title: Use of fertility treatment modalities in a large United States cohort of professional women.
abstract: OBJECTIVE
  To evaluate the use of fertility treatments among a large cohort of women in the United States.
  
  
  METHODS
  Cohort study.
  
  
  METHODS
  Nurses' Health Study II.
  
  
  METHODS
  Ten thousand thirty-six women who reported having used fertility treatment on biennial questionnaires from 1993-2009.
  
  
  METHODS
  None.
  
  
  METHODS
  Data on patterns of treatment modality were collected via self-report from validated mailed questionnaires. Information on clomiphene, gonadotropin injections alone, and gonadotropin injections as part of intrauterine insemination (IUI) and in vitro fertilization (IVF) was queried.
  
  
  RESULTS
  Most women who reported fertility treatment used clomiphene (94%), with a large majority reporting clomiphene as their only form of treatment (73%). Of women who reported treatment more advanced than clomiphene, 13% had used gonadotropin injections alone, 11% IUI treatment, and 11% IVF. Several subgroups were more likely to use multiple treatment modalities and to initiate treatment with gonadotropins rather than clomiphene, including women living in states with insurance coverage of fertility procedures, with higher household income, younger in age, who remained nulliparous at the study close, and treated after 2000.
  
  
  CONCLUSIONS
  Results should be interpreted cautiously, but to our knowledge, this represents the first study of fertility treatment patterns in the United States and could inform public health planning.
authors.affiliation: Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts. Electronic address: lfarland@hsph.harvard.edu.
authors.forename: Leslie V
authors.initials: LV
authors.lastname: Farland
authors.affiliation: Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts; Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Stacey A
authors.initials: SA
authors.lastname: Missmer
authors.affiliation: Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts; Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Janet
authors.initials: J
authors.lastname: Rich-Edwards
authors.affiliation: Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts; Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts.
authors.forename: Jorge E
authors.initials: JE
authors.lastname: Chavarro
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Barbieri
authors.affiliation: Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts; Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Francine
authors.initials: F
authors.lastname: Grodstein
mesh_terms: D000328:Adult; D000367:Age Factors; D002996:Clomiphene / Q000627:therapeutic use; D003131:Combined Modality Therapy; D017723:Drug Utilization Review; D005260:Female; D005298:Fertility; D005300:Fertility Agents, Female / Q000191:economics / Q000627:therapeutic use*; D005307:Fertilization in Vitro / Q000706:statistics & numerical data; D005382:Financing, Personal; D006062:Gonadotropins / Q000627:therapeutic use; D019538:Health Care Surveys; D006801:Humans; D007182:Income; D007247:Infertility, Female / Q000175:diagnosis / Q000191:economics / Q000503:physiopathology / Q000628:therapy*; D007315:Insemination, Artificial / Q000706:statistics & numerical data; D019458:Insurance Coverage; D009726:Nurses / Q000191:economics / Q000706:statistics & numerical data*; D010298:Parity; D011247:Pregnancy; D027724:Reproductive Techniques, Assisted / Q000191:economics / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014481:United States
chemical_list: D005300:Fertility Agents, Female; D006062:Gonadotropins; D002996:Clomiphene
keywords: Fertility treatment; IUI; IVF; clomiphene; gonadotropins
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