%. Details of the survey and

Results

Women considered for the current duration group (group 1) were compared with those not included (groups 2 and 3) and found to be statistically significantly different with respect to age, relationship status, education, income, health insurance, parity, gynecologic disorders, and history of medical treatment for pregnancy (Supplemental Table 1, available online). There was a borderline significantly higher proportion of non-tryers (19.3%) vs. tryers (10.2%) who identified as non-Hispanic black (

Discussion

Using the novel current duration approach, we estimated the prevalence of infertility to be approximately two times greater than the estimate derived from the traditionally applied constructed measure (15.5% vs. 7.0%, respectively), which remained consistent across sensitivity analyses. In addition, the confidence intervals for these estimates do not overlap, suggesting significant differences in prevalence estimates according to choice of approach. The higher US prevalence estimate using the

Acknowledgments

The authors thank Drs. Niels Keiding, Oluf Hansen, and Ditte Sorensen for their feedback on the current duration method and programs for implementing this approach.

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    M.E.T. has nothing to disclose. A.C.M. has nothing to disclose. J.F.L. has nothing to disclose. R.B.K. has nothing to disclose. A.C.T. has nothing to disclose. R.S. has nothing to disclose. G.M.B.L. has nothing to disclose.

    The 2002 National Survey of Family Growth was conducted by the Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics with the support and assistance of a number of other organizations and individuals, and with the participation and funding support of the following programs of the US Department of Health and Human Services: Eunice Kennedy Shriver National Institute for Child Health and Human Development (NICHD), National Institutes of Health (NIH); Office of Population Affairs; CDC’s National Center for Health Statistics; CDC’s Division of HIV/AIDS Prevention; CDC’s Division of Sexually Transmitted Disease Prevention; CDC’s Division of Reproductive Health; Office of the Assistant Secretary for Planning and Evaluation; and Children’s Bureau of the Administration for Children and Families. Analyses and preparation of the manuscript was funded by the Intramural Research Program, NICHD, NIH.

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