Factors that influence the childbearing intentions of Canadian men

Determinants of childbearing intentions among pregnant women with a suspected fetal congenital heart disease

BACKGROUND

The Saudi population is characterized by a high fertility rate, a conservative sociocultural context, and an ongoing societal and lifestyle transition. Yet, data regarding childbearing intentions and the associated factors is scarce. Furthermore, childbearing intention may be impacted by abnormal pregnancy events, such as the clinical suspicion or diagnosis of a fetal congenital disease and the negative experience that may result from it.

OBJECTIVES

The present study explored childbearing intention and determined the sociodemographic and health-related factors discouraging from future pregnancies among women visiting the cardiology clinic for antenatal screening of congenital heart diseases (CHD).

METHODS

A one-year cross-sectional study involved 150 consecutive pregnant women aged between 18 and 47 years old, who presented for antenatal screening of CHD at the fetal echocardiography clinic for, of a teaching hospital in Jeddah, Saudi Arabia. An interview-based questionnaire was administered before the clinic visit and collected sociodemographic data, obstetrical history, risk factors of congenital diseases, mothers' knowledge about fetal echocardiography and CHDs, and childbearing intention (the primary outcome).

RESULTS

Fetal echocardiography and CHD were correctly described by 60 % and 31.3 % of the participants respectively, while 40.7 % and 12 % recognized the association of congenital diseases with consanguinity and advanced maternal age respectively. Childbearing intentions showed 68.0 % of the participants declared desiring a future baby while the remaining 32.0 % declared having no further pregnancy expectations. Attitudes towards a hypothetical baby with CHD were positive in 97.3 % of the participants, and only 30 % declared that the fetal echocardiography results will impact their future childbearing decision. However, childbearing intention showed no significant association with knowledge or attitudes towards CHD. On the other hand, childbearing intention was independently associated with the number of children (OR=0.34; p<0.001), consanguinity with husband (OR=3.64; p = 0.010), and history of gestational diabetes (OR=0.28; p = 0.040).

CONCLUSION

Fertility expectations among Saudi mothers are more likely to be impacted by the personal experience and judgment of own pregnancy fitness, while no significant impact of fetal risks and events. This demonstrates a certain level of autonomy balanced with deeply rooted religious ethics yet combined with a lack of awareness about fetal and maternal risks associated with advanced maternal age and consanguinity. We emphasize the unmet need of education and family planning.

Fitness Costs of Insecure Romantic Attachment: The Role of Reproductive Motivation and Long-Term Mating

Attachment styles are frequently viewed from within the evolutionary conceptual framework; however, their associations with evolutionary fitness are very rarely empirically explored. In the present research (N = 448), we analyzed the relations between romantic attachment (anxiety and avoidance) and various fitness indicators in Serbian adults: matting patterns (short and long-term mating), reproductive motivation, reproductive success (age of first birth, number of children, and grandchildren), and kin care (care for biological relatives in general and care for children). Congruent negative associations between insecure styles and fitness outcomes were found: this is particularly true for avoidance, which is negatively related to long-term mating, reproductive motivation, number of children, and kin care. Furthermore, the data showed that reproductive motivation and long-term mating may mediate the links between avoidance and the number of children. Anxiety was negatively related to reproductive motivation and the number of children; this attachment style was also negatively associated with care for children, but only in males. The present data suggest that secure romantic bonding may be evolutionary adaptive; the obtained results contradict some evolutionary theories that assume that insecure attachment has some adaptive benefits as well. Findings provide new insights into the role of romantic attachment in the behavioral ecology of pair bonding.

Factors related to pregnancy status and unwanted pregnancy among lebanese women during the COVID-19 lockdown: a cross-sectional study

Background

Home confinement and lockdowns have created challenges and vulnerabilities, causing relevant changes in sexual health and couple stability, particularly in women. The objective of this study was to evaluate the socio-economic and psychological factors related to current pregnancy status and unwanted pregnancy among Lebanese women during the COVID-19 lockdown.

Methods

A cross-sectional online study conducted between June 8 and August 1, 2020, enrolled 369 Lebanese women using the snowball technique for data collection. All married women between 18 and 51, with access to the internet and currently living with their partners, were eligible to participate. Current pregnancy status and unwanted pregnancy were assessed using binary questions. The SPSS software 25 was used for data analysis, and multivariable analysis was performed, taking the pregnancy status and unwanted pregnancy as the dependent variables. The statistical significance was set at a p-value < 0.05.

Results

Our results showed that 11.1% of women were pregnant, of whom 22.0% reported unwanted pregnancies. Having children (ORa = 0.183) and taking contraceptives (ORa = 0.231) were significantly associated with a reduced chance of becoming pregnant. Higher psychological violence would negatively affect pregnancy, but the association was not significant (p = 0.065). Regular visits to the physician for routine checks were also linked to a decreased risk of unwanted pregnancy (ORa = 0.053). Higher psychological violence would affect unwanted pregnancy; however, the association was insignificant (p = 0.056).

Conclusion

The study findings showed that having children and taking contraceptives are associated with a reduced pregnancy. Additionally, psychological violence was found to be related to current pregnancy status and unplanned pregnancy. During a pandemic, vulnerable women should be identified and given adequate care, knowledge, and awareness regarding their reproductive health.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13690-022-00833-2.

Phenotypic Signals of Sexual Selection and Fast Life History Dynamics for the Long-Term but Not Short-Term Mating

Mating patterns are crucial for understanding selection regimes in current populations and highly implicative for sexual selection and life history theory. However, empirical data on the relations between mating and reproductive outcomes in contemporary humans are lacking. In the present research we examined the sexual selection on mating (with an emphasis on Bateman's third parameter - the association between mating and reproductive success) and life history dynamics of mating by examining the relations between mating patterns and a comprehensive set of variables which determine human reproductive ecology. We conducted two studies (Study 1: N = 398, Study 2: N = 996, the sample was representative for participants' sex, age, region, and settlement size). The findings from these studies were mutually congruent and complementary. In general, the data suggested that short-term mating was unrelated or even negatively related to reproductive success. Conversely, long-term mating was positively associated with reproductive success (number of children in Study 1; number of children and grandchildren in Study 2) and there were indices that the beneficial role of long-term mating is more pronounced in males, which is in accordance with Bateman's third principle. Observed age of first reproduction mediated the link between long-term mating and number of children but only in male participants (Study 2). There were no clear indications of the position of the mating patterns in human life history trajectories; however, the obtained data suggested that long-term mating has some characteristics of fast life history dynamics. Findings are implicative for sexual selection and life history theory in humans.

The other face of advanced paternal age: a scoping review of its terminological, social, public health, psychological, ethical and regulatory aspects

BACKGROUND

There is a global tendency for parents to conceive children later in life. The maternal dimension of the postponement transition has been thoroughly studied, but interest in the paternal side is more recent. For the moment, most literature reviews on the topic have focused on the consequences of advanced paternal age (APA) on fertility, pregnancy and the health of the child.

OBJECTIVE AND RATIONALE

The present review seeks to move the focus away from the biological and medical dimensions of APA and synthesise the knowledge of the other face of APA.

SEARCH METHODS

We used the scoping review methodology. Searches of interdisciplinary articles databases were performed with keywords pertaining to APA and its dimensions outside of biology and medicine. We included scientific articles, original research, essays, commentaries and editorials in the sample. The final sample of 177 documents was analysed with qualitative thematic analysis.

OUTCOMES

We identified six themes highlighting the interdisciplinary nature of APA research. The 'terminological aspects' highlight the lack of consensus on the definition of APA and the strategies developed to offer alternatives. The 'social aspects' focus on the postponement transition towards reproducing later in life and its cultural dimensions. The 'public health aspects' refer to attempts to analyse APA as a problem with wider health and economic implications. The 'psychological aspects' focus on the consequences of APA and older fatherhood on psychological characteristics of the child. The 'ethical aspects' reflect on issues of APA emerging at the intersection of parental autonomy, children's welfare and social responsibility. The 'regulatory aspects' group different suggestions to collectively approach the implications of APA. Our results show that the field of APA is still in the making and that evidence is lacking to fully address the issues of APA. The review suggests promising avenues of research such as introducing the voice of fathers of advanced age into the research agenda.

WIDER IMPLICATIONS

The results of this review will be useful for developing policies and preconception health interventions that consider and include prospective fathers of advanced age.

Complementary medicine seeking behaviour among infertile women: A sudanese study

INTRODUCTION

It is not surprising in developing countries with psychological, familial and community pressure to produce child, infertile women, in addition to conventional medicine, seek various traditional methods and religious practices.This study was conducted in Sudan to explore the perspectives of currently married infertile Sudanese women on complementary medicine seeking behaviour with more emphasis on traditional self-management strategies.

METHODS

A cross-sectional survey involving 203 infertile women was conducted. Collection of data was performed by means of a specifically designed questionnaire using a convenient sampling method at the women's visits of infertility treatment clinics in Khartoum, Sudan.

RESULTS

Findings of the study revealed that 43.3% of participated women had rich experience with infertility self-management strategies, and 65.0% of them used these strategies to treat infertility. Also 59.1% of the participants mentioned unaffordability of modern treatment as a main factor for trying self-management strategies.

CONCLUSION

The study revealed women's rich experience and wide use of different types of self-management strategies together with formal infertility health care services either simultaneously or subsequently. Also, unaffordability of formal treatment services was reported as one of the most encouraging factors towards seeking traditional treatment options.

Uninformed decision-making and regret about delaying childbearing decisions: A cross-sectional study

Aim

The aim of this study was to examine regret over the timing of the childbearing decision and reasons for its delay.

Design

A cross-sectional study.

Methods

This cross-sectional study included 219 women and 169 men referred to fertility facilities in Japan from July-December 2018. Participants completed a questionnaire on the reasons for their delay in childbearing decision and the degree of regret regarding their decision. Multiple linear regression was used to analyse the association between degree of regret and the reasons for the delay.

Results

The top three reasons for the delay in childbearing decision in women were "Establishing the relationship," "Health problems," and "Financial security." The top three reasons in men were "Establishing the relationship," "Financial security," and "Lack of fertility knowledge." Multiple linear regression showed that lack of fertility knowledge was associated with regret over the timing of childbearing decisions in women and men.

Knowledge gaps in the understanding of fertility among non-medical graduate students

Objective

To assess knowledge of female and male fertility among students enrolled in a Master of Business Administration (MBA) program.

Design

Web-based cross-sectional survey.

Setting

Academic setting.

Patient(s)

Not applicable.

Intervention(s)

None.

Main Outcome Measure(s)

Knowledge of how female and male age impacts reproduction, fecundability, and success rates with in vitro fertilization (IVF).

Result(s)

A total of 133 female and male MBA students completed the survey. Nearly 10% of participants were not aware that women are born with a fixed number of oocytes and that oocyte quantity and quality decline with age. More than 30% of participants overestimated fecundability in women aged ≥35 years, and >50% overestimated IVF success rates in women older than 40 years. Fifteen percent of participants did not know that men have stem cells in the testes, and >25% were not aware that men experience a decrease in sperm concentration and quality with age. Nearly 30% believed that a man’s age never impacts reproductive outcomes. Less than 30% of participants correctly estimated fecundability and IVF success rates based on male age.

Conclusion(s)

These data highlight important knowledge gaps in a highly educated group of MBA students, most whom desire future childbearing. Specifically, there is a lack of understanding of both male and female reproductive aging and an overestimation of treatment success. As delayed childbearing continues, particularly among those with high educational attainment, attention should be focused on introducing broad fertility education at a younger age to improve future reproductive success.

Gender Identity and Future Thinking About Parenthood: A Qualitative Analysis of Focus Group Data With Transgender and Non-binary People in the United Kingdom

The idea that people who are transgender or non-binary are not interested in becoming parents has been refuted by several studies. However, both medical unknowns and cisnormativity surround the process of becoming a parent for transgender or non-binary people, with little known about the psychosocial impact on the family formation dilemmas of transgender and non-binary adults. Employing Life Course Theory as our theoretical framework, three focus group interviews were conducted with eleven transgender or non-binary adults. Qualitative data analysis of focus group interview transcripts was conducted through Thematic Analysis. Four overarching interlinked themes were identified concerning the dilemmas perceived by the nine participants who contemplated future parenthood: (i) Balancing a desire for parenthood and desires for other life goals; (ii) Feeling that who I am doesn't fit into the cisgender system of accessing fostering, adoption or fertility services; (iii) Experiencing the conjoined challenges of gender and fertility embodiment as I see them; (iv) Searching for a non-binary or gender appropriate self and the need for flexible future planning centered on reproductive capacity. Overall, thoughts about gender transition were often interwoven with parenthood plans and in a dialectical fashion the desire and intention to have, or not have, children was implicated in satisfaction with gender transition. The significance of these themes is discussed in relation to how hopes for parenthood could be realized without jeopardizing gender identity and the need for a future focused, flexible, and open-minded approach on the part of fertility and adoption services.

Declining realisation of reproductive intentions with age

STUDY QUESTION

What is the likelihood of having a child within 4 years for men and women with strong short-term reproductive intentions, and how is it affected by age?

SUMMARY ANSWER

For women, the likelihood of realising reproductive intentions decreased steeply from age 35: the effect of age was weak and not significant for men.

WHAT IS KNOWN ALREADY

Men and women are postponing childbearing until later ages. For women, this trend is associated with a higher risk that childbearing plans will not be realised due to increased levels of infertility and pregnancy complications.

STUDY DESIGN, SIZE, DURATION

This study analyses two waves of the nationally representative Household, Income and Labour Dynamics in Australia (HILDA) survey. The analytical sample interviewed in 2011 included 447 men aged 18–45 and 528 women aged 18–41. These respondents expressed a strong intention to have a child in the next 3 years. We followed them up in 2015 to track whether their reproductive intention was achieved or revised.

PARTICIPANTS/MATERIALS, SETTINGS, METHODS

Multinomial logistic regression is used to account for the three possible outcomes: (i) having a child, (ii) not having a child but still intending to have one in the future and (iii) not having a child and no longer intending to have one. We analyse how age, parity, partnership status, education, perceived ability to conceive, self-rated health, BMI and smoking status are related to realising or changing reproductive intentions.

MAIN RESULTS AND THE ROLE OF CHANCE

Almost two-thirds of men and women realised their strong short-term fertility plans within 4 years. There was a steep age-related decline in realising reproductive intentions for women in their mid- and late-30s, whereas men maintained a relatively high probability of having the child they intended until age 45. Women aged 38–41 who planned to have a child were the most likely to change their plan within 4 years. The probability of realising reproductive intention was highest for married and highly educated men and women and for those with one child.

LIMITATIONS, REASONS FOR CAUTION

Our study cannot separate biological, social and cultural reasons for not realising reproductive intentions. Men and women adjust their intentions in response to their actual circumstances, but also in line with their perceived ability to have a child or under the influence of broader social norms on reproductive age.

WIDER IMPLICATIONS OF THE FINDINGS

Our results give a new perspective on the ability of men and women to realise their reproductive plans in the context of childbearing postponement. They confirm the inequality in the individual consequences of delayed reproduction between men and women. They inform medical practitioners and counsellors about the complex biological, social and normative barriers to reproduction among women at higher childbearing ages.

STUDY FUNDING/COMPETING INTEREST(S)

This research was partly supported by a Research School of Social Sciences Visiting Fellowship at the Australian National University and an Australian Research Council Discovery Project (DP150104248). Éva Beaujouan’s work was partly funded by the Austrian Science Fund (FWF) project ‘Later Fertility in Europe’ (Grant agreement no. P31171-G29). This paper uses unit record data from the HILDA Survey. The HILDA Project was initiated and is funded by the Australian Government Department of Social Services (DSS) and is managed by the Melbourne Institute of Applied Economic and Social Research (Melbourne Institute). The findings and views reported in this paper, however, are those of the authors and should not be attributed to either DSS or the Melbourne Institute. The authors have no conflicts of interest.

‘It's most of my life – going to the pub or the group’: the social networks of involuntarily childless older men

The social networks of older people are a significant influence on their health and wellbeing. Adult children are an important element in their parent's network and provide the majority of informal care. The morphology of personal networks alters with age, employment, gender and relationships. Not having children automatically reduces both vertical familial structure and affects the wider formal and informal social links that children can bring. Childless men are missing from gerontological, reproduction, sociological and psychological research. These fields have all mainly focused on family and women. This paper reports on an auto/biographical qualitative study framed by biographical, feminist, gerontological and lifecourse approaches. Data were gathered from semi-structured biographical interviews with 14 self-defined involuntarily childless men aged between 49 and 82 years old. A latent thematic analysis highlighted the complex intersections between childlessness and individual agency, relationships and socio-cultural structures. The impact of major lifecourse events and non-events had significant implications for how childless people perform and view their social and self-identity. I argue that involuntary childlessness affects the social, emotional and relational aspects of men's lived experience across the lifecourse.

Attitudes towards family formation among men attending fertility counselling

Men and women are increasingly postponing childbearing until an age where fertility has decreased, meaning that they might have difficulties in achieving their desired family size. This study explored childless men's attitudes towards family formation. Data were collected through semi-structured qualitative interviews with 21 men attending the Fertility Assessment and Counselling Clinic in Copenhagen or Horsens, Denmark. Data were analysed using content analysis. The men envisioned a nuclear family with their own biological children, but they experienced doubts and ambivalence about parenthood and feeling 'ready'. Their lack of readiness was linked to their awareness of the sacrifices and costs involved with parenthood, and their belief that they could safely delay parenthood. The men did not consider that they may be unable to have their own biological children. This study highlights the importance of considering men's attitudes and preferences towards family formation when understanding couples' decision-making. Contrary to common understanding, the findings show that men are as concerned with the planning and timing of parenthood as women, but their knowledge of the age-related decline in fertility is poor. Men need to gain more awareness of the limitations of fertility and the impact of female and male age on the ability to achieve parenthood aspirations.

The evolved psychological mechanisms of fertility motivation: hunting for causation in a sea of correlation

Cultural, ecological, familial and physiological factors consistently influence fertility behaviours, however, the proximate psychological mechanisms underlying fertility decisions in humans are poorly understood. Understanding the psychological mechanisms underlying human fertility may illuminate the final processes by which some of these known predictors have their influence. To date, research into the psychological mechanisms underlying fertility has been fragmented. Aspects of reproductive psychology have been examined by researchers in a range of fields, but the findings have not been systematically integrated in one review. We provide such a review, examining current theories and research on psychological mechanisms of fertility. We examine the methods and populations used in the research, as well as the disciplines and theoretical perspectives from which the work has come. Much of the work that has been done to date is methodologically limited to examining correlations between ecological, social and economic factors and fertility. We propose, and support with examples, the use of experimental methods to differentiate causal factors from correlates. We also discuss weaknesses in the experimental research, including limited work with non-WEIRD (western, educated, industrialized, rich and democratic) populations.

Fertility knowledge and the timing of first childbearing: a cross-sectional study in Japan

Although fertility educational initiatives have increased in developed countries to prevent infertility and to broaden fertility choices, the relationship between knowledge and behaviour is still poorly understood. In order to investigate the association between fertility knowledge and timing of childbearing, we investigated male and female participants between 35 and 44 years of age who had children (n = 640) from an online survey conducted in Japan in 2013. The age at which participants actually gave birth to or fathered their first child was compared between those who were aware for at least a decade of age-related decline in female fertility (hereinafter, those with past fertility knowledge) and those without. Age at first birth was significantly younger and more narrowly distributed among women with past fertility knowledge than among those without: 28.2 ± 3.4 vs. 29.8 ± 4.6 (mean ± SD). A multivariate linear regression analysis showed that women with past fertility knowledge gave birth to their first child 2.34 [95% confidence interval (CI): 1.09-3.59] years earlier compared to those without such knowledge. No significant relation existed among men. Being informed in young adulthood about the facts of fertility might be related to starting a family at an earlier age, although further longitudinal evaluation will be necessary.

Effects of fertility education on knowledge, desires and anxiety among the reproductive-aged population: findings from a randomized controlled trial

STUDY QUESTION

What are the effects of fertility education on knowledge, childbearing desires and anxiety?

SUMMARY ANSWER

Providing fertility information contributed to greater knowledge, but increased anxiety.

WHAT IS KNOWN ALREADY

Past studies have found that exposure to educational material improved fertility awareness and changed desires toward childbearing and its timing. Existing educational websites with evidence-based medical information provided in a non-judgmental manner have received favorable responses from reproductive-aged men and women.

STUDY DESIGN, SIZE, DURATION

This three-armed (one intervention and two control groups), randomized controlled trial was conducted using online social research panels (SRPs) in Japan in January 2015.

PARTICIPANTS/MATERIALS, SETTING, METHODS

A total of 1455 participants (726 men and 729 women) between 20 and 39 years of age who hoped to have (more) children in the future were block-randomized and exposed to one of three information brochures: fertility education (intervention group), intake of folic acid during pregnancy (control group 1) or governmental financial support for pregnancy and childbirth (control group 2). Fertility knowledge was measured with the Japanese version of the Cardiff Fertility Knowledge Scale (CFKS-J). Knowledge, child-number and child-timing desires, subjective anxiety (i.e. whether participants felt anxiety [primary outcome]), and scores on the State-Trait Anxiety Inventory were assessed immediately after exposure. Non-inferiority comparisons were performed on subjective anxiety with non-inferiority declared if the upper limit of the two-sided 95% confidence interval (CI) for risk difference did not exceed a margin of 0.15. This test for non-inferiority was only performed for subjective anxiety; all the other variables were tests of superiority.

MAIN RESULTS AND THE ROLE OF CHANCE

Posttest scores on the CFKS-J (mean, SD) were higher in the intervention group than that of the control groups: intervention versus Control 1 and versus Control 2: 52.8 (28.8) versus 40.9 (26.2) (P< 0.001) versus 45.1 (27.1) (P = 0.003) among men and 64.6 (26.0) versus 50.8 (26.9) (P< 0.001) versus 53.0 (26.4) (P< 0.001) among women.The percentage of participants who felt subjective anxiety after exposure to the intervention brochure was significantly higher than that of the control groups: intervention versus Control 1 and versus Control 2: 32.6 versus 17.8% (risk difference [RD] = 0.149, 95% CI: 0.073-0.225) versus 14.5% (RD = 0.182, 95% CI: 0.108-0.256) among men, and 50.2 versus 26.3% (RD = 0.239, 95% CI: 0.155-0.322) versus 14.0% (RD = 0.362, 95% CI: 0.286-0.439) among women. Non-inferiority of the intervention was inconclusive (i.e. the CI included 0.15) among men whereas inferiority was declared among women. The incidence of anxiety was higher in the intervention group than that of the control groups especially among men aged 30 and older and among women aged 25 and older. No difference existed in childbearing desires between groups after exposure.

LIMITATIONS, REASONS FOR CAUTION

The possibility of selection bias associated with the use of SRPs (higher socioeconomic status and education) and volunteer bias toward those more interested in fertility may limit the generalizability of these findings.

WIDER IMPLICATIONS OF THE FINDINGS

In addition to education targeting a younger generation, psychological approaches are needed to alleviate possible anxiety caused by fertility information.

STUDY FUNDING/COMPETING INTERESTS

This study was funded by National Center for Child Health and Development, Seiiku Medical Study Grant (24-6), the Daiwa Foundation Small Grants and Grant-in-Aid for JSPS Fellows (26-1591). No competing interest declared.

TRIAL REGISTRATION NUMBER

UMIN Clinical Trials Registry. Trial registration number, 000016168.

TRIAL REGISTRATION DATE

13 January 2015.

DATE OF FIRST PATIENT'S ENROLMENT

15 January 2015.

Factors influencing first childbearing timing decisions among men: Path analysis

BACKGROUND

Factors that influence men's childbearing intentions have been relatively unexplored in the literature.

OBJECTIVE

This study aimed to determine the influencing factors about the first childbearing timing decisions of men.

MATERIALS AND METHODS

In this cross-sectional study, 300 men who were referred to private and governmental healthcare centers in Shahrood, Iran were randomly recruited from April to September 2014. Data were collected using a demographic questionnaire, the Quality of Life Questionnaire; ENRICH Marital Satisfaction Questionnaire, Synder's Hope Scale, and the Multidimensional Scale of Perceived Social Support.

RESULTS

After removing the statistically insignificant paths, men's age at marriage had the highest direct effect (β=0.86) on their first childbearing decision. Marital satisfaction (β=-0.09), social support (β=0.06), economic status (β=0.06), and quality of life (β=-0.08) were other effective factors on men's first childbearing decisions. Moreover, marital satisfaction and social support had significant indirect effects on men's childbearing decisions (β=-0.04 and -0.01, respectively).

CONCLUSION

Many factors, including personal factors (age at marriage and quality of life), family factors (marital satisfaction), and social factors (social support), can affect men's decision to have a child. Policymakers are hence required to develop strategies to promote the socioeconomic and family conditions of the couples and to encourage them to have as many children as they desire at an appropriate time.

Knowledge of ovarian reserve and reproductive choices

OBJECTIVE

To determine the factors that influence the reproductive choices of health care professionals, and to assess whether knowledge of ovarian reserve would modify those choices.

METHOD

A cross-sectional survey utilizing anonymous questionnaires that assessed demographics, knowledge, attitudes and choices of female and male health care professionals between the ages of 20-55 (N = 185) who work at an academic medical center

RESULT(S)

Of the 185 respondents, 75% were female, 35% were residents and 35% were married. Among those who were delaying childbearing 39% wanted to complete their education, 25% had no identified partner, 10% were too active professionally and 4% could not afford children at the time. If testing of the individual or individual's partner indicated diminished ovarian reserve, 48% of those responding would try to have a child sooner, 21% would opt for oocyte cryopreservation, 7% would try to find a partner sooner, 7% would pursue adoption, and 3% would select embryo cryopreservation. Only 14% would not actively pursue treatment or make lifestyle changes. These results varied significantly with marital status but did not differ between participants with and without children. Similarly, choices did not vary significantly with religious belief or ethnicity.

CONCLUSION(S)

Increased information about a woman's reproductive reserve would lead individuals to modify life choices. Physicians caring for reproductive-age women and men should inquire about their childbearing plans, and educate those who are postponing childbearing regarding the normal pattern of reproductive decline.

Infertility care and the introduction of new reproductive technologies in poor resource settings

BACKGROUND

The overall prevalence of infertility was estimated to be 3.5-16.7% in developing countries and 6.9-9.3% in developed countries. Furthermore, according to reports from some regions of sub-Saharan Africa, the prevalence rate is 30-40%. The consequences of infertility and how it affects the lives of women in poor-resource settings, particularly in developing countries, has become an important issue to be discussed in reproductive health. In some societies, the inability to fulfill the desire to have children makes life difficult for the infertile couple. In many regions, infertility is considered a tragedy that affects not only the infertile couple or woman, but the entire family.

METHODS

This is a position paper which encompasses a review of the needs of low-income infertile couples, mainly those living in developing countries, regarding access to infertility care, including ART and initiatives to provide ART at low or affordable cost. Information was gathered from the databases MEDLINE, CENTRAL, POPLINE, EMBASE, LILACS, and ICTRP with the key words: infertility, low income, assisted reproductive technologies, affordable cost, low cost.

RESULTS

There are few initiatives geared toward implementing ART procedures at low cost or at least at affordable cost in low-income populations. Nevertheless, from recent studies, possibilities have emerged for new low-cost initiatives that can help millions of couples to achieve the desire of having a biological child.

CONCLUSIONS

It is necessary for healthcare professionals and policymakers to take into account these new initiatives in order to implement ART in resource-constrained settings.

Attitudes towards motherhood and fertility awareness among 20-40-year-old female healthcare professionals

OBJECTIVE

To explore attitudes towards family formation and fertility awareness among Danish female healthcare professionals.

METHODS

We collected cross-sectional baseline data from a prospective cohort study of 863 women, ranging in age from 20 to 40 years, working at a hospital in Denmark. Information about participants' intentions and attitudes towards family formation and fertility knowledge was gathered by means of a questionnaire.

RESULTS

Only 2% of the respondents did not want children. Most women believed that motherhood is important, and hoped to have two to three children. About half of the respondents intended to have their last child after the age of 35 years. The most important prerequisites for family formation included: living in a stable relationship, having completed one's studies, a sound financial situation, a job that can be kept when having children, access to public child day care, and the possibility of travelling. As many as 50% of women underrated the impact of a woman's age on fertility, and overestimated the success rates of assisted reproductive technology (ART) treatments.

CONCLUSIONS

Many female healthcare professionals contemplated giving birth after the age of 35 years. Knowledge of fertility and ART success rates is needed to make well-informed decisions about when to have children.

Increasing paternal age at childbirth is associated with taller stature and less favourable lipid profiles in their children

BACKGROUND

Paternal age at childbirth has been increasing worldwide, and we assessed whether this increase affects growth, body composition and metabolism in their children.

METHODS

We studied 277 children (aged 3-12 years) born to fathers aged 19·8-51·8 years. Clinical assessments were height and weight adjusted for parental measurements, DEXA-derived body composition, fasting lipids, glucose homoeostasis and hormonal profiles.

RESULTS

Children born to fathers aged 31-35 (P = 0·009) and >35 years (P = 0·021) were 2 cm taller than those of fathers aged ≤30 years. Children of fathers aged >35 years at childbirth had a lower body mass index (BMI) (-0·32 SDS) than offspring of fathers aged 31-35 (-0·01 SDS; P = 0·043) and ≤30 (0·22 SDS; P = 0·019). There were marked effects of paternal age at childbirth on childhood blood lipids. LDL-C concentrations in children born to fathers aged >35 years were 11% and 21% higher than in children of fathers aged 31-35 and ≤30 years, respectively (P < 0·01). Total cholesterol to HDL-C ratio was also higher among the children of fathers aged 31-35 (12%; P = 0·014) and >35 (16%; P = 0·004) years at childbirth compared with the ≤30 group. In addition, HOMA-IR in girls (but not boys) born of fathers aged 31-35 (0·99) and >35 years (1·11) indicated better insulin sensitivity compared with offspring in the ≤30 group (1·63; P < 0·05).

CONCLUSIONS

Increasing paternal age at childbirth is associated with a more favourable phenotype in their children (taller and slimmer, with better insulin sensitivity in girls) but with a less favourable lipid profile.

Socioeconomic and emotional predictors of decision making for timing motherhood among Iranian women in 2013

BACKGROUND

Decision making for timing motherhood is one of the vital aspects of reproductive health. Separating sexual relationship from having a child has led to a different and unprecedented lifestyle in human history.

OBJECTIVES

The objective of this study was to determine the socioeconomic and emotional factors predicting decision making for timing motherhood among Iranian women using the statistical softwares of IBM SPSS 21 and LISREL 8.8.

PATIENTS AND METHODS

This cross-sectional study enrolled 820 primiparous women from different hospitals across the country using multistage random sampling method in 2013. The tools of the study were enrich marital satisfaction, socioeconomic status, perceived social support, hopefulness, and life regard index. The data was analyzed using SPSS 20 and LISREL 8.8.

RESULTS

The results revealed that among direct pathways, marital age (β = 0.62) was the most effective predictor of timing motherhood. The hopefulness had an inverse association with timing motherhood through inverse effect of marital satisfaction. Moreover, marital satisfaction (β = -0.09), perceived social support (β = -0.09), and life regard index (β = 0.01) had an inverse effect on timing motherhood. Marital satisfaction had a non-causal effect of 0.024.

CONCLUSIONS

Marital age, and socioeconomic status had a direct association, and hopefulness and marital satisfaction had an indirect one with Iranian women's decision for timing motherhood. Therefore, this is the responsibility of policy-makers and healthcare providers to advise women by providing appropriate interventions and facilities.

Educational attainment, perception of workplace support and its influence on timing of childbearing for Canadian women: a cross-sectional study

Under Canada's Employment Insurance system, parents are entitled to receive up to 50 weeks of parental leave at 55 % of salary. Despite this national policy, women with higher education are more likely to delay childbearing. This analysis aimed to assess the association between workplace support, educational attainment and the timing of first births. Women who had recently given birth to their first live-born infant and lived in Alberta, Canada, were randomly selected to participate in a telephone survey. Logistic regression was used to assess the relationship between workplace support, educational attainment and timing of first pregnancy. Among 835 women with a planned pregnancy, 26 % agreed that support or lack of support for pregnant women at their workplace affected their decision about when to begin their family. After controlling for age and income, women who had completed a post-graduate degree were three times (OR 3.39, 95 % CI 1.69-6.81) more likely to indicate that support or lack of support for pregnant women in their workplace affected their childbearing decisions. In spite of national policies, and the potential risks associated with delayed childbearing, workplace support impacts timing of pregnancy, particularly for highly educated women.

Still childless at the age of 28 to 40 years: a cross-sectional study of Swedish women's and men's reproductive intentions

BACKGROUND

Delayed childbearing is associated with adverse reproductive outcomes. Our aim was to investigate Swedish women's and men's childbearing intentions at the age of 28, 32, 36 and 40 years, in terms of: (1) time point for a first child, (2) number of children, and (3) reasons for not yet having children.

METHODS

Cross-sectional data from the Swedish Young Adult Panel Study, including 365 childless women and 356 childless men aged 28, 32, 36 and 40 years who responded to a questionnaire in 2009. Descriptive and multivariate logistic regression analyses were conducted.

RESULTS

Most 28- and 32-year-olds intended to have children, but only 32% of women and 37% of men aged 36/40 years (merged), many of whom still postponed childbearing. Reasons for remaining childless differed by age. Most prominent in the 36/40-year-olds were: lack of a partner (women 60%, men 59%), no desire for children (women 44%, men 44%), not mature enough (women 29%, men 35%), and wanting to do other things before starting a family (women 26%, men 33%). The 36/40-year-olds had the highest odds for infertility problems (OR 3.8; CI 95% 1.8-7.9) and lacking a suitable partner (OR 1.8 CI 95% 1.1-3.0), and lower odds for reasons related to work and financial situation.

CONCLUSIONS

Many childless 36- and 40-year-olds intended to have children but seemed to overestimate their fecundity. The most prominent reasons for being childless were: not having wanted children up to now, lack of a partner, infertility problems, and prioritising an independent life.

Relationship characteristics and feelings about pregnancy among black and puerto rican young adults

CONTEXT

Unintended pregnancy is common among black and Hispanic young adults in the United States. How pregnancy intentions form and change is poorly understood, although research indicates that intentions and attitudes are dependent on partners' views and other relationship factors, and are different by gender.

METHODS

A sample of black and Puerto Rican men and women aged 18-25 from low-income neighborhoods in two cities were surveyed in 2007-2008. Using data on 520 serious and casual sexual relationships reported by 460 respondents, generalized ordered logistic regression analysis was conducted to identify individual- and relationship-level correlates of how respondents would feel if they became involved in a pregnancy with a particular partner.

RESULTS

About one-quarter of respondents reported each of four possibilities of how they would feel about a pregnancy with a particular partner-very upset, a little upset, a little pleased and very pleased. In 45% of relationships, respondents believed that their partners would be very pleased about a pregnancy, whereas they themselves would be very pleased in only one-quarter of cases. Overall, women were less likely to feel positive about a pregnancy than were men (odds ratio, 0.3). Respondents' positive feelings about their relationships were associated with a strong tendency toward more positive feelings about a pregnancy (2.1), as was a measure of how positive respondents thought their partners would feel (1.5-2.6). The latter association was particularly strong among women (1.7).

CONCLUSIONS

Relationship characteristics were associated with feelings about pregnancy for both genders. Future research should utilize a more comprehensive framework for conceptualizing and examining sexual relationships.

Conceiving of change: a brief intervention increases young adults' knowledge of fertility and the effectiveness of in vitro fertilization

OBJECTIVE

To examine the effectiveness of an educational intervention in increasing knowledge of fertility and the effectiveness of IVF among university students in Australia.

DESIGN

Two-group, pretest-posttest design.

SETTING

A large metropolitan university in Queensland, Australia.

PATIENT(S)

One hundred thirty-seven male and female undergraduate students.

INTERVENTION(S)

Online information brochure on fertility (intervention group), or an online information brochure on home ownership (control group).

MAIN OUTCOME MEASURE(S)

Knowledge of fertility, knowledge of IVF effectiveness, and desired age at commencement and completion of childbearing, assessed immediately before and after exposure to the brochure.

RESULT(S)

Exposure to the brochure resulted in significant increases in knowledge of fertility and knowledge of IVF effectiveness in the intervention group and significant decreases in desired age at commencement and completion of childbearing. No changes were observed in the control group.

CONCLUSION(S)

Educational intervention is a worthwhile endeavor that can increase knowledge of fertility and IVF effectiveness in the short-term. Further research is needed to evaluate whether increased knowledge persists and affects intentions in the longer-term. Because the determinants of timing of childbearing are highly multifactorial, fertility education should be paired with policies and practices that support men and women to make informed decisions about the timing of childbearing.

Knowledge about factors that influence fertility among Australians of reproductive age: a population-based survey

OBJECTIVE

To explore knowledge about the effects on fertility of age, obesity, smoking, and timing of intercourse among Australians of reproductive age.

DESIGN

Telephone survey of a representative sample of Australians.

SETTING

Not applicable.

PATIENT(S)

Australians aged 18 to 45 years who wish to have a child or another child now or in the future.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

Knowledge about the effect on fertility of age, obesity, smoking, and timing of intercourse.

RESULT(S)

A total of 462 interviews were conducted. The majority of respondents underestimated, by about 10 years, the age at which male and female fertility starts to decline. Only one in four correctly identified that female fertility starts to decline before age 35, and one in three identified that male fertility starts to decline before age 45. Most (59%) were aware that female obesity and smoking affect fertility, but fewer recognized that male obesity (30%) and smoking (36%) also influence fertility. Almost 40% of respondents had inadequate knowledge of when in the menstrual cycle a woman is most likely to conceive.

CONCLUSION(S)

Considerable knowledge gaps about modifiable factors that affect fertility were identified. These are targeted in a national education campaign to promote awareness of factors that influence fertility.

The other side of the fertility coin: a comparison of childless men's and women's knowledge of fertility and assisted reproductive technology

OBJECTIVE

To determine childless men's knowledge about fertility and assisted reproductive technology (ART) treatments and family building options, compared to knowledge of a sample of childless women.

DESIGN

Self-report questionnaire comprising 2 self-ratings and 20 knowledge questions related to later childbearing and ART.

SETTING

Online survey.

PATIENT(S)

A total of 599 presumed fertile, childless men between the ages of 20 and 50 years.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

Knowledge of fertility and ART as measured by the male version of the Fertility Awareness Survey.

RESULT(S)

The majority of participants rated themselves as having some knowledge or being fairly knowledgeable about fertility and ART. However, on the 20 knowledge questions, overall knowledge was limited, with more than 50% of the sample answering correctly only 4 of 20 knowledge questions. The men demonstrated even less knowledge of fertility and ART than childless women.

CONCLUSION(S)

Given that the childless men in our study had no coherent body of knowledge regarding age-related fertility and ART treatment and family-building options, men may be contributing to the trend to delay childbearing. If they are to be effective in supporting informed fertility and childbearing decisions, education programs must target both women and men.

Why Parenthood, and Why Now?: Gay Men's Motivations for Pursuing Parenthood

The current qualitative study of 35 pre-adoptive gay male couples (70 men) examined gay men's motivations to parent and their reasons for pursuing parenthood at the current time. Similar to heterosexual couples, gay men described a range of psychologically-oriented reasons as shaping their decision to become parents. Some of these (e.g., desire to teach a child tolerance) may have been uniquely shaped by their sexual minority status, and others (e.g., desire to give a child a good home) in part reflect their adoptive status. Men named age, finances, and relationship factors, as well as unique contextual factors such as the need to find and move to gay-friendly neighborhoods, as influencing their readiness to pursue parenthood at the current time. Gay men's motivations to parent echo normative life course decision-making processes, but also reflect concerns that are uniquely informed by their sexual minority status.