Is perception of inability to procreate a temporal phenomenon?: A longitudinal exploration of changes and determinants among women and men of reproductive age in Germany

Research on influencing factors of college teachers' second child fertility intentions--Taking Jinan as an example

BACKGROUND

Fertility intentions, as a direct driver of fertility behavior, play an important role in the implementation of national fertility policy and population development. This study explored the influencing factors of college teachers' second child fertility intentions in Jinan, China on the basis of TPB.

METHODOLOGY/PRINCIPAL FINDINGS

Based on the theory of planned behavior, this paper employs basic characteristics analysis, difference analysis, and factor analysis related to the fertility intentions of the participants. Analysis found participants between 31 and 40 years old had the highest second child fertility intentions, and participants with a college-age first child had the lowest second child fertility intentions. Attitude and subjective norms had a positive impact on second child fertility intentions, and policy awareness had a positive impact on attitude, which indirectly affected second child fertility intentions. Subjective norms had the greatest influence on second child fertility intentions, followed by attitude, and policy awareness had the least influence on second child fertility intentions.

SIGNIFICANCE/FUTURE RESEARCH

The findings of this paper can enrich the theoretical research on fertility intentions, and also provide more optimal practical references for the formulation and propagation of China's fertility policy as well as the improvement of the division of family roles in China. Future research can further explore the impact of fertility policy on the fertility intentions of other groups.

Self-Perceived Infertility is Not Always Associated with Having Fewer Children: Evidence from German Panel Data

Proximate determinants theory considers infertility rates a risk factor for lower fertility rates, but the assumption that people who perceive infertility will have fewer children has not been tested. This study investigates the association of self-perceived infertility with the number of children people have had after 11 years. Infertility implies reduced chances of conception (rather than sterility), but people do not always consistently perceive infertility over time. If people who think they are infertile at one time can later report no infertility, then does self-perceived infertility necessarily lead to having fewer children? We answer this question by analyzing 11 waves of the German family panel (pairfam) data using negative binomial growth curve models for eight core demographic subgroups created by combinations of gender (men/women), parity (0/1+children), and initial age groups (25-27 and 35-37). Those who repeatedly perceived themselves to be infertile (three times or more) had fewer children than those who perceived themselves to be infertile once or twice in only four of eight gender by initial parity by age groups. Only in four groups did people who perceived themselves to be infertile once or twice have fewer children than those who never perceived themselves to be infertile in both the unadjusted and adjusted models. Thus, self-perceived infertility does not necessarily result in fewer children. Rather, the association depends upon life course context and gender.

Pregnancy and pregnancy intention after experiencing infertility: A longitudinal study of women in Malawi

BACKGROUND

Infertility is a common experience among individuals and couples. Infertility may resolve without intervention, but little is known about pregnancy intentions and incidence of pregnancy following infertility, particularly in low-resource settings.

METHODS

Data come from UTHA, a longitudinal cohort study in Central Malawi, with baseline and follow up surveys conducted from 2014-2019 (N = 1,030 reproductive-aged women). We assessed bivariable and multivariable relationships between reported infertility at baseline and subsequent pregnancy and retrospective pregnancy intentions. Pregnancy intention was measured with the London Measure of Unplanned Pregnancy (LMUP), a scale validated in Malawi (Range = 0-12).

RESULTS

Approximately 20% of the sample reported that they had ever experienced infertility (tried to become pregnant for at least two years without conceiving in that time) at baseline. The proportion of women who reported a new pregnancy during the follow up period (mean = 4.3 years) was the same (65%) for women who had and had not experienced infertility. Among women who became pregnant, levels of pregnancy intendedness were similar between women who had and had not experienced infertility. Prospective desire for a/another child at baseline was associated with subsequent pregnancy (AOR: 1.59; 95%CI: 1.06-2.39) and was also associated with higher levels of pregnancy intendedness measured retrospectively (LMUP of 9.4 vs. 8.4).

CONCLUSIONS

Experienced infertility was not associated with differential odds of having a subsequent pregnancy or the intendedness of a subsequent pregnancy. Thus, women who have experienced infertility should be included in family planning programs and research to support all women in achieving their reproductive goals.

Is perceived inability to procreate associated with life satisfaction? Evidence from a German panel study

Most studies of the psychosocial consequences of infertility have focused on those who seek medical treatment, leaving a research gap regarding the psychosocial consequences of perceived inability to procreate in the general population. Moreover, most studies are cross-sectional and the results are thus likely affected by omitted variable bias. Inspired by aspects of the Theory of Conjunctural Action, this study analysed 10 waves of data from the German Family Panel (pairfam) for women and men using fixed effects panel regression and including time-varying control variables suggested by theory and research. This study found that both women and men experienced lower life satisfaction in years when they perceived an inability to procreate. This association was not affected by the inclusion of relevant time-varying control variables. Furthermore, the association between perceived barriers to procreation and life satisfaction was found to differ depending on life circumstances and gender. Women with partners and men without partners had lower life satisfaction when they perceived an inability to procreate compared with when they did not. Women and men who intended to have a(nother) child had lower life satisfaction when they perceived an inability to procreate compared with when they did not. The association, however, was only significant for men. Somewhat surprisingly, women who perceived an inability to procreate also had lower life satisfaction when they were not intending to have a(nother) child. This study makes an important contribution to research on the psychosocial consequences of perceived infertility, and provides insights into why some people may pursue assisted reproductive technology for family creation.

Who can take advantage of medically assisted reproduction in Germany?

Compared with other European societies, access to medically assisted reproduction (MAR) in Germany is rather restrictive. Surprisingly little is known about the actual utilization of MAR in Germany and its social selectivity, primarily due to a lack of appropriate data. This article studies the use of MAR by drawing on 11 waves of the German Family Panel (pairfam), an annual survey that collects data on partnership and family dynamics in Germany. In estimating pooled logistic regression models that take into account whether or not MAR has been used, the following treatments were included: (i) in-vitro fertilization or micro-fertilization; (ii) intrauterine insemination; and (iii) any type of surgery performed to treat infertility. The highest odds of seeking medical help for infertility were found among married, childless couples who had a higher income, a strong desire to have children, a poor self-assessed health status, and who reported having problems conceiving a child prior to the year of the interview. Among these married couples, those with an above-average income were particularly likely to use MAR. These findings indicate that social selectivity in the uptake of MAR is based on economic resources and on the importance of marriage as the cultural ideal for a 'normal family'.

On estimating the prevalence of use of medically assisted reproduction in developed countries: a critical review of recent literature

BACKGROUND

Existing reviews on the prevalence of use of medically assisted reproduction (MAR) are relatively old and include mainly studies from the 1980s and 1990s. Since then, MAR has developed at a rapid pace, public awareness and acceptance of medical solutions to infertility problems has increased, and, consequently, the use of MAR has risen in developed countries.

OBJECTIVE AND RATIONALE

This study provides a comprehensive overview of the state of research on the prevalence of MAR use in women and men, as well as a critique of methodology used in studies of the use of MAR, and suggestions for moving forward.

SEARCH METHODS

Articles were located via the databases Academic Search Complete, Biomed Central, FirstSearch, Google Scholar, Medline, Health and Medical Collection, Medline and Social Science Citation Index using the key words 'infertile', 'infertility', 'subfecund', 'subfecundity', 'treatment', 'help-seeking', 'service use', 'service utilization', 'ART use' and 'MAR use' separately and in various combinations. The focus was on studies from developed countries, published between 1990 and 2018, in English, German or French.

OUTCOMES

In this article, we have reviewed 39 studies covering 13 countries or regions; approximately half of these covered the USA. Ten studies were published in the 1990s, 10 in the 2000s and 19 since 2010. Studies report different types of prevalence rates such as lifetime and current prevalence rates of MAR use. Prevalence rates are based on very different denominators: women who tried to become pregnant for at least 12 months without success, women who experienced at least 12 months of unprotected intercourse without success, women of reproductive age from the general population or women with a life birth. There are few studies that report help-seeking rates for men or make direct comparisons between genders. Knowledge on medical help-seeking across different stages, such as seeing a doctor, undergoing tests, having operations to restore fertility or ART, has started to accumulate in recent years. There are conceptual reasons for being cautious about drawing conclusions about gender, regional, country level and differences over time in help-seeking rates.

LIMITATIONS REASONS FOR CAUTION

In a narrative review, the risk of bias in the interpretation of findings cannot be completely eliminated. The literature search was limited to languages the authors speak: English, French and German.

WIDER IMPLICATIONS

In line with earlier reviews, we found that studies on help-seeking are not comparable across time and space, preventing researchers and healthcare providers from understanding the relation between social change, social policy, social structure and help-seeking for infertility. The discussion in this article should assist future researchers in designing better studies on the prevalence of MAR use. We provide suggestions for producing better estimates of the prevalence of MAR use. More cross-country and cross-gender comparisons are needed. Studies that treat help-seeking as a continuum and report on different stages are preferable compared to choosing arbitrary cutoff points, as is common practice in the studies reviewed.

STUDY FUNDING/COMPETING INTERESTS

None.