Attitudes to infertility work-up and treatment during the COVID-19 pandemic: survey of couples from Vietnam

A number of factors other than those specifically related to the COVID-19 pandemic were significantly associated with continuation of infertility treatment during the pandemic. Individualization of infertility treatment incorporating patient preferences is essential.

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Authors:

Lan N Vuong, MD, PhD,a Vu NA Ho,b Toan D Pham,b Tuan H Phung,c Vinh Q Dang,b Tuong M Hoc

aUniversity of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
bIVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam
cIVFMD, My Duc – Phu Nhuan Hospital, Ho Chi Minh City, Vietnam

Abstract:

Objective: This study evaluated the perspective of infertile couples on infertility treatment during and after the COVID-19 pandemic.

Design: Online survey using a 40-item questionnaire, which included questions about patient demographics and infertility treatments, knowledge about COVID-19, and the effects of the pandemic on infertility treatment plans.

Setting: Two private IVF clinics in Vietnam

Patients: 1420 couples with a valid e-mail address who were scheduled to return for a check-up or treatment at either of the two infertility clinics in April 2020 were e-mailed a link to the questionnaire.

Main Outcome Measure(s): Questionnaire responses.

Results: Responses from 891 couples were included in the main analysis; 60% (n=532) were having infertility treatment during the COVID-19 pandemic. Those continuing versus suspending infertility treatment were significantly more likely to rate infertility treatment as a current priority, significantly less likely to be practising social distancing, and did not have any concerns about the impact of COVID-19 on their pregnancy or newborn. However, two-thirds were concerned about being exposed to a COVID-19-positive individual. Factors significantly associated with continuation of infertility treatment during the pandemic on multivariable analysis included occupation, income, longer time spent trying to conceive, having more time to rest at home after treatment, and less waiting time at the hospital.

Conclusion(s): These findings provide relevant insights for policy makers and IVF centres when developing, modifying and implementing infertility treatment strategies during and after the COVID-19 pandemic.

 

Introduction:

As at May 4, 2020, there were more than 3.5 million cases of COVID-19 infection worldwide with nearly 250,000 deaths (1). This has resulted in strict “lockdown” and social distancing rules being enforced in many countries to try and slow the spread of the virus. In addition, a large proportion of “elective” or “non-essential” procedures have been postponed or cancelled to allow healthcare systems to cope with the influx of infectious disease cases.

Infertility is not a life-threatening condition, so treatments might therefore be considered “non-essential” in the unprecedented global times. Infertility treatment does not meet the “essential” criteria of being needed to prevent worsening of a life-threatening condition or prognosis (2). In fact, for a small proportion of patients, infertility procedures such as ovarian hyperstimulation may be associated with adverse events that require urgent medical attention, potentially putting additional strain on resources already stretched dealing with the pandemic. In addition, each cycle of in vitro fertilisation (IVF) requires multiple healthcare visits and involves the use of personal protective equipment and medical supplies that might be required in the treatment of COVID-19 patients (2). However, the goal of infertile couples to achieve pregnancy and have a child does not necessarily disappear just because there is a current viral pandemic. Alternatively, priorities may change under the new circumstances, including the possibility of financial challenges due to the global situation that might impact on planned or future IVF treatment.

In mid-March, the American Society of Reproductive Medicine (ASRM) provided guidance around infertility treatment during the developing pandemic (3). Other major societies subsequently made similar recommendations, with the overall message being that providers suspend initiation of new reproductive treatment cycles, including ovulation induction, intrauterine insemination, IVF/embryo transfer (fresh and frozen), and non-urgent gamete cryopreservation (4-6).

As the COVID-19 pandemic begins to stabilise in some regions, the focus is now shifting to address issues relating to restarting the provision of assisted reproductive technology treatments (7-9). This recognises the time-sensitivity of infertility treatment in some cases, and the fact that COVID-19 will likely be a factor for some time until a reliable and effective vaccine becomes available. The current recommendations are based on expert opinion and do not necessarily take the views of other stakeholders into account. In addition, there may not be a “one size fits all” approach to the issue of infertility treatment during the COVID-19 pandemic, and there is a lack of information about how couples with infertility feel about treatment in the setting of a global pandemic.

Vietnam is a country of 96 million people. As of 4 May 2020, the total number of COVID-19 cases was only 271 and no deaths had been recorded (1), making this a country with relatively low impact from COVID-19. As at 31 March 2020, government recommendations to manage COVID-19 in Vietnam included social distancing by staying at home, but the country did not have a full “lockdown”. Infertility clinics remained open, although there was no specific policy regarding infertility treatment, which is largely self-funded. This survey was conducted to determine the perspective of infertile couples in Vietnam on infertility treatment during and after the COVID-19 pandemic to facilitate planning for current and future services. 

Materials and Methods:

Study design and participants

This cross-sectional survey was conducted at My Duc Hospital and My Duc-Phu Nhuan Hospitals in Ho Chi Minh City, Vietnam. In 2019, between them these hospitals conducted check-ups on 25,000 infertile couples, 9,600 ovum pick-up procedures and 11,500 frozen transfer IVF cycles. Eligible participants were couples identified from the institutional databases from the two hospitals who had a current, valid e-mail address and were scheduled to return to either of the IVF clinics for a check-up or treatment in April 2020. All contact and e-mail was conducted in the Vietnamese language. The study was approved by the hospital ethics committee (07/20/DD-BVMD; 6 April 2020). Completion of the survey was optional and patients were advised that all responses would be kept confidential.

Survey

A 40-item survey was constructed to obtain information on patient demographics and infertility treatments, and to assess knowledge about COVID-19 and determine the effects of the COVID-19 pandemic on participants’ infertility treatment plan (see online supplement for an English language translation of the final version). An e-mail linking to the first version of the questionnaire was sent to 60 couples on 10 April 2020; 30 responses were received within 2 days. These were used to determine whether any questions were unclear or prone to misunderstanding. As a result, questions relating to marital status, location and number of children were modified, one question was removed because it was very similar to another question, and the order of questions was revised. An e-mail invitation to complete the revised questionnaire was sent out to a wider patient sample on 13 April 2020; couples were asked to complete the online survey by 24 April 2020.

 

Data analysis

The final analysis included all responses to the revised survey. Data are presented using descriptive statistics: mean and standard deviation for normally distributed variables, median and interquartile range for skewed variables and number (%) for categorical variables. Univariate and multivariate logistic regression analyses were performed to identify variables associated with having or not having infertility treatment during the COVID-19 pandemic. All variables with a p-value of <0.25 in the univariate analysis were included in the multivariate analysis. All analyses were performed using the R statistical package (R version 3.3.3). Statistical significance was defined as p<0.05.

Results

Participants

Overall, 1420 e-mails were sent, including the first 60 with the preliminary questionnaire, and a total of 921 completed questionnaires were returned (65% response rate). The final analysis included 891 responses (882 married couples, 9 unmarried couples) (Table 1). Age was between 25 and 40 years for most couples, nearly 80% lived in South Vietnam (including Ho Chi Minh City), and more than half lived in an area defined by the Vietnamese government as being at high COVID-19 infection risk (Table 1). The majority of respondents (89%) had been trying to conceive for between 1 and 3 years, and the most common causes of infertility were unexplained (37%) and male factors (27%) (Table 2). Based on survey responses, 61% of couples had an accurate understanding of COVID-19; understanding was not very accurate in 37% and inaccurate in 2% (accurate was defined as correctly identifying 5/5 statements about COVID-19 correct, not very accurate was a score of 4/5, and inaccurate was a score of  ≤3/5; see Question 19 of the survey in the online supplement). Almost all respondents (90%) knew how to prevent the spread of COVID-19 (score of 4/4 on Question 20 of the survey; see online supplement for full details).

Table 1. Demographic characteristics of survey respondents

Characteristics

Returned questionnaires (n=891)

Female partner (n=891)

Male partner (n=891)

Age range, n (%)

 

 

<25 years

30 (3.4)

6 (0.7)

25 to <30 years

265 (29.7)

147 (16.5)

30 to <35 years

332 (37.3)

315 (35.4)

35 to <40 years

173 (19.4)

225 (25.3)

40 to <45 years

69 (7.7)

114 (12.8)

≥45 years

22 (2.5)

84 (9.4)

Place of residence since Jan 2020, n (%)

 

 

North Vietnam

22 (2.5)

23 (2.6)

Central Vietnam

156 (17.5)

153 (17.5)

South Vietnam (excl. Ho Chi Minh City)

261 (29.4)

252 (28.8)

Ho Chi Minh City

450 (50.6)

448 (51.1)

Outside Vietnam

2 (0.2)

15 (1.7)

Residence by infection risk area*, n (%)

 

 

High (Ho Chi Minh City)

450 (50.5)

448 (50.3)

High (outside Ho Chi Minh City)

59 (6.6)

59 (6.6)

Medium

92 (10.3)

85 (9.7)

Low

288 (32.4)

284 (32.4)

Occupation, n (%)

 

 

Healthcare provider

31 (3.5)

12 (1.3)

Office worker

347 (38.9)

387 (43.4)

Teacher

83 (9.3)

17 (1.9)

Government worker

69 (7.7)

95 (10.7)

Factory worker

86 (9.7)

98 (11.0)

Farmer

20 (2.2)

27 (3.0)

Police/military

3 (0.3)

40 (4.5)

Business/shop owner

148 (16.6)

192 (21.5)

Service provider

22 (2.5)

23 (2.6)

Housewife

82 (9.2)

-

Working arrangement since Jan 2020, n (%)

 

 

Fulltime in an office

341 (38.3)

491 (55.1)

Part-time in an office

42 (4.7)

53 (5.9)

Remotely from home

219 (24.6)

176 (19.8)

Unemployed

224 (25.1)

151 (16.9)

Other

65 (7.3)

20 (2.2)

Income before COVID-19**, n (%)

 

 

<5 M VND/month

169 (19.0)

124 (13.9)

5–15 M VND/month

489 (54.9)

488 (54.8)

>15–30 M VND/month

153 (17.2)

176 (19.8)

>30–50 M VND/month

28 (3.1)

50 (5.6)

>50–100 M VND/month

25 (2.8)

32 (3.6)

Other

27 (3.0)

21 (2.4)

Change in income during COVID-19, n (%)

 

 

Decreased

395 (44.3)

416 (46.7)

Increased

4 (0.4)

2 (0.2)

No change

315 (35.4)

354 (39.7)

No income

177 (19.9)

119 (13.4)

*As defined by the Vietnamese government. **5 million (M) Vietnamese dong (VND) is equivalent to approximately $US 215.

Table 2. Infertility characteristics of survey respondents

 

Couples (n-891)

Number of children, n (%)

 

None

695 (78.0)

1

166 (18.6)

≥2

30 (3.4)

Time spent trying to conceive, n (%)

 

12 months

308 (34.6)

>12 to 24 months

201 (22.6)

>24 to 48 months

180 (20.2)

>48 to 72 months

102 (11.4)

>72 to 84 months

29 (3.3)

>84 to 96 months

21 (2.4)

> 96 months

50 (5.6)

Causes of infertility, n (%)

 

Male factors

243 (27.3)

Advanced maternal age

61 (6.8)

Diminished ovarian reserve

70 (7.9)

Tubal disease

80 (9.0)

Endometriosis

21 (2.4)

Unexplained

329 (36.9)

Ovulation disorder

19 (2.1)

Polycystic ovary syndrome

68 (7.6)

Previous infertility treatment, n (%)

 

Intrauterine insemination

108 (31.9)

In vitro fertilisation

231 (68.2)

 

Effect of the pandemic on infertility treatment

Sixty percent of couples (n=532) were having infertility treatment during the COVID-19 pandemic. A number of questionnaire responses differed significantly between those who were versus were not receiving infertility treatment, including those relating to travel and clinic wait times, the impact of COVID-19 infection on pregnancy and neonatal outcomes, and time available in general (Figure 1). Those continuing infertility treatment were significantly more likely to rate infertility treatment as a current priority, significantly less likely to be practising social distancing, and did not have any concerns about the impact of COVID-19 on their pregnancy or newborn (Figure 1). Another important between-group difference was in the proportion of patients who been recommended to postpone infertility treatment until the COVID-19 pandemic was over, with nearly all those continuing treatment receiving no such recommendation (Figure 1).

Figure 1. Reasons for stopping or continuing infertility treatment based on survey responses.
*p<0.001 and **p<0.05 vs those who stopped infertility treatment. 

For couples currently having infertility treatment, IVF was the most common assisted reproductive technology procedure (43% of patients) followed by frozen embryo transfer (29%); intrauterine insemination (9%), ovarian induction (6%), in vitro maturation (2%) and oocyte freezing for fertility preservation (1%) were less common. Reasons for making the decision to continue infertility treatment are shown in Figure 2. The possibility of being exposed to a COVID-19-positive individual was by far the biggest concern for couples continuing infertility treatment (66%), and having more rest at home was seen as the main benefit for having infertility treatment at this time (59%). Couples also cited more convenient transportation (40%), less waiting time at the hospital (35%), more time for consultation with doctors (33%), and the potential for a higher success rate as benefits to continuing their infertility treatment during the COVID-19 pandemic. The majority of couples responded that they would prefer to receive test reports, embryological outcomes and pregnancy test results in a consultation with a doctor at the hospital or clinic (84%).

Figure 2. Reasons for continuing infertility treatment in 532 couples

The main reasons cited by couples for postponing infertility treatment are shown in Figure 3. In terms of future plans for infertility treatment, re-starting when the pandemic is over (52%) or when social distancing requirements have been lifted (11%) were the most common responses, with an additional 19% stating that they don’t have any plans for infertility treatment yet. The most common response to the question about concerns regarding infertility treatment in those not currently being treated was “none” (40%); financial concerns after the COVID-19 pandemic were cited as concerning by 18% of couples. Over the pandemic period, of couples not seeking infertility treatment, 45% were not actively trying to improve their chances of conception, 36% were timing sexual intercourse, 18% were using dietary supplements, 17% were changing their diet, 16% were exercising, 6% were taking herbal supplements, and 4% were trying to lose weight.

Figure 3. Reasons for postponing infertility treatment in 359 couples

Overall, 52% of respondents said that they would have infertility treatment as soon as possible after the pandemic was over, 47% said they would improve their overall health, 36% wanted to get back to a normal routine and 19% responded that they would try to improve their financial situation. The effectiveness of infertility treatment was the most common concern for post-pandemic fertility treatment (83%), followed by safety (49%); financial considerations were only important for 27% of respondents. 

Factors associated with infertility treatment during the pandemic

Factors included in the multivariate model (p<0.25 in the univariate analysis) were: age, residence area, occupation and working arrangement of the female partner; income before and during the COVID-19 pandemic; time already spent trying to conceive; cause of  infertility; perceptions about how COVID-19 is spread; concern about the impact of COVID-19 on pregnancy and delivery; transportation issues; social distancing practices; recommendation to postpone treatment; hospital wait times; time at home to rest; and the priority given to infertility treatment at the current time. Infertility treatment during the COVID-19 pandemic was significantly less likely in couples where the woman lived in Central or South Vietnam, in couples with unexplained infertility, in those whose understanding about how to prevent spread of COVID-19 was not very accurate, when social distancing was being practiced, for couples who had concerns about a potential negative impact of the COVID-19 virus on pregnancy and delivery, and when couples had received a recommendation to postpone infertility treatment until after the pandemic (Table 3). Conversely, the following factors were significantly associated with continuation of infertility treatment during the COVID-19 pandemic: female partner being a factory worker or farmer or working remotely from home; income of >15 to 30 M VND/month (vs 5–15 M VND); time spent trying to conceive of >12 to 84 months (vs 12 months); having more time to rest at home after treatment; and less waiting time at the hospital (Table 3).

Table 3. Factors associated with infertility treatment during the COVID-19 pandemic (multivariate analysis)

Characteristics

Odds ratio

(95% confidence interval)

p-value

Age of female partner

 

 

<25 years

0.74 (0.12–4.74)

0.751

25 to <30 years

1.25 (0.64–2.45)

0.509

30 to <35 years

Reference

 

35 to <40 years

1.50 (0.65–3.52)

0.346

40 to <45 years

3.99 (0.89–20.70)

0.083

≥45 years

1.32 (0.15–13.84)

0.804

Residence of female partner since Jan 2020

 

 

North Vietnam

0.29 (0.05–2.17)

0.18

Central Vietnam

0.15 (0.06–0.37)

<0.001

South Vietnam (excluding Ho Chi Minh City)

0.38 (0.19–0.77)

0.007

Ho Chi Minh City

Reference

 

Occupation of female partner

 

 

Healthcare provider

4.68 (0.92–27.73)

0.075

Office worker

Reference

 

Teacher

1.35 (0.50–3.83)

0.559

Government worker

1.02 (0.38–2.77)

0.972

Manufacturing/factory worker

3.93 (1.36–12.51)

0.015

Farmer

9.79 (1.18–115.20)

0.049

Police/military

0.47 (0.01–57.35)

0.763

Business/Shop owner

0.80 (0.34–1.91)

0.612

Service provider

0.57 (0.10–3.26)

0.534

Housewife

1.90 (0.38–10.97)

0.45

Working arrangement of female partner since Jan 2020

 

 

Working fulltime in the office

Reference

 

Working part-time in the office

0.74 (0.22–2.70)

0.641

Working remotely from home

3.83 (1.71–8.93)

0.001

Unemployed

1.93 (0.77–5.02)

0.168

Others

20.58 (2.78–240.09)

0.007

Income of female partner before COVID-19*

 

 

<5 M VND/month

0.68 (0.26–1.75)

0.417

5–15 M VND/month

Reference

 

>15–30 M VND/month

3.05 (1.19–8.20)

0.023

>30–50 M VND/month

-

0.283

>50–100 M VND/month

-

0.989

Others

0.05 (0.00–0.58)

0.025

Income of male partner before COVID-19*

 

 

<5,000,000 (5M) VND/month

3.59 (1.16–11.68)

0.029

5–15 M VND/month

Reference

 

>15–30 M VND/month

0.51 (0.21–1.20)

0.124

>30–50 M VND/month

1.22 (0.17–10.51)

0.854

>50–100 M VND/month

8.07 (0.16–1094.41)

0.408

Others

0.06 (0.00–0.74)

0.058

Income of female partner during COVID-19

 

 

Decreased

0.46 (0.20–1.06)

0.07

Increased

0.66 (0.00–1444.33)

0.92

No change

Reference

 

No income

0.92 (0.26–3.25)

0.897

Income of male partner during COVID-19

 

 

Decreased

1.99 (0.93–4.32)

0.077

Increased

-

0.997

No change

Reference

 

No income

2.42 (0.77–7.76)

0.133

Time spent trying to conceive

 

 

12 months

Reference

 

>12 to 24 months

3.85 (1.85–8.26)

<0.001

>24 to 48 months

4.95 (2.22–11.62)

<0.001

>48 to 72 months

4.56 (1.65–13.57)

0.005

>72 to 84 months

12.07 (2.22–86.08)

0.007

>84 to 96 months

150.00 (3.55–17035.13)

0.065

>96 months

5.12 (1.08–30.76)

0.053

Cause of infertility

 

 

Male factors

Reference

 

Advanced maternal age

0.40 (0.09–1.79)

0.222

Diminished ovarian reserve

1.47 (0.46–4.96)

0.524

Tubal disease

0.85 (0.30–2.56)

0.768

Endometriosis

2.64 (0.47–21.74)

0.302

Unexplained

0.44 (0.21–0.90)

0.027

Ovulation disorder

0.34 (0.07–1.52)

0.161

Polycystic ovary syndrome

1.61 (0.49–5.60)

0.439

Understanding of how to prevent spread of COVID-19

 

 

Accurate

Reference

 

Not very accurate

0.22 (0.08–0.59)

0.003

Inaccurate

-

0.994

Practicing “social distancing”

 

 

No

Reference

 

Yes

0.29 (0.14–0.59)

0.001

Concerned that the COVID-19 virus could affect the pregnancy (and delivery if treatment is successful)

 

 

No

Reference

 

Yes

0.01 (0.00–0.03)

<0.001

Recommendation to postpone treatment until after the COVID-19 pandemic

 

 

No

Reference

 

Yes

0.01 (0.00–0.03)

<0.001

Less waiting time at the hospital

 

 

No

Reference

 

Yes

18.33 (3.26–353.76)

0.008

Having more time to rest at home after treatment

 

 

No

Reference

 

Yes

26.51 (8.53–121.28)

<0.001

Infertility is our priority at this time

 

 

No

Reference

 

Yes

1.77 (0.99–3.20)

0.055

*5 million (M) Vietnamese dong (VND) is equivalent to approximately $US 215.

 

Discussion

The results of this survey provide the first detailed information on patient attitudes to a variety of aspects of infertility treatment during the COVID-19 pandemic. In a country where infertility treatment was permitted to continue, 60% of the infertility clinic patients surveyed were continuing with their treatment. A number of factors associated with continuing infertility treatment were identified, including the time already spent trying to conceive, occupation and working circumstances, pre-pandemic income, and more time at home. Patients concerned about potential negative effects of the COVID-19 on pregnancy and delivery, and about breaching social distancing requirements were less likely to continue infertility treatments, as were those whose knowledge of how COVID-19 spreads was not very accurate. Concern about exposure to COVID-19 was also a concern for two-thirds of couples who continued infertility treatment. These findings highlight the fact that a wide variety of factors are important in decisions about, and preferences for, infertility treatment during the COVID-19 pandemic. There are currently few data on the impact of COVID-19 during pregnancy, but the information available suggests that there is no vertical transmission or any negative effects of infection with the COVID-19 virus on neonatal outcomes (10-14). Therefore, available data suggest that there are no absolute contraindications for achieving pregnancy during the current pandemic.

One other study used an online survey to evaluate the effects of recommendations to suspend fertility treatment from a patient perspective in the United States (15). The response rate in that survey was 17%, substantially lower than the 65% response rate from infertility clinic patients in our study. In the US survey, half of all patients had had a cycle cancelled due to the pandemic (higher than the 40% of couples not having infertility treatment in our survey), and cycle cancellation was moderately or extremely upsetting for 85% of respondents. Just over one-third of patients agreed with the ASRM decision to recommend cancellation of all fertility treatment cycles, but the majority (82%) would have preferred to consult with their doctor and have the option of starting a new treatment cycle. In our study, significantly more patients who were not having infertility treatment during the COVID-19 pandemic had been given a recommendation to postpone treatment at this time (although that still only accounted for just over half of those postponing infertility treatment). Compared to the other survey, ours included a wider variety of parameters and covered more aspects of infertility treatment, providing a more comprehensive picture of factors influencing the uptake of infertility treatment during the COVID-19 pandemic as well as patient concerns. It is important to note that the impact of the COVID-19 pandemic is markedly different in the US compared with Vietnam. Taken together, the findings of the two surveys support an individualised approach to managing infertility treatment during COVID-19, as much as possible within local and national healthcare guidelines during the pandemic. An individualised approach is consistent with how infertility services should be provided under normal circumstances – it is important to take patient needs and preferences into account to optimise infertility treatment and provide a personalised solution for each couple.

An important priority across a variety of sectors, including health, retail and tourism, is to safety return to pre-pandemic levels of activity as quickly and safely as possible. To enable IVF centres to achieve this it is important to understand what patients think and feel about their treatment. It is possible that patient requirements and behaviours my change as a result of the COVID-19 pandemic. For example, some couples may have experienced significant loss of income during the pandemic and may therefore need to postpone or cancel their treatment due to financial issues. Interestingly though, only a small proportion of patients in our survey cited financial concerns regarding post-pandemic infertility treatment. This may reflect the comparatively low COVID-19 case numbers, lack of any COVID-19-related deaths, and absence of strict lockdown requirements in Vietnam.

The findings of this survey may be useful to other clinics around the world because patients might change their attitude and behaviour towards infertility treatment during or after a long period of enforced social distancing or lockdown. However, our results need to be interpreted in the context of some important limitations. Firstly, questionnaire responses are likely to depend on the level of perceived threat from the local pandemic situation and may therefore vary by region or country. In addition, our data only reflect the opinions of patients from Vietnam and can therefore only be generalized to countries with similar social and cultural conditions and the requirement to self-fund infertility treatment.

In conclusion, this study presents data on infertility treatment during the COVID-19 pandemic from the perspective of couples with infertility. This information provides relevant insights for policy makers and IVF centres when developing, modifying and implementing infertility treatment strategies during and after the pandemic.

Acknowledgements

We would like to acknowledge Ms Chau H Vo; Ms Thao T Hoang and staff at My Duc and My Duc – Phu Nhuan Hospitals for their assistance in collecting data.

Funding: No external funding was received for this study.

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Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. The journal publishes juried original scientific articles in clinical and laboratory research relevant to reproductive endocrinology, urology, andrology, physiology, immunology, genetics, contraception, and menopause. Fertility and Sterility® encourages and supports meaningful basic and clinical research, and facilitates and promotes excellence in professional education, in the field of reproductive medicine.

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