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Human Reproduction Update Advance Access originally published online on August 25, 2005
Human Reproduction Update 2005 11(6):607-611; doi:10.1093/humupd/dmi032
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© The Author 2005. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oupjournals.org

Using infertile patients in epidemiologic studies on subfecundity and embryonal loss

J. Olsen1,2,5, J.P. Bonde3, N.H. Hjøllund3, O. Basso1 and E. Ernst4

1 The Danish Epidemiology Science Centre, University of Aarhus, Aarhus C, Denmark, 2 Department of Epidemiology, UCLA School of Public Health, Los Angeles, CA, USA, 3 Department of Occupational Medicine and 4 Department of Gynaecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark

5 To whom correspondence should be addressed at: The Danish Epidemiology Science Centre, University of Aarhus, Vennelyst Boulevard 6, Building 260, DK-8000, Aarhus C, Denmark. E-mail: jo{at}soci.au.dk

Submitted on October 21, 2004; revised on June 29, 2005; accepted on July 19, 2005.

Subfecundity is a frequent and serious problem that may sometimes be preventable, but we need to know more about its determinants. Different epidemiologic designs are available. The best of these use prospectively collected data from the population, but they are time consuming, expensive and often hampered by low-participation rates. Most patients undergoing infertility treatment are closely monitored for clinical reasons, making it feasible to use secondary data to study the period from conception to implantation and pregnancy. In spite that infertility patients are highly selected, there are specific exposure-effect relations that can be studied in cohorts of infertility patients. These patients offer a potentially useful setting for studying exposures that operate late in fertilization, whereas the designs may be inadequate to identify exposures that cause reduced sperm counts, anovulation and total occlusion. The clinical sampling and the treatment set limitations for what can be studied. In certain situations, infertile patients can, however, provide useful epidemiologic evidence for learning about the causes of subfecundity.

Key words: epidemiology / ICSI outcome / infertility / IVF


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