Induced Abortions Previous to IVF: An Epidemiologic Register-based Study
Induced Abortions Previous to IVF: An Epidemiologic Register-based Study
Background: The purpose of this study was to identify how many women treated for infertility had an abortion history, as well as when those abortions were carried out, and for what reasons.
Methods: Data on all women treated in Finland from 1996–1998 for infertility either with IVF (n = 9175) or ovulation induction (OI, n = 10 254) and the age-matched controls of IVF women were linked to the Abortion and Hospital Discharge Registers for the period 1969–2000.
Results: A notable proportion of IVF women (12%) and OI women (11%) had previous induced abortion(s). Practically all abortions were for social or age reasons. Most IVF women (72% of n = 1099) had their most recent abortion more than 10 years previous to fertility treatment, but more recently among OI women (45% of n = 1123 of the most recent abortions were in the preceding 10 years). Many IVF- and OI women were young and single at the time of the most recent abortion. At the time of IVF treatment most women were aged over 30 and married; OI women were also frequently married, but 42% of them were aged younger than 30.
Conclusions: At different points in their life, women may rely on opposite fertility regulation strategies. Health care professionals providing IVF need to consider the possibility of a previous abortion. Young women need information on the possibility of future infertility in later age.
In developed countries, access to effective contraception and induced abortions have given women control over the decision not to have a child. In contrast, a woman’s decision to have a child is no guarantee that she can have a child. The effectiveness of fertility treatments is still limited (Nyboe Andersen et al., 2007), the partner’s co-operation is needed and, at least in Finland, many women lack information on the negative effects of age on fertility (Sannisto et al., 2001).
Decisions not to continue with a pregnancy often occur at a young age or when the father of the child is not supportive to pregnancy or not suitable as the partner; the possibility of remaining unintentionally childless may seem remote. If a woman faces infertility later in life, the history of a previous induced abortion may be a psychological burden, because the opportunity to have a child was once missed. We found no published studies on how common this situation is.
Baseline data from our earlier study on the health consequences of IVF (Klemetti et al., 2004, 2005b) showed that the pregnancy history of some IVF-treated women in the birth register included induced abortions (unpublished data). In Finland, in the 1990s, about 5% of children were born either after IVF or ovulation induction (OI) (Klemetti et al., 2005a), and the rate of IVF treatments per fertile-aged woman was 7.3 cycles per 1000 women per year (Klemetti et al., 2004), one of the highest in Europe (Nyboe Andersen et al., 2007). Treatments are commonly made in the private sector, but partly reimbursed by public funds. Despite financial barriers and age limits in the public sector, IVF is well accessed (Klemetti et al., 2004).
Induced abortions (hereafter simply abortions) are not subject to a woman’s choice alone and a certificate from a physician indicating a legally founded reason is required. Nevertheless, since 1970, abortions have been readily available (Gissler, 1999; Knudsen et al., 2003). Abortions are carried out mainly in public hospitals and the costs to women are small. Compared with other European countries, Finland has low abortion rates: since 1990, there were less than 10 abortions per 1000 women aged 15–49 years (Induced Abortion Worldwide, 1999; WHO, 2006).
The aim of this study was to identify how many women who were treated for infertility in Finland had an abortion history, when those abortions were carried out, and for what reasons.
Background: The purpose of this study was to identify how many women treated for infertility had an abortion history, as well as when those abortions were carried out, and for what reasons.
Methods: Data on all women treated in Finland from 1996–1998 for infertility either with IVF (n = 9175) or ovulation induction (OI, n = 10 254) and the age-matched controls of IVF women were linked to the Abortion and Hospital Discharge Registers for the period 1969–2000.
Results: A notable proportion of IVF women (12%) and OI women (11%) had previous induced abortion(s). Practically all abortions were for social or age reasons. Most IVF women (72% of n = 1099) had their most recent abortion more than 10 years previous to fertility treatment, but more recently among OI women (45% of n = 1123 of the most recent abortions were in the preceding 10 years). Many IVF- and OI women were young and single at the time of the most recent abortion. At the time of IVF treatment most women were aged over 30 and married; OI women were also frequently married, but 42% of them were aged younger than 30.
Conclusions: At different points in their life, women may rely on opposite fertility regulation strategies. Health care professionals providing IVF need to consider the possibility of a previous abortion. Young women need information on the possibility of future infertility in later age.
In developed countries, access to effective contraception and induced abortions have given women control over the decision not to have a child. In contrast, a woman’s decision to have a child is no guarantee that she can have a child. The effectiveness of fertility treatments is still limited (Nyboe Andersen et al., 2007), the partner’s co-operation is needed and, at least in Finland, many women lack information on the negative effects of age on fertility (Sannisto et al., 2001).
Decisions not to continue with a pregnancy often occur at a young age or when the father of the child is not supportive to pregnancy or not suitable as the partner; the possibility of remaining unintentionally childless may seem remote. If a woman faces infertility later in life, the history of a previous induced abortion may be a psychological burden, because the opportunity to have a child was once missed. We found no published studies on how common this situation is.
Baseline data from our earlier study on the health consequences of IVF (Klemetti et al., 2004, 2005b) showed that the pregnancy history of some IVF-treated women in the birth register included induced abortions (unpublished data). In Finland, in the 1990s, about 5% of children were born either after IVF or ovulation induction (OI) (Klemetti et al., 2005a), and the rate of IVF treatments per fertile-aged woman was 7.3 cycles per 1000 women per year (Klemetti et al., 2004), one of the highest in Europe (Nyboe Andersen et al., 2007). Treatments are commonly made in the private sector, but partly reimbursed by public funds. Despite financial barriers and age limits in the public sector, IVF is well accessed (Klemetti et al., 2004).
Induced abortions (hereafter simply abortions) are not subject to a woman’s choice alone and a certificate from a physician indicating a legally founded reason is required. Nevertheless, since 1970, abortions have been readily available (Gissler, 1999; Knudsen et al., 2003). Abortions are carried out mainly in public hospitals and the costs to women are small. Compared with other European countries, Finland has low abortion rates: since 1990, there were less than 10 abortions per 1000 women aged 15–49 years (Induced Abortion Worldwide, 1999; WHO, 2006).
The aim of this study was to identify how many women who were treated for infertility in Finland had an abortion history, when those abortions were carried out, and for what reasons.
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