Prevalence and Risk factors of Infertility in a Mongolian Population

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Infertility, which is defined by the World Health Organization (WHO) as the failure to conceive after 12 months of unprotected regular sexual intercourse, is reproductive health problems carries a social stigma and can greatly impact a couple’s self-esteem and wellbeing. There are a number of risk factors associated with infertility such as: culture, socio-economic factors, age and health care including treatment of sexually transmitted diseases. We have achieved the first population-based study on the prevalence of infertility in reproductive aged women in Mongolia, and the factors that influence it. Method: We conducted a population-based cross-sectional study in 4 regions (Khangai, Eastern, Western, Central) of Mongolia and the capital city Ulaanbaatar. Our questionnaire consisted of categories that influenced infertility such as: socio-economic status, lifestyle factors, health, reproductive history, present status and sexual function. Trained staff conducted face-to-face interviews with the participants. Results: A total of 1,920 couples residing in 4 regions of Mongolia and the capital city, Ulaanbaatar were studied. The median prevalence rate of infertility was 7.2%, which is similar to the worldwide infertility rate of 9%. Primary and secondary infertility was 2.4% and 4.8% respectively. Our study showed that the most important risk factors for infertility were age, rural living, low levels of education, obesity and diseases of the female reproductive system. Only 14.8% of infertile patients received hormone therapy, and even fewer infertile patients (0.8%) received in vitro fertilization (IVF) treatment. Conclusions: The prevalence rate of infertility is comparable to global rates among other developing countries. Our study shows that significant risk factors for infertility were: age, living in rural communities, having a low level of education, obesity and diseases of the female reproductive system. Occupational conditions, and monthly household income were not significant risk factors for infertility. Since this is the first population-based study in Mongolia we were not able to measure trends in infertility prevalence but intend to do so in the future. Sexual & Reproductive Medicine Prevalence female infertility risk factors population-based study developing country Mongolia Figures Figure 1 Figure 2 Plain English Summary Infertility is one of the most important and underappreciated reproductive health problems and carries a stigma that can affect the wellbeing of a couple, and lead to depression and low self-esteem. The World Health Organization (WHO) defines infertility as the failure to conceive after at least 12 months of regular unprotected intercourse. The average prevalence of infertility worldwide is 9%, although it varies from country to country depending on a number of risk factors. Relevant risk factors are the socio-economic conditions of a country and its health care. We studied infertility amongst married couples living in 4 regions of Mongolia as well as in the capital city, Ulaanbaatar. In Mongolia the average infertility rate was 7.2%, which is similar to the average infertility rate worldwide. We found that in Mongolia infertility prevalence was significantly higher in rural communities and with couples who had lower levels of education. These two risk factors were often associated. Besides these two risk factors age and history reproductive system diseases posed risks. Furthermore, Assisted Reproductive Technologies (ART) for the treatment of infertile is rare in Mongolia. Background Infertility, as defined by WHO, is the failure to conceive after at least 12 months of regular unprotected sexual intercourse (1) . Infertility is a medical issue that also carries a social stigma and leads to a decrease in the quality of life, emotional instability, and low self-esteem, especially in women (2). There are wide-ranging estimates of infertility prevalence depending on the study and definition of infertility (3) (4, 5). A global study estimated the 12-month infertility prevalence to be 9%. With rates, ranging from 3.5–16.7% in more developed nations and from 6.9–9.3% in less-developed nations (6). There are around 186 million married women in developing countries (excluding China) between the ages of 15 and 49 with primary and secondary infertility (7). The differences between the developed and developing world have been increasing because of the availability, accessibility in infertility care and differing socio-cultural values for procreation and childlessness (8). The only available data on infertility in Mongolia was represented demographically with a primary infertility occurrence of 1-1.99% while secondary infertility was 13% (9). In certain regions of the world including developing countries unsafe abortion, poor maternity care and sexually transmitted infections contribute to the higher rate of secondary infertility compared to primary infertility (10). Mongolia has one of the highest rates of secondary infertility (9) and this may largely be attributed to high rates of sexually transmitted infections (STIs). For instance, the rate of gonorrhea among women and men in Mongolia was 3.3% and 2.9%, and chlamydia was 19.5% and 15.6% respectively (11). Mongolia has an unregulated growth of the private healthcare sector and poor enforcement of standards and technical guidelines for safe abortion (12). Mongolian based studies on infertility such as Bayasgalan et al 2004, are in a clinically based they found a female infertility rate of 45.8%, and a male infertility rate of 25.6%, unexplained infertility was 9.8% and the combined rate for couples was 18.8%. In Mongolia, the major factors influencing female infertility were tubal adhesions and endocrinal factors, while in the male they were varicocele, azoospermia and testicular damage(13). Infertility studies in Mongolia have mainly been hospital-based with limited epidemiological studies. Therefore, accurate assessment of infertility using epidemiological study methods are crucial in order to provide high quality assessment, treatment, and management. The aim of this study was to provide the first 12-month prevalence rate of infertility with a population-based study, including causative factors leading to infertility in women of a reproductive age in Mongolia. Methods Study population and sampling We conducted a population-based cross-sectional study from September 2016 to November 2018 in the four regions of Mongolia as well as the capital city of Ulaanbaatar. Mongolia is divided into four regions based on geographical and economic factors (Eastern, Western, Central and Khangai) while the capital city Ulaanbaatar is viewed as a separate region. Each region is made up of provinces with a total of 21 provinces in all. The appropriate sample size for the study was calculated by taking the average international rates of infertility of around 8–10%. International infertility rates were used to calculate the appropriate sample size since there were no previous infertility studies undertaken in Mongolia. With an allowable error of 5% and a confidence level of 95%, a total sample size of 2000 couples was required for the study. Incomplete questionnaires (80 respondents) were excluded resulting in a total 1920 couples participating in the study giving in a response rate of 96%. This was a nation-wide study that involved one or two provinces within each region randomly selected by a multi-stage stratified cluster sampling design. We calculated the study sample of reproductive-age couples in each of four main regions (Govi-Altai province (n = 300) from Western region, Khuvsgul (n = 200) and Orkhon (n = 218) provinces from the Northern region Darkhan (n = 174) and Umnugovi (n = 150) provinces from the Central region and Ulaanbaatar (n = 695) region. For the study we selected married couples who were citizens of Mongolia and who had been living together at least one year at a permanent residence in one of the selected regions. The women were between 20–45 years of age while there was no age selection for men. Couples excluded from the study were those who had lived apart for longer than three months, used birth control in any form, were presently breastfeeding, or those women in early menopause. After participants agreed to take part in the study, they were asked to sign a consent form. The Mongolian National University of Medical Sciences approved these studies (No 16/3/2016-16). We randomly approached eligible couples with assistance from the local family healthcare centers from each Sum (territorial administrative unit of Mongolia) and District, the couples that agreed to participate were interviewed at the local family healthcare center. In some cases, participants were not able to come to the local healthcare center, so we conducted the survey in their homes. A pretested standardized and structured questionnaire was used to gather data from the participants. As precaution to possible difficulties arising from illiteracy and cultural miscommunication errors, we conducted a verbal interview in accordance with the questionnaire. In order to protect the participants privacy and to gather accurate information a trained interviewer conducted the interview individually with each person in a private setting. Our questionnaire assessed general demographic and socio-economic status, medical history, toxin exposure, reproductive history, female reproductive health (e.g. age of menarche, last menstrual period, menstrual regularity, menstrual cycle, menstrual blood volume, medical history, operative history), marriage and child bearing status (e.g. length of marriage and cohabitation, pregnancy history including information concerning live births, miscarriage, induced abortions and stillbirths, frequency of sexual intercourse) and past medical consultation on infertility. We also conducted anthropometrics measurements. For gauging alcohol consumption, tobacco use and physical activity we based our questions on WHO STEPS Instrument’s NCD (non-communicable disease) risk factor questionnaire(14). For our study we used WHO’s definition of infertility as “a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse” (15). Primary female infertility is defined as a woman who has never before been diagnosed with a clinical pregnancy and meets the criteria of being classified as having infertility”, while “secondary female infertility is defined as a woman currently unable to establish a clinical pregnancy but who has previously been diagnosed with a clinical pregnancy” (16). Since infertility is usually defined by the female population we calculated the epidemiology of infertility solely based on female data (4). Data analysis was performed using the Statistical Program for Social Sciences (SPSS v 20, IBM). Missing data for the variables analyzed were excluded. Continuous measurements were shown as mean standard deviation (SD) and categorical variables were expressed as percentages. For statistical analysis distributions were compared using Pearson’s chi-square test and Fisher’s exact test when appropriate. Binary logistic regression analyses were then performed within each subgroup, adjusting for confounders. For comparison of variables t-test and ANOVA test were used; 95% confidence interval was considered statistically significant p < 0.05. Results Study population Our study population of 1920 participants consisted of residents of Ulaanbaatar city and four regions of Mongolia (Western, Eastern, Central and Khangai). The demographic and socio-economic characteristics of the participants are shown in Table 1. Table 1. Demographic and socio-economic characteristics of study participants Characteristics Women n % of total Number of participants 1920 100 Region Ulaanbaatar 695 36.2 Eastern 163 8.5 Western 300 15.6 Khangai 395 20.5 Central 368 19.2 Age, years (Mean (SD)) 32.57±6.61 BMI, kg/m 2 (Mean (SD)) 25.08±4.52 BMI, normal 1075 56 Overweight 555 28.9 Obese 1 class 246 12.8 Obese 2 class 35 1.8 Obese 3 class 9 0.5 Education Primary school and below 212 11 Middle and high school 533 27.8 College and above 1175 61.2 Occupational Conditions A Normal 1663 86.6 Hazardous 257 13.4 А nnual household income, MNT 1500000 170 8.9 Tobacco use No B 1810 94.2 Yes 110 5.7 Alcohol consumption No 715 37.2 Yes C 1205 62.8 A According to Mongolian Labor Legislation, working conditions are divided into normal and hazardous B Included people who never smoked’ C Included people who consumed alcohol within the past 12 months Prevalence of infertility and patterns of region Our study showed an infertility incidence of 7.2% (n=138), with primary infertility at 2.4% (n=46) and secondary infertility at 4.8% (n=92). Geographically the prevalence rate was as follows: Central region (8.2%, n=30), Khangai region (12.4%, n=49), Western region (7%, n=21), Eastern region (8%, n=13), Capital city Ulaanbaatar (3.6%, n=25) (Figure 1). In comparison with the sole urban area of Ulaanbaatar, the prevalence of infertility is significantly higher (p<0.001) amongst the rural population. As it is the only territory with a city status in Mongolia, we viewed it as the sole urban area. Age related patterns of infertility Our results show that there is a trend of secondary and overall infertility that increases with the women’s age. However, the same trend is present in primary infertility (Table 2). Women between 40-45 years of age had the highest rate of infertility (10.6%) compared to women of the 20-24 years of age who had a low infertility rate (1.4%) (n=40) (p<0.0001) Table 2. Infertility prevalence age groups Age group Fertile women n=1782 Infertile women n=138 n (%) Overall infertility (%) Primary infertility (%) Secondary infertility (%) 20-24 216 11.3 1.4 1.4 0 25-29 482 25.1 5.4 2.9 2.5 30-34 471 24.5 7.9 3 4.9 35-39 373 19.4 8.6 1.6 7 40-45 378 19.7 10.6 2.4 8.2 <p? Furthermore, when we map the prevalence of infertility as individual ages instead of groups, we notice a slow decline from ages 30-36 and then a sudden spike at ages 36-39 followed by a plateau until age 45. (Figure 2). Risk factors for infertility We then divided our participants into two groups of either infertile or fertile females. Adjusting for age we calculated for the association between infertility and risk factors among women. We calculated the risk of infertility compared to the 20–24-year age group. Among the risk factors age was the most significant risk factor, with the risk increasing by 4 to 8-fold with each progressing age group. Social factors, such as: occupational conditions and monthly household income were not significent risk factors for infertility however alcohol consumption, obesity, rural living and lower levels of education were significant risk factors (Table 3) Table 3. Infertility risk factors Characteristic Fertile woman n=1782 Infertility women n=138 Overall infertility n=138 Unadjusted OR (95 CI) Age adjusted OR (95% CI) Age groups (women) (%) 20-24 12 2.2 ref 25-29 25.6 18.8 4.04 (1.21-13.52)* 30-34 24.4 26.8 6.05 (1.84-19.85)** 35-39 19.1 23.2 6.66 (2.01-22.02)** 40-45 19 29 8.4 (2.56-27.5)*** Education Primary school and below 10.9 13 1.44 (0.84-2.47) 1.18 (0.68-2.05) Middle and high school 27.2 35.5 1.57 (1.07-2.3)** 1.4 (0.95-2.06) College and above 62 51.4 ref ref Living region City region 58.1 37.7 ref ref Rural region 41.9 62.3 2.29 (1.06-3.27)*** 2.05 (1.38-3.04)*** BMI Normal 53.4 45.7 ref ref Underweight 3.6 1.4 0.47 (0.11-1.99) 1.2 (0.08-17.34) Pre-Obesity 27.9 31.3 1.41 (0.93-2.13) 0.93 (0.49-1.79) Obesity 15.1 21.7 1.8 (1.17-2.98)** 2.9 (1.21-6.99)* Physical activity Active A 18 19.6 ref ref Inactive 82 80.4 0.9 (0.58-1.39) 0.89 (0.57-1.38) Smoking No B 94.1 92 ref ref Yes 5.9 8 1.3 (0.72-2.64) 1.33 (0.69-2.55) Alcohol consumption No C 37.2 23.2 ref ref Yes 62.8 76.8 2.05 (1.37-3.09)*** 1.98 (1.31-2.98)*** *<0.05, **<0.01, ***<0.001 A Defined as at least 150–300 minutes of moderate-intensity aerobic physical activity or at least 75–150 minutes of vigorous-intensity aerobic physical activity; or an equivalent combination of moderate- and vigorous-intensity activity throughout the week B Included people who have never smoked C Included people who consumed alcohol within the past 12 months We used the participant’s self-reported gynecological history to calculate the risks it imposed. We found the following risks associated with infertility: abnormal menstrual cycles 1.5 (CI 1.07-2.15 p<0.01 ), thyroid disease 1.6 (CI 0.98-2.79 p<0.05), intrauterine growth restriction 2.1 (CI 1.22-3.73 p<0.001), ectopic pregnancy 2.6 (CI 1.2-5.69 p<0.01) recurrent ectopic pregnancy 13.3 (CI 1.87-95.84 p<0.01), ovarian cysts 4.7 (CI 3.12-7.34 p<0.0001), endometrial polyps 4.1 (CI 1.99-8.59 p<0.0001), endometriosis 5.8 (CI 1.78-19.34 p<0.01), gynecological operative history (ovarian cystectomy, oophorectomy, salpingectomy, abortion, cesarean section) 2.6 (CI 1.72-4.06 p<0.0001) . Clinical consultations for infertile couples Of the total infertile participants (n=138), 77.5% (n=107) had sought clinical consultation regarding their infertility, while 22.5% (n=31) never sought any type of clinical consultation. Among the group that sought clinical consultation 29.7% (n=41) of the women had received some form of treatment, with hormonal therapy being most commonly used at 14.3%, followed by timing therapy at 4.5%, IUI therapy 0% and assisted reproductive technology ART at 0.8% (n=1) was scarce. Discussion Mongolia is a land locked nation that borders the People’s Republic China to the south and the Russian Federation to the north. It is comprised of 21 provinces distributed in 4 regions (Khangai, Central, Eastern and Western) and Ulaanbaatar city. Globally it ranks 6th for the least densely populated country at approximately 1.7 persons per squared kilometer. The Mongolian Government's policy on population development between 2016–2025 is to create favorable conditions for sustainable population growth. Until now there has not been population-based studies on infertility and its risk factors in Mongolia. Researchers used the number of couples and females with infertility in a certain time and location in relation to the total population to calculate the prevalence rate of infertility. The prevalence of infertility can be defined as the total number of women or couples who experience infertility within a given period of time and in a given place, in proportion to the total population in the same time and place(3). Our study was done using this definition, for the population of Ulaanbaatar and the four regions of Mongolia. We found an infertility prevalence of 7.2% which is in agreement with similar studies from around the world that had a median infertility prevalence ranging from 6.9–9.3% [ 4 ]. Mongolia is a developing country and our result of 7.2% was similar to the global rate of infertility in developing countries at 6.9–9.3%(9). Larsen et al.’s study of primary and secondary infertility in sub-Saharan Africa showed a prevalence of primary and secondary infertility of 3% and 5% respectively(17). This was in keeping with our study, which showed a prevalence of primary and secondary infertility of 2.4% and 4.8% respectively. However, their definition of infertility as “5 years or more of failure to conceive” was not the same as our definition of infertility, which was 12 months of failed conception. Both Mongolia and the Sub-Saharan region had a high rate of gonorrhea and chlamydia(11) (18), which are risk factors for secondary infertility that could explain the similar results of the two studies. A study done in a fellow low- and middle-income country, Nigeria had a prevalence rate of infertility rate of 31.1%(19). This is much higher than the infertility rate we measured in Mongolia but it may be due to a different study design. A population-based study conducted in our neighboring country China, had a prevalence of 15.5%(20). Although both studies used the same definition of infertility and study methods, we believe the contrasting result of 7.2% is due to governmental policy on reproduction (China’s one-child policy), inclusion criteria, the age of the participants, socio-economic values and other factors. Recent meta-analysis study results in Iran showed a very similar result to our own with a total infertility prevalence of 7.8% to our 7.2%. However, these studies had primary and secondary infertility rates of 3.9% and 2.18% while our data showed 2.4% and 4.8% respectively. (21) There are numerous risk factors that contribute to female subfertility and it is important to diagnose each carefully in order to treat patients appropriately(22). Risk factors which vary between different regions of the world, include: the genetics of the population, socio-economic factors, differences in government policy, health care, nutrition, age of the participants, and STIs. High levels of STIs present in the population contribute to secondary infertility (23). Our study shows that important risk factors for infertility in Mongolia are age of the woman, alcohol consumption, obesity, rural living, and the level of education of the couple In women, the quantity and quality of oocytes is known to decline with age, with the resulting decline in fecundity becoming clinically relevant by the mid 30s (24). Interestingly our results showed a steady decline in fertility through the ages of 30–36 followed by a sudden spike then plateauing until age 45. Another possible contributing factor for infertility increasing with age in women is that susceptibility to infection also increases with age. A Scottish fertility clinic study found that women over 35 were more likely to be diagnosed with tubal factor infertility than younger women (OR 2.2, CI 1.7–2.7) (25). In a study conducted in Turkey infertility was significantly higher among women aged between 35 and 49 (p < 0.01)(26). In our study a women’s level of education was one of the factors affecting female infertility. This is agreement with a study China which showed that increasing levels of education was inversely correlated with a decreased the risk of infertility(27). This may be due to a link between higher levels od education healthier lifestyles and better healthcare. We also found that obesity contributed to infertility which may be related to abnormal metabolism. Clinical studies definitively demonstrate an impact of obesity on the risk of subfertility(28). Cohort studies showed that there is an increased risk of anovulation in extremely heavy exercisers (> 60 min/day), but vigorous exercise of 30–60 min/day was associated with reduced risk of anovulatory infertility(29). We attribute the higher rates of infertility in rural areas compared to urban areas due to limited the access to healthcare. For instance, all 6 of the fertility clinics in Mongolia are located in the city of Ulaanbaatar. Among the infertile women in our study, only 0.8% had undergone IVF therapy, compared to China’s 5.6% IVF therapy and 29.4% traditional Chinese medicine rates. (27) Furthermore with only 14.3% of our infertile participants who received hormone therapy had poor access to advanced fertility treatment. Infertility is expected to change in populations over time. In a US National Health report it was shown that infertility fell from 8.5% in 1982 to 7.4% in 2002(30). Further declines in infertility were seen in 2006 (31). These declines in infertility may be due to improved nutrition and general health of the population and improvements in assisted reproductive techniques (ART). In Mongolia we were unable to look for these trends as this was our first report, but we hope in the future to conduct further studies on infertility. Our study calls for further quantitative and qualitative research specifically designed to identify the causes of declining fertility, the socio-demographic and medical factors contributing to infertility and the links between infertility and the use of ART in Mongolia. Furthermore, we hope our results can help highlight the need for legislation and policies to increase ART accessibility and availability to patients in rural areas. Strengths and Limitations We used a population-based method to study infertility in 4 regions of Mongolia and the city Ulaanbaatar. The sample size and methods were rigorous for this study. We used only one definition to determine infertility, which limited us to using strict inclusion criteria. We used a self-reporting method to assess infertility and this can be subject to bias. Conclusions In conclusion, the overall 12 months prevalence of infertility was 7.2% and primary and secondary infertility was 2.4% and 4.8%. Our study shows the most significant risk factors for infertility were: age, obesity alcohol consumption, rural living and having a low level of education. An unfavorable gynecological history also posed a risk to fertility. Occupational conditions, and monthly household income were not significant risk factors for infertility. Since this is the first population-based study in Mongolia we were not able to measure trends in infertility prevalence but intend to do so in the future. Abbreviations ANOVA: Analysis of variance ART: Assisted reproductive technology IVF: in vitro fertilization SD: Standard deviation SPSS: Statistical Program for Social Sciences STI’s: Sexually transmitted infections WHO: World Health Organization Declarations Details of ethics approval Ethical approval was obtained from the Ethics Committee of Mongolian National University of Medical Sciences (No16/3/2016-16) to conduct our survey. All participants agreed to an informed consent form, after accepting to be included. Consent for publication: Not applicable Availability of data and materials: All data generated or analyzed during this study are included in this published article [and its supplementary information files]. Competing interests: The authors declare that they have no competing interests Funding: Our study was supported by the Mongolian National University of Medical Sciences’ Science and Technology Support Fund’s “Domestication of IVF technology in Mongolia project.” The funders of this study had no influence in the design, implementation, analysis, or the manuscript preparation of this study. Authors' contributions OE, MM, ET, LE, have drafted the work and substantively revised it as well as the design conception. TN, KhB, AE, AG, BM, have participated in the acquisition and analysis of data, as well as drafted this manuscript. KhN worked on the interpretation of data. All authors read and approved the final manuscript. Acknowledgements: We express our sincere gratitude to the Mongolian National University of Medical Sciences for their immense support. We thank the School of Bio-Medicine and Department of Pathophysiology for the crucial advice and organization. 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Supplementary Files Data.sav Cite Share Download PDF Status: Published Journal Publication published 01 Jan, 2023 Read the published version in Asian Pacific Journal of Reproduction → Version 3 posted You are reading this latest preprint version Show more versions Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-26781","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research","associatedPublications":[],"authors":[{"id":25198561,"identity":"1ceb55b7-9bc8-4c2a-86ba-418682dc8daa","order_by":0,"name":"Tuvshinbayar Negdel","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABBklEQVRIiWNgGAWjYJACZgYDhgQo2wYhiAvwoGlJI1YLA1zLYcJa7CVyjD8XFNzJ45+R/OwD447z0eYS2ckfGCqsExvEzh7AaotEjpn0DINnxRI30oxnMJ65nbtzRu42CYYz6YkN0nkJ2LWkpTHzGBxObLiRYMzA2HY7d8ON3G1ABlBEOscAh5bkzyAt82+kfwaqPAfSsvkD4z98WpIPSIO0bLiRA7LlAEjLBgnGBjxazjw+BtJSbHjmTTFDYlty7oYzb7dJJBxLN27DoYW9PbH5M8+fw3lyx9M3M3xss8vdcBzosA811rL9OLQggEACInbADDb86oGA/wBBJaNgFIyCUTBCAQC+WmQq5mAmtAAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0000-0002-7702-4583","institution":"Mongolian National University of Medical Sciences Dornogobi Medical College","correspondingAuthor":true,"prefix":"","firstName":"Tuvshinbayar","middleName":"","lastName":"Negdel","suffix":""},{"id":25198562,"identity":"d84e41c0-2473-4dc7-bde7-d895f3433000","order_by":1,"name":"Khishigjargal Ulziisaikhan","email":"","orcid":"","institution":"Mongolian National University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Khishigjargal","middleName":"","lastName":"Ulziisaikhan","suffix":""},{"id":25198563,"identity":"93c1ec9b-e583-4fc4-9450-2c6ed555559a","order_by":2,"name":"Davaakhuu Sengebaljir","email":"","orcid":"","institution":"Mongolian National University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Davaakhuu","middleName":"","lastName":"Sengebaljir","suffix":""},{"id":25198564,"identity":"db2a8347-a850-452a-936d-14b8b439af2b","order_by":3,"name":"Arigbukh Enkhbat","email":"","orcid":"","institution":"Mongolian National University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Arigbukh","middleName":"","lastName":"Enkhbat","suffix":""},{"id":25198565,"identity":"64b2041e-610b-41ec-a4c8-687722bde06e","order_by":4,"name":"Badrakh Munkhbayar","email":"","orcid":"","institution":"Mongolian National University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Badrakh","middleName":"","lastName":"Munkhbayar","suffix":""},{"id":25198566,"identity":"eb25a18e-9597-4a9a-b0d3-158d16a66f35","order_by":5,"name":"Khantushig Bilegsuren","email":"","orcid":"","institution":"Mongolian National University of Medical Sciences School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Khantushig","middleName":"","lastName":"Bilegsuren","suffix":""},{"id":25198567,"identity":"7e5c6b78-c109-43a6-9a16-7c237db1fc99","order_by":6,"name":"Ariunaa Ganbold","email":"","orcid":"","institution":"Regenerative Medical Center IVF Ulaanbaatar, Mongolia","correspondingAuthor":false,"prefix":"","firstName":"Ariunaa","middleName":"","lastName":"Ganbold","suffix":""},{"id":25198568,"identity":"f9dc1d23-6239-4266-bf62-dd294d871e40","order_by":7,"name":"Khuderchuluun Nanjid","email":"","orcid":"","institution":"Mongolian National University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Khuderchuluun","middleName":"","lastName":"Nanjid","suffix":""},{"id":25198569,"identity":"7d5667d4-6fad-4cb6-a735-e87436464073","order_by":8,"name":"Carol W. Readhead","email":"","orcid":"","institution":"California Institute of Technology","correspondingAuthor":false,"prefix":"","firstName":"Carol","middleName":"W.","lastName":"Readhead","suffix":""},{"id":25198570,"identity":"4a66334b-aedc-4add-8102-0c11921bb970","order_by":9,"name":"Lkhagva-Ochir Erkhembaatar","email":"","orcid":"","institution":"First Maternity Hospital of Mongolia","correspondingAuthor":false,"prefix":"","firstName":"Lkhagva-Ochir","middleName":"","lastName":"Erkhembaatar","suffix":""},{"id":25198571,"identity":"c03c31bd-cf2c-45ec-bef6-a309477f1f9d","order_by":10,"name":"Ekhembaatar Tuduvdorj","email":"","orcid":"","institution":"Mongolian National University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Ekhembaatar","middleName":"","lastName":"Tuduvdorj","suffix":""},{"id":25198572,"identity":"58f3cb25-4d9b-4e32-a33d-7925f50f386a","order_by":11,"name":"Munkhzol Malchinkhuu","email":"","orcid":"","institution":"Mongolian National University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Munkhzol","middleName":"","lastName":"Malchinkhuu","suffix":""},{"id":25198573,"identity":"5f72c9c5-0d3f-4235-95fb-0ca119c8cbd8","order_by":12,"name":"Odkhuu Enkhtaivan","email":"","orcid":"","institution":"Mongolian National University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Odkhuu","middleName":"","lastName":"Enkhtaivan","suffix":""}],"badges":[],"createdAt":"2020-05-03 13:38:26","currentVersionCode":3,"declarations":"","doi":"10.21203/rs.3.rs-26781/v3","doiUrl":"https://doi.org/10.21203/rs.3.rs-26781/v3","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.4103/2305-0500.377501","type":"published","date":"2023-01-01T22:22:16+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":8869626,"identity":"6e3f7233-dd38-4d1f-81d8-f5d5176ff03f","added_by":"auto","created_at":"2021-05-06 17:05:15","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":139491,"visible":true,"origin":"","legend":"Infertility prevalence by region. Note: The designations employed and the presentation of the material on this map do not imply the expression of any opinion whatsoever on the part of Research Square concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. This map has been provided by the authors.\n","description":"","filename":"Fig1.png","url":"https://assets-eu.researchsquare.com/files/rs-26781/v3/fcd898d3fb6fa9c494af05eb.png"},{"id":8870024,"identity":"daed825c-c8e5-4698-bdc5-d873054a5dd7","added_by":"auto","created_at":"2021-05-06 17:08:15","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":24678,"visible":true,"origin":"","legend":"Infertility prevalence by age","description":"","filename":"Fig2.png","url":"https://assets-eu.researchsquare.com/files/rs-26781/v3/f71bace041faae4b9aaf4c12.png"},{"id":55689951,"identity":"4690a9db-5ed7-4a8b-802b-95018ce79bfe","added_by":"auto","created_at":"2024-05-01 22:22:21","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":949117,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-26781/v3/273059c1-4a48-4c7d-a228-76db6cf9a93f.pdf"},{"id":8870025,"identity":"d756e742-90b7-4687-a502-abbac89ac2ec","added_by":"auto","created_at":"2021-05-06 17:08:15","extension":"sav","order_by":4,"title":"","display":"","copyAsset":false,"role":"supplement","size":4946426,"visible":true,"origin":"","legend":"","description":"","filename":"Data.sav","url":"https://assets-eu.researchsquare.com/files/rs-26781/v3/4d98d28f2437878dd5e35b48.sav"}],"financialInterests":"","formattedTitle":"Prevalence and Risk factors of Infertility in a Mongolian Population","fulltext":[{"header":"Plain English Summary","content":" \u003cp\u003eInfertility is one of the most important and underappreciated reproductive health problems and carries a stigma that can affect the wellbeing of a couple, and lead to depression and low self-esteem. The World Health Organization (WHO) defines infertility as the failure to conceive after at least 12 months of regular unprotected intercourse. The average prevalence of infertility worldwide is 9%, although it varies from country to country depending on a number of risk factors. Relevant risk factors are the socio-economic conditions of a country and its health care.\u003c/p\u003e \u003cp\u003eWe studied infertility amongst married couples living in 4 regions of Mongolia as well as in the capital city, Ulaanbaatar. In Mongolia the average infertility rate was 7.2%, which is similar to the average infertility rate worldwide. We found that in Mongolia infertility prevalence was significantly higher in rural communities and with couples who had lower levels of education. These two risk factors were often associated. Besides these two risk factors age and history reproductive system diseases posed risks. Furthermore, Assisted Reproductive Technologies (ART) for the treatment of infertile is rare in Mongolia.\u003c/p\u003e "},{"header":"Background","content":" \u003cp\u003eInfertility, as defined by WHO, is the failure to conceive after at least 12 months of regular unprotected sexual intercourse \u003csup\u003e(1)\u003c/sup\u003e. Infertility is a medical issue that also carries a social stigma and leads to a decrease in the quality of life, emotional instability, and low self-esteem, especially in women (2).\u003c/p\u003e \u003cp\u003eThere are wide-ranging estimates of infertility prevalence depending on the study and definition of infertility (3) (4, 5). A global study estimated the 12-month infertility prevalence to be 9%. With rates, ranging from 3.5\u0026ndash;16.7% in more developed nations and from 6.9\u0026ndash;9.3% in less-developed nations (6). There are around 186\u0026nbsp;million married women in developing countries (excluding China) between the ages of 15 and 49 with primary and secondary infertility (7). The differences between the developed and developing world have been increasing because of the availability, accessibility in infertility care and differing socio-cultural values for procreation and childlessness (8).\u003c/p\u003e \u003cp\u003eThe only available data on infertility in Mongolia was represented demographically with a primary infertility occurrence of 1-1.99% while secondary infertility was 13% (9). In certain regions of the world including developing countries unsafe abortion, poor maternity care and sexually transmitted infections contribute to the higher rate of secondary infertility compared to primary infertility (10). Mongolia has one of the highest rates of secondary infertility (9) and this may largely be attributed to high rates of sexually transmitted infections (STIs). For instance, the rate of gonorrhea among women and men in Mongolia was 3.3% and 2.9%, and chlamydia was 19.5% and 15.6% respectively (11). Mongolia has an unregulated growth of the private healthcare sector and poor enforcement of standards and technical guidelines for safe abortion (12).\u003c/p\u003e \u003cp\u003eMongolian based studies on infertility such as Bayasgalan et al 2004, are in a clinically based they found a female infertility rate of 45.8%, and a male infertility rate of 25.6%, unexplained infertility was 9.8% and the combined rate for couples was 18.8%. In Mongolia, the major factors influencing female infertility were tubal adhesions and endocrinal factors, while in the male they were varicocele, azoospermia and testicular damage(13).\u003c/p\u003e \u003cp\u003eInfertility studies in Mongolia have mainly been hospital-based with limited epidemiological studies. Therefore, accurate assessment of infertility using epidemiological study methods are crucial in order to provide high quality assessment, treatment, and management. The aim of this study was to provide the first 12-month prevalence rate of infertility with a population-based study, including causative factors leading to infertility in women of a reproductive age in Mongolia.\u003c/p\u003e "},{"header":"Methods","content":" \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStudy population and sampling\u003c/h2\u003e \u003cp\u003eWe conducted a population-based cross-sectional study from September 2016 to November 2018 in the four regions of Mongolia as well as the capital city of Ulaanbaatar. Mongolia is divided into four regions based on geographical and economic factors (Eastern, Western, Central and Khangai) while the capital city Ulaanbaatar is viewed as a separate region. Each region is made up of provinces with a total of 21 provinces in all.\u003c/p\u003e \u003cp\u003eThe appropriate sample size for the study was calculated by taking the average international rates of infertility of around 8\u0026ndash;10%. International infertility rates were used to calculate the appropriate sample size since there were no previous infertility studies undertaken in Mongolia. With an allowable error of 5% and a confidence level of 95%, a total sample size of 2000 couples was required for the study. Incomplete questionnaires (80 respondents) were excluded resulting in a total 1920 couples participating in the study giving in a response rate of 96%.\u003c/p\u003e \u003cp\u003eThis was a nation-wide study that involved one or two provinces within each region randomly selected by a multi-stage stratified cluster sampling design. We calculated the study sample of reproductive-age couples in each of four main regions (Govi-Altai province (n\u0026thinsp;=\u0026thinsp;300) from Western region, Khuvsgul (n\u0026thinsp;=\u0026thinsp;200) and Orkhon (n\u0026thinsp;=\u0026thinsp;218) provinces from the Northern region Darkhan (n\u0026thinsp;=\u0026thinsp;174) and Umnugovi (n\u0026thinsp;=\u0026thinsp;150) provinces from the Central region and Ulaanbaatar (n\u0026thinsp;=\u0026thinsp;695) region.\u003c/p\u003e \u003cp\u003eFor the study we selected married couples who were citizens of Mongolia and who had been living together at least one year at a permanent residence in one of the selected regions. The women were between 20\u0026ndash;45 years of age while there was no age selection for men. Couples excluded from the study were those who had lived apart for longer than three months, used birth control in any form, were presently breastfeeding, or those women in early menopause. After participants agreed to take part in the study, they were asked to sign a consent form. The Mongolian National University of Medical Sciences approved these studies (No 16/3/2016-16).\u003c/p\u003e \u003cp\u003eWe randomly approached eligible couples with assistance from the local family healthcare centers from each Sum (territorial administrative unit of Mongolia) and District, the couples that agreed to participate were interviewed at the local family healthcare center. In some cases, participants were not able to come to the local healthcare center, so we conducted the survey in their homes.\u003c/p\u003e \u003cp\u003eA pretested standardized and structured questionnaire was used to gather data from the participants. As precaution to possible difficulties arising from illiteracy and cultural miscommunication errors, we conducted a verbal interview in accordance with the questionnaire. In order to protect the participants privacy and to gather accurate information a trained interviewer conducted the interview individually with each person in a private setting.\u003c/p\u003e \u003cp\u003eOur questionnaire assessed general demographic and socio-economic status, medical history, toxin exposure, reproductive history, female reproductive health (e.g. age of menarche, last menstrual period, menstrual regularity, menstrual cycle, menstrual blood volume, medical history, operative history), marriage and child bearing status (e.g. length of marriage and cohabitation, pregnancy history including information concerning live births, miscarriage, induced abortions and stillbirths, frequency of sexual intercourse) and past medical consultation on infertility. We also conducted anthropometrics measurements. For gauging alcohol consumption, tobacco use and physical activity we based our questions on WHO STEPS Instrument\u0026rsquo;s NCD (non-communicable disease) risk factor questionnaire(14).\u003c/p\u003e \u003cp\u003eFor our study we used WHO\u0026rsquo;s definition of infertility as \u0026ldquo;a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse\u0026rdquo; (15). Primary female infertility is defined as a woman who has never before been diagnosed with a clinical pregnancy and meets the criteria of being classified as having infertility\u0026rdquo;, while \u0026ldquo;secondary female infertility is defined as a woman currently unable to establish a clinical pregnancy but who has previously been diagnosed with a clinical pregnancy\u0026rdquo; (16). Since infertility is usually defined by the female population we calculated the epidemiology of infertility solely based on female data (4).\u003c/p\u003e \u003cp\u003eData analysis was performed using the Statistical Program for Social Sciences (SPSS v 20, IBM). Missing data for the variables analyzed were excluded. Continuous measurements were shown as mean standard deviation (SD) and categorical variables were expressed as percentages. For statistical analysis distributions were compared using Pearson\u0026rsquo;s chi-square test and Fisher\u0026rsquo;s exact test when appropriate. Binary logistic regression analyses were then performed within each subgroup, adjusting for confounders. For comparison of variables t-test and ANOVA test were used; 95% confidence interval was considered statistically significant p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e "},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eStudy population\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOur study population of 1920 participants consisted of residents of Ulaanbaatar city and four regions of Mongolia (Western, Eastern, Central and Khangai). The demographic and socio-economic characteristics of the participants are shown in Table 1.\u003c/p\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:justify;line-height:150%;'\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003eTable 1. Demographic and socio-economic characteristics of study participants\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv align=\"center\" style='margin-top:0in;margin-right:0in;margin-bottom:10.0pt;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;'\u003e\n \u003ctable style=\"border-collapse:collapse;border:none;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 221.4pt;border-right: none;border-bottom: none;border-left: none;border-image: initial;border-top: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;line-height:150%;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003eCharacteristics\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 243pt;border-right: none;border-bottom: none;border-left: none;border-image: initial;border-top: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003eWomen\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 221.4pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;line-height:150%;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.5in;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003en\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003e% of total\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 221.4pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;line-height:150%;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003eNumber of participants\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.5in;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family: \"Arial\",sans-serif;'\u003e1920\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family: \"Arial\",sans-serif;'\u003e100\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 221.4pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;line-height:150%;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003eRegion\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 243pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family: \"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 221.4pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003eUlaanbaatar\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.5in;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family: \"Arial\",sans-serif;'\u003e695\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family: \"Arial\",sans-serif;'\u003e36.2\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 221.4pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003eEastern\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.5in;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family: \"Arial\",sans-serif;'\u003e163\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family: \"Arial\",sans-serif;'\u003e8.5\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 221.4pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003eWestern\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.5in;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family: \"Arial\",sans-serif;'\u003e300\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family: \"Arial\",sans-serif;'\u003e15.6\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 221.4pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003eKhangai\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.5in;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family: \"Arial\",sans-serif;'\u003e395\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family: \"Arial\",sans-serif;'\u003e20.5\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 221.4pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003eCentral\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.5in;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family: \"Arial\",sans-serif;'\u003e368\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family: \"Arial\",sans-serif;'\u003e19.2\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 221.4pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;line-height:150%;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003eAge, years (Mean (SD))\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 243pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family: \"Arial\",sans-serif;'\u003e32.57\u0026plusmn;6.61\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 221.4pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;line-height:150%;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003eBMI, kg/m\u003csup\u003e2 \u0026nbsp;\u003c/sup\u003e(Mean (SD))\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 243pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family: \"Arial\",sans-serif;'\u003e25.08\u0026plusmn;4.52\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 221.4pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003eBMI, normal\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.5in;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family: \"Arial\",sans-serif;'\u003e1075\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family: \"Arial\",sans-serif;'\u003e56\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 221.4pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003eOverweight\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.5in;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family: \"Arial\",sans-serif;'\u003e555\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family: \"Arial\",sans-serif;'\u003e28.9\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 221.4pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003eObese 1 class\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.5in;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family: \"Arial\",sans-serif;'\u003e246\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family: \"Arial\",sans-serif;'\u003e12.8\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 221.4pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003eObese 2 class\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.5in;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family: \"Arial\",sans-serif;'\u003e35\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family: \"Arial\",sans-serif;'\u003e1.8\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 221.4pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003eObese 3 class\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.5in;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family: \"Arial\",sans-serif;'\u003e9\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family: \"Arial\",sans-serif;'\u003e0.5\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 221.4pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;line-height:150%;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003eEducation\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.5in;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family: \"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family: \"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 221.4pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003ePrimary school and below\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.5in;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family: \"Arial\",sans-serif;'\u003e212\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family: \"Arial\",sans-serif;'\u003e11\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 221.4pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003eMiddle and high school\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.5in;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family: \"Arial\",sans-serif;'\u003e533\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family: \"Arial\",sans-serif;'\u003e27.8\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 221.4pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003eCollege and above\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.5in;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family: \"Arial\",sans-serif;'\u003e1175\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family: \"Arial\",sans-serif;'\u003e61.2\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 221.4pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;line-height:150%;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003eOccupational Conditions\u003csup\u003eA\u003c/sup\u003e\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.5in;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family: \"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family: \"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 221.4pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003eNormal\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.5in;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family: \"Arial\",sans-serif;'\u003e1663\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family: \"Arial\",sans-serif;'\u003e86.6\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 221.4pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003eHazardous\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.5in;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family: \"Arial\",sans-serif;'\u003e257\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family: \"Arial\",sans-serif;'\u003e13.4\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 221.4pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;line-height:150%;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003eА\u003c/span\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003ennual household income, MNT\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.5in;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family: \"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family: \"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 221.4pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003e\u0026lt;900000\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.5in;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family: \"Arial\",sans-serif;'\u003e1232\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family: \"Arial\",sans-serif;'\u003e64.1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 221.4pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003e900000-\u003c/span\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003e1499999\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.5in;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family: \"Arial\",sans-serif;'\u003e518\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family: \"Arial\",sans-serif;'\u003e27\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 221.4pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003e\u0026gt;1500000\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.5in;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family: \"Arial\",sans-serif;'\u003e170\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family: \"Arial\",sans-serif;'\u003e8.9\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 221.4pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;line-height:150%;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003eTobacco use\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.5in;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family: \"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family: \"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 221.4pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003eNo\u003csup\u003eB\u003c/sup\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.5in;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003e1810\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003e94.2\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 221.4pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003eYes\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.5in;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003e110\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003e5.7\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 221.4pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;line-height:150%;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003eAlcohol consumption\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.5in;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 221.4pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003eNo\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.5in;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family: \"Arial\",sans-serif;'\u003e715\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family: \"Arial\",sans-serif;'\u003e37.2\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 221.4pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003eYes\u003csup\u003eC\u003c/sup\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.5in;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family: \"Arial\",sans-serif;'\u003e1205\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family: \"Arial\",sans-serif;'\u003e62.8\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:10.0pt;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;'\u003e\u003cstrong\u003e\u003csup\u003e\u003cspan style='font-size:15px;font-family:\"Arial\",sans-serif;'\u003eA\u0026nbsp;\u003c/span\u003e\u003c/sup\u003e\u003c/strong\u003e\u003cspan style='font-size:15px;font-family:\"Arial\",sans-serif;'\u003eAccording to Mongolian Labor Legislation, working conditions are divided into normal and hazardous\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:10.0pt;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;'\u003e\u003cstrong\u003e\u003csup\u003e\u003cspan style='font-size:15px;font-family:\"Arial\",sans-serif;'\u003eB\u0026nbsp;\u003c/span\u003e\u003c/sup\u003e\u003c/strong\u003e\u003cspan style='font-size:15px;font-family:\"Arial\",sans-serif;'\u003eIncluded people who never smoked\u0026rsquo;\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:10.0pt;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;'\u003e\u003cstrong\u003e\u003csup\u003e\u003cspan style='font-size:15px;font-family:\"Arial\",sans-serif;'\u003eC\u0026nbsp;\u003c/span\u003e\u003c/sup\u003e\u003c/strong\u003e\u003cspan style='font-size:15px;font-family:\"Arial\",sans-serif;'\u003eIncluded people who consumed alcohol within the past 12 months\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePrevalence of infertility and patterns of region\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOur study showed an infertility incidence of 7.2% (n=138), with primary infertility at 2.4% (n=46) and secondary infertility at 4.8% (n=92). Geographically the prevalence rate was as follows: Central region (8.2%, n=30), Khangai region (12.4%, n=49), Western region (7%, n=21), Eastern region (8%, n=13), Capital city Ulaanbaatar (3.6%, n=25) (Figure 1). In comparison with the sole urban area of Ulaanbaatar, the prevalence of infertility is significantly higher (p\u0026lt;0.001) amongst the rural population. As it is the only territory with a city status in Mongolia, we viewed it as the sole urban area.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAge related patterns of infertility\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOur results show that there is a trend of secondary and overall infertility that increases with the women\u0026rsquo;s age. However, the same trend is present in primary infertility (Table 2). Women between 40-45 years of age had the highest rate of infertility (10.6%) compared to women of the 20-24 years of age who had a low infertility rate (1.4%) (n=40) (p\u0026lt;0.0001)\u0026nbsp;\u003c/p\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;line-height:150%;'\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003eTable 2. Infertility prevalence age groups\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv align=\"center\" style='margin-top:0in;margin-right:0in;margin-bottom:10.0pt;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;'\u003e\n \u003ctable style=\"border-collapse:collapse;border:none;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 77.4pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;height: 48.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;line-height:150%;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;line-height:150%;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003eAge group\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 112.5pt;border-right: none;border-bottom: none;border-left: none;border-image: initial;border-top: 1pt solid windowtext;padding: 0in 5.4pt;height: 48.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:115%;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:115%;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:115%;font-family:\"Arial\",sans-serif;'\u003eFertile women n=1782\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 275.4pt;border-right: none;border-bottom: none;border-left: none;border-image: initial;border-top: 1pt solid windowtext;padding: 0in 5.4pt;height: 48.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003eInfertile women n=138\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 77.4pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;line-height:150%;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.85pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003en\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48.65pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003e(%)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003eOverall infertility (%)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003ePrimary infertility (%)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95.4pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003eSecondary infertility (%)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 77.4pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003e20-24\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.85pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family: \"Arial\",sans-serif;'\u003e216\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48.65pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family: \"Arial\",sans-serif;'\u003e11.3\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family: \"Arial\",sans-serif;'\u003e1.4\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family: \"Arial\",sans-serif;'\u003e1.4\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95.4pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family: \"Arial\",sans-serif;'\u003e0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 77.4pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003e25-29\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n 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style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family: \"Arial\",sans-serif;'\u003e5.4\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family: \"Arial\",sans-serif;'\u003e2.9\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95.4pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family: \"Arial\",sans-serif;'\u003e2.5\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 77.4pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003e30-34\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.85pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family: \"Arial\",sans-serif;'\u003e471\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48.65pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family: \"Arial\",sans-serif;'\u003e24.5\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family: \"Arial\",sans-serif;'\u003e7.9\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family: \"Arial\",sans-serif;'\u003e3\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95.4pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family: \"Arial\",sans-serif;'\u003e4.9\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 77.4pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003e35-39\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.85pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family: \"Arial\",sans-serif;'\u003e373\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48.65pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family: \"Arial\",sans-serif;'\u003e19.4\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family: \"Arial\",sans-serif;'\u003e8.6\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family: \"Arial\",sans-serif;'\u003e1.6\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95.4pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family: \"Arial\",sans-serif;'\u003e7\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 77.4pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003e40-45\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.85pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family: \"Arial\",sans-serif;'\u003e378\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48.65pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family: \"Arial\",sans-serif;'\u003e19.7\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family: \"Arial\",sans-serif;'\u003e10.6\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family: \"Arial\",sans-serif;'\u003e2.4\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95.4pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height:150%;font-family: \"Arial\",sans-serif;'\u003e8.2\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\u003cp?\n\u003cp\u003eFurthermore, when we map the prevalence of infertility as individual ages instead of groups, we notice a slow decline from ages 30-36 and then a sudden spike at ages 36-39 followed by a plateau until age 45. \u0026nbsp;(Figure 2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRisk factors for infertility\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe then divided our participants into two groups of either infertile or fertile females. Adjusting for age we calculated for the association between infertility and risk factors among women.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWe calculated the risk of infertility compared to the 20\u0026ndash;24-year age group. Among the risk factors age was the most significant risk factor, with the risk increasing by 4 to 8-fold with each progressing age group. Social factors, such as: occupational conditions and monthly household income were not significent risk factors for infertility however alcohol consumption, obesity, rural living and lower levels of education were significant risk factors (Table 3)\u0026nbsp;\u003c/p\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:10.0pt;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;line-height:150%;'\u003e\u003cspan style='font-family:\"Arial\",sans-serif;'\u003eTable 3. Infertility risk factors\u003c/span\u003e\u003c/p\u003e\n\u003cdiv align=\"center\" style='margin-top:0in;margin-right:0in;margin-bottom:10.0pt;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;'\u003e\n \u003ctable style=\"width:507.55pt;border-collapse:collapse;border:none;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 139.05pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;height: 52.25pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003eCharacteristic\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 76.5pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;height: 52.25pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003eFertile woman n=1782\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 292pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;height: 52.25pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003eInfertility women n=138\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 94.5pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 35.25pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003eOverall infertility n=138\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;height: 35.25pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003eUnadjusted OR (95 CI)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98.5pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;height: 35.25pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003eAge adjusted OR (95% CI)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139.05pt;border: none;padding: 0in 5.4pt;height: 17.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003eAge groups (women) (%)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76.5pt;border: none;padding: 0in 5.4pt;height: 17.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94.5pt;border: none;padding: 0in 5.4pt;height: 17.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99pt;border: none;padding: 0in 5.4pt;height: 17.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98.5pt;border: none;padding: 0in 5.4pt;height: 17.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139.05pt;padding: 0in 5.4pt;height: 17.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003e20-24\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76.5pt;padding: 0in 5.4pt;height: 17.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003e12\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94.5pt;padding: 0in 5.4pt;height: 17.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003e2.2\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99pt;padding: 0in 5.4pt;height: 17.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003eref\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98.5pt;padding: 0in 5.4pt;height: 17.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139.05pt;padding: 0in 5.4pt;height: 17pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003e25-29\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76.5pt;padding: 0in 5.4pt;height: 17pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003e25.6\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94.5pt;padding: 0in 5.4pt;height: 17pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003e18.8\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99pt;padding: 0in 5.4pt;height: 17pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003e4.04 (1.21-13.52)*\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98.5pt;padding: 0in 5.4pt;height: 17pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139.05pt;padding: 0in 5.4pt;height: 11.2pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003e30-34\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76.5pt;padding: 0in 5.4pt;height: 11.2pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003e24.4\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94.5pt;padding: 0in 5.4pt;height: 11.2pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003e26.8\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99pt;padding: 0in 5.4pt;height: 11.2pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003e6.05 (1.84-19.85)**\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98.5pt;padding: 0in 5.4pt;height: 11.2pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139.05pt;padding: 0in 5.4pt;height: 15.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003e35-39\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76.5pt;padding: 0in 5.4pt;height: 15.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003e19.1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94.5pt;padding: 0in 5.4pt;height: 15.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003e23.2\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99pt;padding: 0in 5.4pt;height: 15.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003e6.66 (2.01-22.02)**\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98.5pt;padding: 0in 5.4pt;height: 15.7pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139.05pt;padding: 0in 5.4pt;height: 17pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003e40-45\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76.5pt;padding: 0in 5.4pt;height: 17pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003e19\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94.5pt;padding: 0in 5.4pt;height: 17pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003e29\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99pt;padding: 0in 5.4pt;height: 17pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003e8.4 (2.56-27.5)***\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98.5pt;padding: 0in 5.4pt;height: 17pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139.05pt;padding: 0in 5.4pt;height: 17.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003eEducation\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76.5pt;padding: 0in 5.4pt;height: 17.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94.5pt;padding: 0in 5.4pt;height: 17.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99pt;padding: 0in 5.4pt;height: 17.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98.5pt;padding: 0in 5.4pt;height: 17.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139.05pt;padding: 0in 5.4pt;height: 17.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003ePrimary school and below\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76.5pt;padding: 0in 5.4pt;height: 17.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003e10.9\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94.5pt;padding: 0in 5.4pt;height: 17.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003e13\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99pt;padding: 0in 5.4pt;height: 17.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003e1.44 (0.84-2.47)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98.5pt;padding: 0in 5.4pt;height: 17.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003e1.18 (0.68-2.05)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139.05pt;padding: 0in 5.4pt;height: 17pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003eMiddle and high school\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76.5pt;padding: 0in 5.4pt;height: 17pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003e27.2\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94.5pt;padding: 0in 5.4pt;height: 17pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003e35.5\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99pt;padding: 0in 5.4pt;height: 17pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003e1.57 (1.07-2.3)**\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98.5pt;padding: 0in 5.4pt;height: 17pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003e1.4 (0.95-2.06)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139.05pt;padding: 0in 5.4pt;height: 17.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003eCollege and above\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76.5pt;padding: 0in 5.4pt;height: 17.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003e62\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94.5pt;padding: 0in 5.4pt;height: 17.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003e51.4\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99pt;padding: 0in 5.4pt;height: 17.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003eref\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98.5pt;padding: 0in 5.4pt;height: 17.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003eref\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139.05pt;padding: 0in 5.4pt;height: 17pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003eLiving region\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76.5pt;padding: 0in 5.4pt;height: 17pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94.5pt;padding: 0in 5.4pt;height: 17pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99pt;padding: 0in 5.4pt;height: 17pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98.5pt;padding: 0in 5.4pt;height: 17pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139.05pt;padding: 0in 5.4pt;height: 17.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003eCity region\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76.5pt;padding: 0in 5.4pt;height: 17.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003e58.1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94.5pt;padding: 0in 5.4pt;height: 17.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003e37.7\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99pt;padding: 0in 5.4pt;height: 17.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003eref\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98.5pt;padding: 0in 5.4pt;height: 17.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003eref\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139.05pt;padding: 0in 5.4pt;height: 17.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003eRural region\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76.5pt;padding: 0in 5.4pt;height: 17.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003e41.9\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94.5pt;padding: 0in 5.4pt;height: 17.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003e62.3\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99pt;padding: 0in 5.4pt;height: 17.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003e2.29 (1.06-3.27)***\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98.5pt;padding: 0in 5.4pt;height: 17.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003e2.05 (1.38-3.04)***\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139.05pt;padding: 0in 5.4pt;height: 17.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003eBMI\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76.5pt;padding: 0in 5.4pt;height: 17.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94.5pt;padding: 0in 5.4pt;height: 17.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99pt;padding: 0in 5.4pt;height: 17.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98.5pt;padding: 0in 5.4pt;height: 17.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139.05pt;padding: 0in 5.4pt;height: 17pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003eNormal\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76.5pt;padding: 0in 5.4pt;height: 17pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003e53.4\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94.5pt;padding: 0in 5.4pt;height: 17pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003e45.7\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99pt;padding: 0in 5.4pt;height: 17pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003eref\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98.5pt;padding: 0in 5.4pt;height: 17pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003eref\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139.05pt;padding: 0in 5.4pt;height: 17.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003eUnderweight\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n 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style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003e0.47 (0.11-1.99)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98.5pt;padding: 0in 5.4pt;height: 17.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003e1.2 (0.08-17.34)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139.05pt;padding: 0in 5.4pt;height: 17.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003ePre-Obesity\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76.5pt;padding: 0in 5.4pt;height: 17.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003e27.9\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94.5pt;padding: 0in 5.4pt;height: 17.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan 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150%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94.5pt;padding: 0in 5.4pt;height: 17.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99pt;padding: 0in 5.4pt;height: 17.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98.5pt;padding: 0in 5.4pt;height: 17.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139.05pt;padding: 0in 5.4pt;height: 17pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003eActive\u003csup\u003eA\u003c/sup\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76.5pt;padding: 0in 5.4pt;height: 17pt;vertical-align: top;\"\u003e\n \u003cp 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style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003e0.9 (0.58-1.39)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98.5pt;padding: 0in 5.4pt;height: 17.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003e0.89 (0.57-1.38)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139.05pt;padding: 0in 5.4pt;height: 17pt;vertical-align: top;\"\u003e\n \u003cp 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style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99pt;padding: 0in 5.4pt;height: 17pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98.5pt;padding: 0in 5.4pt;height: 17pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan 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150%;font-family:\"Arial\",sans-serif;'\u003e94.1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94.5pt;padding: 0in 5.4pt;height: 17.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003e92\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99pt;padding: 0in 5.4pt;height: 17.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003eref\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98.5pt;padding: 0in 5.4pt;height: 17.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003eref\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139.05pt;padding: 0in 5.4pt;height: 17.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003eYes\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76.5pt;padding: 0in 5.4pt;height: 17.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003e5.9\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94.5pt;padding: 0in 5.4pt;height: 17.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003e8\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99pt;padding: 0in 5.4pt;height: 17.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003e1.3 (0.72-2.64)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98.5pt;padding: 0in 5.4pt;height: 17.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003e1.33 (0.69-2.55)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139.05pt;padding: 0in 5.4pt;height: 17pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Arial\",sans-serif;'\u003eAlcohol consumption\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76.5pt;padding: 0in 5.4pt;height: 17pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94.5pt;padding: 0in 5.4pt;height: 17pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99pt;padding: 0in 5.4pt;height: 17pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98.5pt;padding: 0in 5.4pt;height: 17pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139.05pt;padding: 0in 5.4pt;height: 17.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003eNo\u003csup\u003eC\u003c/sup\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76.5pt;padding: 0in 5.4pt;height: 17.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003e37.2\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94.5pt;padding: 0in 5.4pt;height: 17.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003e23.2\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99pt;padding: 0in 5.4pt;height: 17.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003eref\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98.5pt;padding: 0in 5.4pt;height: 17.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003eref\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139.05pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 12.55pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003eYes\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76.5pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 12.55pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003e62.8\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94.5pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 12.55pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003e76.8\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 12.55pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003e2.05 (1.37-3.09)***\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98.5pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 12.55pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style='font-size:13px;line-height: 150%;font-family:\"Arial\",sans-serif;'\u003e1.98 (1.31-2.98)***\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:10.0pt;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;'\u003e\u003cspan style='font-size:15px;font-family:\"Arial\",sans-serif;'\u003e*\u0026lt;0.05, **\u0026lt;0.01, ***\u0026lt;0.001\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:10.0pt;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:justify;'\u003e\u003csup\u003e\u003cspan style='font-size:15px;font-family:\"Arial\",sans-serif;'\u003eA\u0026nbsp;\u003c/span\u003e\u003c/sup\u003e\u003cspan style='font-size:15px;font-family:\"Arial\",sans-serif;'\u003eDefined as at\u0026nbsp;\u003c/span\u003e\u003cspan style='font-size:15px;font-family:\"Arial\",sans-serif;'\u003eleast 150\u0026ndash;300 minutes of moderate-intensity aerobic physical activity\u003c/span\u003e\u003cspan style='font-size:15px;font-family:\"Arial\",sans-serif;'\u003e\u0026nbsp;or\u0026nbsp;\u003c/span\u003e\u003cspan style='font-size:15px;font-family:\"Arial\",sans-serif;'\u003eat least 75\u0026ndash;150 minutes of vigorous-intensity aerobic physical activity; or an equivalent combination of moderate- and vigorous-intensity activity throughout the week\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:10.0pt;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:justify;'\u003e\u003csup\u003e\u003cspan style='font-size:15px;font-family:\"Arial\",sans-serif;'\u003eB\u0026nbsp;\u003c/span\u003e\u003c/sup\u003e\u003cspan style='font-size:15px;font-family:\"Arial\",sans-serif;'\u003eIncluded people who have never smoked\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:10.0pt;margin-left:0in;font-size:16px;font-family:\"Cambria\",serif;text-align:justify;'\u003e\u003csup\u003e\u003cspan style='font-size:15px;font-family:\"Arial\",sans-serif;'\u003eC \u0026nbsp;\u003c/span\u003e\u003c/sup\u003e\u003cspan style='font-size:15px;font-family:\"Arial\",sans-serif;'\u003eIncluded people who consumed alcohol within the past 12 months\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003eWe used the participant\u0026rsquo;s self-reported gynecological history to calculate the risks it imposed. We found the following risks associated with infertility: abnormal menstrual cycles 1.5 (CI 1.07-2.15 p\u0026lt;0.01 ), thyroid disease\u0026nbsp;1.6\u0026nbsp;(CI 0.98-2.79 p\u0026lt;0.05),\u0026nbsp;intrauterine growth restriction\u0026nbsp;2.1\u0026nbsp;(CI 1.22-3.73 p\u0026lt;0.001), ectopic pregnancy\u0026nbsp;\u0026nbsp;2.6\u0026nbsp;(CI 1.2-5.69 p\u0026lt;0.01) recurrent ectopic pregnancy\u0026nbsp;13.3\u0026nbsp;(CI 1.87-95.84 p\u0026lt;0.01), ovarian cysts\u0026nbsp;4.7\u0026nbsp;(CI 3.12-7.34 p\u0026lt;0.0001), endometrial polyps\u0026nbsp;4.1\u0026nbsp;(CI 1.99-8.59 p\u0026lt;0.0001), endometriosis\u0026nbsp;5.8\u0026nbsp;(CI 1.78-19.34 p\u0026lt;0.01), gynecological operative history (ovarian cystectomy,\u0026nbsp;oophorectomy, salpingectomy,\u0026nbsp;abortion,\u0026nbsp;cesarean section)\u0026nbsp;2.6 (CI 1.72-4.06 p\u0026lt;0.0001) .\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical consultations for infertile couples\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOf the total infertile participants (n=138), 77.5% (n=107) had sought clinical consultation regarding their infertility, while 22.5% (n=31) never sought any type of clinical consultation. Among the group that sought clinical consultation 29.7% (n=41) of the women had received some form of treatment, with hormonal therapy being most commonly used at 14.3%, followed by timing therapy at 4.5%, IUI therapy 0% and assisted reproductive technology ART at 0.8% (n=1) was scarce.\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":" \u003cp\u003eMongolia is a land locked nation that borders the People\u0026rsquo;s Republic China to the south and the Russian Federation to the north. It is comprised of 21 provinces distributed in 4 regions (Khangai, Central, Eastern and Western) and Ulaanbaatar city. Globally it ranks 6th for the least densely populated country at approximately 1.7 persons per squared kilometer.\u003c/p\u003e \u003cp\u003eThe Mongolian Government's policy on population development between 2016\u0026ndash;2025 is to create favorable conditions for sustainable population growth.\u003c/p\u003e \u003cp\u003eUntil now there has not been population-based studies on infertility and its risk factors in Mongolia. Researchers used the number of couples and females with infertility in a certain time and location in relation to the total population to calculate the prevalence rate of infertility. The prevalence of infertility can be defined as the total number of women or couples who experience infertility within a given period of time and in a given place, in proportion to the total population in the same time and place(3). Our study was done using this definition, for the population of Ulaanbaatar and the four regions of Mongolia. We found an infertility prevalence of 7.2% which is in agreement with similar studies from around the world that had a median infertility prevalence ranging from 6.9\u0026ndash;9.3% [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Mongolia is a developing country and our result of 7.2% was similar to the global rate of infertility in developing countries at 6.9\u0026ndash;9.3%(9).\u003c/p\u003e \u003cp\u003eLarsen et al.\u0026rsquo;s study of primary and secondary infertility in sub-Saharan Africa showed a prevalence of primary and secondary infertility of 3% and 5% respectively(17). This was in keeping with our study, which showed a prevalence of primary and secondary infertility of 2.4% and 4.8% respectively. However, their definition of infertility as \u0026ldquo;5 years or more of failure to conceive\u0026rdquo; was not the same as our definition of infertility, which was 12 months of failed conception. Both Mongolia and the Sub-Saharan region had a high rate of gonorrhea and chlamydia(11) (18), which are risk factors for secondary infertility that could explain the similar results of the two studies. A study done in a fellow low- and middle-income country, Nigeria had a prevalence rate of infertility rate of 31.1%(19). This is much higher than the infertility rate we measured in Mongolia but it may be due to a different study design. A population-based study conducted in our neighboring country China, had a prevalence of 15.5%(20). Although both studies used the same definition of infertility and study methods, we believe the contrasting result of 7.2% is due to governmental policy on reproduction (China\u0026rsquo;s one-child policy), inclusion criteria, the age of the participants, socio-economic values and other factors. Recent meta-analysis study results in Iran showed a very similar result to our own with a total infertility prevalence of 7.8% to our 7.2%. However, these studies had primary and secondary infertility rates of 3.9% and 2.18% while our data showed 2.4% and 4.8% respectively. (21)\u003c/p\u003e \u003cp\u003eThere are numerous risk factors that contribute to female subfertility and it is important to diagnose each carefully in order to treat patients appropriately(22). Risk factors which vary between different regions of the world, include: the genetics of the population, socio-economic factors, differences in government policy, health care, nutrition, age of the participants, and STIs. High levels of STIs present in the population contribute to secondary infertility (23). Our study shows that important risk factors for infertility in Mongolia are age of the woman, alcohol consumption, obesity, rural living, and the level of education of the couple\u003c/p\u003e \u003cp\u003eIn women, the quantity and quality of oocytes is known to decline with age, with the resulting decline in fecundity becoming clinically relevant by the mid 30s (24). Interestingly our results showed a steady decline in fertility through the ages of 30\u0026ndash;36 followed by a sudden spike then plateauing until age 45. Another possible contributing factor for infertility increasing with age in women is that susceptibility to infection also increases with age. A Scottish fertility clinic study found that women over 35 were more likely to be diagnosed with tubal factor infertility than younger women (OR 2.2, CI 1.7\u0026ndash;2.7) (25). In a study conducted in Turkey infertility was significantly higher among women aged between 35 and 49 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01)(26).\u003c/p\u003e \u003cp\u003eIn our study a women\u0026rsquo;s level of education was one of the factors affecting female infertility. This is agreement with a study China which showed that increasing levels of education was inversely correlated with a decreased the risk of infertility(27). This may be due to a link between higher levels od education healthier lifestyles and better healthcare.\u003c/p\u003e \u003cp\u003eWe also found that obesity contributed to infertility which may be related to abnormal metabolism. Clinical studies definitively demonstrate an impact of obesity on the risk of subfertility(28). Cohort studies showed that there is an increased risk of anovulation in extremely heavy exercisers (\u0026gt;\u0026thinsp;60 min/day), but vigorous exercise of 30\u0026ndash;60 min/day was associated with reduced risk of anovulatory infertility(29).\u003c/p\u003e \u003cp\u003eWe attribute the higher rates of infertility in rural areas compared to urban areas due to limited the access to healthcare. For instance, all 6 of the fertility clinics in Mongolia are located in the city of Ulaanbaatar. Among the infertile women in our study, only 0.8% had undergone IVF therapy, compared to China\u0026rsquo;s 5.6% IVF therapy and 29.4% traditional Chinese medicine rates. (27) Furthermore with only 14.3% of our infertile participants who received hormone therapy had poor access to advanced fertility treatment.\u003c/p\u003e \u003cp\u003eInfertility is expected to change in populations over time. In a US National Health report it was shown that infertility fell from 8.5% in 1982 to 7.4% in 2002(30). Further declines in infertility were seen in 2006 (31). These declines in infertility may be due to improved nutrition and general health of the population and improvements in assisted reproductive techniques (ART). In Mongolia we were unable to look for these trends as this was our first report, but we hope in the future to conduct further studies on infertility.\u003c/p\u003e \u003cp\u003eOur study calls for further quantitative and qualitative research specifically designed to identify the causes of declining fertility, the socio-demographic and medical factors contributing to infertility and the links between infertility and the use of ART in Mongolia. Furthermore, we hope our results can help highlight the need for legislation and policies to increase ART accessibility and availability to patients in rural areas.\u003c/p\u003e "},{"header":"Strengths and Limitations","content":" \u003cp\u003eWe used a population-based method to study infertility in 4 regions of Mongolia and the city Ulaanbaatar. The sample size and methods were rigorous for this study. We used only one definition to determine infertility, which limited us to using strict inclusion criteria. We used a self-reporting method to assess infertility and this can be subject to bias.\u003c/p\u003e "},{"header":"Conclusions","content":" \u003cp\u003eIn conclusion, the overall 12 months prevalence of infertility was 7.2% and primary and secondary infertility was 2.4% and 4.8%. Our study shows the most significant risk factors for infertility were: age, obesity alcohol consumption, rural living and having a low level of education. An unfavorable gynecological history also posed a risk to fertility. Occupational conditions, and monthly household income were not significant risk factors for infertility. Since this is the first population-based study in Mongolia we were not able to measure trends in infertility prevalence but intend to do so in the future.\u003c/p\u003e "},{"header":"Abbreviations","content":"\u003cp\u003e\u003cstrong\u003eANOVA: \u003c/strong\u003eAnalysis of variance\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eART: \u003c/strong\u003eAssisted reproductive technology\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIVF: \u003c/strong\u003ein vitro fertilization\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSD: \u003c/strong\u003eStandard deviation\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSPSS: \u003c/strong\u003eStatistical Program for Social Sciences\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSTI\u0026rsquo;s: \u003c/strong\u003eSexually transmitted infections\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eWHO: \u003c/strong\u003eWorld Health Organization\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eDetails of ethics approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from the Ethics Committee of Mongolian National University of Medical Sciences (No16/3/2016-16) to conduct our survey. All participants agreed to an informed consent form, after accepting to be included.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analyzed during this study are included in this published article [and its supplementary information files].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding: \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOur study was supported by the Mongolian National University of Medical Sciences\u0026rsquo; Science and Technology Support Fund\u0026rsquo;s \u0026ldquo;Domestication of IVF technology in Mongolia project.\u0026rdquo; The funders of this study had no influence in the design, implementation, analysis, or the manuscript preparation of this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOE, MM, ET, LE, have drafted the work and substantively revised it as well as the design conception. TN, KhB, AE, AG, BM, have participated in the acquisition and analysis of data, as well as\u0026nbsp;drafted this manuscript. KhN worked on the interpretation of data. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe express our sincere gratitude to the Mongolian National University of Medical Sciences for their immense support. We thank the School of Bio-Medicine and Department of Pathophysiology for the crucial advice and organization. We extend our appreciation to ZEPH (Young Pathophysiologists\u0026rsquo; Club) for their contribution for the integrity of our survey.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eZegers-Hochschild F, Adamson GD, de Mouzon J, Ishihara O, Mansour R, Nygren K, et al. 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Facts, views \u0026amp; vision in ObGyn. 2011;3(4):257 \u0026ndash; 66.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMascarenhas MN, Flaxman SR, Boerma T, Vanderpoel S, Stevens GA. National, regional, and global trends in infertility prevalence since 1990: a systematic analysis of 277 health surveys. PLoS Med. 2012;9(12):e1001356.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbebe MS, Afework M, Abaynew Y. Primary and secondary infertility in Africa: systematic review with meta-analysis. Fertility research practice. 2020;6(1):20.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBadrakh J, Zayasaikhan S, Jagdagsuren D, Enkhbat E, Jadambaa N, Munkhbaatar S, et al. Trends in adult chlamydia and gonorrhoea prevalence, incidence and urethral discharge case reporting in Mongolia from 1995 to 2016 - estimates using the Spectrum-STI model. Western Pacific surveillance response journal: WPSAR. 2017;8(4):20\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBeck C, Berry NS, Choijil S. Health system reform and safe abortion: a case study of Mongolia. Glob Public Health. 2013;8(2):174\u0026ndash;86.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBayasgalan G, Naranbat D, Tsedmaa B, Tsogmaa B, Sukhee D, Amarjargal O, et al. Clinical patterns and major causes of infertility in Mongolia. J Obstet Gynaecol Res. 2004;30(5):386\u0026ndash;93.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organization. Regional Office for South-East A. WHO STEPS survey: step towards a healthier world: monitoring noncommunicable diseases and their risk factors. New Delhi: World Health Organization. Regional Office for South-East Asia; 2018 2018.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZegers-Hochschild F, Nygren KG, Adamson GD, de Mouzon J, Lancaster P, Mansour R, et al. The International Committee Monitoring Assisted Reproductive Technologies (ICMART) glossary on ART terminology. Fertility sterility. 2006;86(1):16\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZegers-Hochschild F, Adamson GD, Dyer S, Racowsky C, de Mouzon J, Sokol R, et al. The International Glossary on Infertility and Fertility Care, 2017. Human reproduction (Oxford, England). 2017;32(9):1786 \u0026ndash; 801.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLarsen U. Primary and secondary infertility in sub-Saharan Africa. Int J Epidemiol. 2000;29(2):285\u0026ndash;91.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDubbink JH, Verweij SP, Struthers HE, Ouburg S, McIntyre JA, Morr\u0026eacute; SA, et al. Genital Chlamydia trachomatis and Neisseria gonorrhoeae infections among women in sub-Saharan Africa: A structured review. Int J STD AIDS. 2018;29(8):806\u0026ndash;24.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePolis CB, Cox CM, Tun\u0026ccedil;alp \u0026Ouml;, McLain AC, Thoma ME. Estimating infertility prevalence in low-to-middle-income countries: an application of a current duration approach to Demographic and Health Survey data. Hum Reprod. 2017;32(5):1064\u0026ndash;74.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhou Z, Zheng D, Wu H, Li R, Xu S, Kang Y, et al. Epidemiology of infertility in China: a population-based study. BJOG: an international journal of obstetrics gynaecology. 2018;125(4):432\u0026ndash;41.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSaei Ghare Naz M, Ozgoli G, Sayehmiri K. Prevalence of Infertility In Iran: A Systematic Review And Meta-Analysis. Urology journal. 2020;17(4):338\u0026ndash;45.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFarquhar CM, Bhattacharya S, Repping S, Mastenbroek S, Kamath MS, Marjoribanks J, et al. Female subfertility. Nature reviews Disease primers. 2019;5(1):7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTsevat DG, Wiesenfeld HC, Parks C, Peipert JF. Sexually transmitted diseases and infertility. American journal of obstetrics gynecology. 2017;216(1):1\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBaird DT, Collins J, Egozcue J, Evers LH, Gianaroli L, Leridon H, et al. Fertility and ageing. Hum Reprod Update. 2005;11(3):261\u0026ndash;76.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMaheshwari A, Hamilton M, Bhattacharya S. Effect of female age on the diagnostic categories of infertility. Human reproduction (Oxford England). 2008;23(3):538\u0026ndash;42.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSarac M, Koc I. PREVALENCE AND RISK FACTORS OF INFERTILITY. IN TURKEY: EVIDENCE FROM DEMOGRAPHIC AND HEALTH SURVEYS, 1993\u0026ndash;2013. J Biosoc Sci. 2018;50(4):472\u0026ndash;90.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZheng D, Zhou Z, Li R, Wu H, Xu S, Kang Y, et al. Consultation and treatment behaviour of infertile couples in China: a population-based study. Reprod Biomed Online. 2019;38(6):917\u0026ndash;25.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBroughton DE, Moley KH. Obesity and female infertility: potential mediators of obesity's impact. Fertility sterility. 2017;107(4):840\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHakimi O, Cameron LC. Effect of Exercise on Ovulation: A Systematic Review. Sports medicine (Auckland, NZ). 2017;47(8):1555\u0026ndash;67.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChandra A, Copen CE, Stephen EH. Infertility and impaired fecundity in the United States, 1982\u0026ndash;2010: data from the National Survey of Family Growth. National health statistics reports. 2013(67):1\u0026ndash;18, 1 p following 9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStephen EH, Chandra A. Declining estimates of infertility in the United States: 1982\u0026ndash;2002. Fertility sterility. 2006;86(3):516\u0026ndash;23.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Prevalence, female infertility, risk factors, population-based study, developing country, Mongolia","lastPublishedDoi":"10.21203/rs.3.rs-26781/v3","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-26781/v3","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eWorldwide, the median prevalence of infertility is 9%, but rates in different countries vary from 3.5% to 16.7%. Infertility, which is defined by the World Health Organization (WHO) as the failure to conceive after 12 months of unprotected regular sexual intercourse, is reproductive health problems carries a social stigma and can greatly impact a couple’s self-esteem and wellbeing. There are a number of risk factors associated with infertility such as: culture, socio-economic factors, age and health care including treatment of sexually transmitted diseases. We have achieved the first population-based study on the prevalence of infertility in reproductive aged women in Mongolia, and the factors that influence it.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMethod: \u003c/strong\u003eWe conducted a population-based cross-sectional study in 4 regions (Khangai, Eastern, Western, Central) of Mongolia and the capital city Ulaanbaatar. Our questionnaire consisted of categories that influenced infertility such as: socio-economic status, lifestyle factors, health, reproductive history, present status and sexual function.\u0026nbsp;Trained staff conducted face-to-face interviews with the participants.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eA total of 1,920 couples residing in 4 regions of Mongolia and the capital city, Ulaanbaatar were studied. The median prevalence rate of infertility was 7.2%, which is similar to the worldwide infertility rate of 9%. Primary and secondary infertility was 2.4% and 4.8% respectively. Our study showed that the most important risk factors for infertility were age, rural living, low levels of education, obesity and diseases of the female reproductive system. Only 14.8% of infertile patients received hormone therapy, and even fewer infertile patients (0.8%) received \u003cem\u003ein vitro\u003c/em\u003e fertilization (IVF) treatment.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eThe prevalence rate of infertility is comparable to global rates among other developing countries. Our study shows that significant risk factors for infertility were: age, living in rural communities, having a low level of education, obesity and diseases of the female reproductive system.\u0026nbsp;Occupational conditions, and monthly household income were not significant risk factors for infertility.\u0026nbsp;Since this is the first population-based study in Mongolia we were not able to measure trends in infertility prevalence but intend to do so in the future.\u003c/p\u003e","manuscriptTitle":"Prevalence and Risk factors of Infertility in a Mongolian Population","msid":"","msnumber":"","nonDraftVersions":[{"code":3,"date":"2021-05-06 17:05:13","doi":"10.21203/rs.3.rs-26781/v3","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}},{"code":"","date":"2021-04-27 00:00:00","doi":"","editorialEvents":[{"type":"notPreprinted","content":""}],"status":"timeline","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}},{"code":2,"date":"2020-07-28 18:53:30","doi":"10.21203/rs.3.rs-26781/v2","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}},{"code":1,"date":"2020-05-11 16:20:52","doi":"10.21203/rs.3.rs-26781/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"143d807a-9405-419a-8de3-e2eeddf629fa","owner":[],"postedDate":"May 6th, 2021","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":4141012,"name":"Sexual \u0026 Reproductive Medicine"}],"tags":[],"updatedAt":"2024-05-01T22:22:16+00:00","versionOfRecord":{"articleIdentity":"rs-26781","link":"https://doi.org/10.4103/2305-0500.377501","journal":{"identity":"asian-pacific-journal-of-reproduction","isVorOnly":true,"title":"Asian Pacific Journal of Reproduction"},"publishedOn":"2023-01-01 22:22:16","publishedOnDateReadable":"January 1st, 2023"},"versionCreatedAt":"2021-05-06 17:05:13","video":"","vorDoi":"10.4103/2305-0500.377501","vorDoiUrl":"https://doi.org/10.4103/2305-0500.377501","workflowStages":[]},"version":"v3","identity":"rs-26781","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-26781","identity":"rs-26781","version":["v3"]},"buildId":"_2-kVJe1T_tPrBINL-cwx","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}