Has fertility declined in recent decades?

The prevalence of male rotating shift work correlates with reduced total fertility rate: an ecological study of 54,734 reproductive-aged males in 35 European countries between 2000 and 2015

Europe has the lowest fertility rate in the world, and 19 European countries are already experiencing negative population growth. Previous studies have shown that light-dark cycle misalignment induces damages to semen quality in animals, but whether shift work impairs male human fertility remains controversial. The diverse types of shift work, which may have distinct health impacts, have not been differentiated in the few previous studies. The present study aims to assess the impact of different male shift work types, i.e., rotating shift work (RSW), permanent shift work (PSW), and daily split shifts (DSS), on male fertility in European countries, based on the European Working Conditions Survey of 54,734 men and 52,457 women of reproductive (15-49 years) age from 35 countries conducted between 2000 and 2015. Year-specific total fertility rate (TFR) for each country was obtained from the World Bank. Mixed linear model was used to analyze the association between the prevalence of shift work types and TFR among the countries during the 15 years span, with adjustment for latitude, per capita GDP, working duration, working frequency, median age of men or women engaged in shift work, education level of men or women, and female shift-work condition in reproductive aged participants. The results showed that the average prevalence of RSW declined from 15.6% in 2000 to 9.8% in 2010, and then rose to 11.1% by 2015, while TFR went up from 1.45 in 2000 to 1.60 in 2010, and then decreased to 1.56 in 2015. A 10% increase of RSW prevalence was associated with a 0.114 decrease of TFR (95% CI: -0.167, -0.061, P < .001), indicating 11.4 fewer births per 100 women throughout lifetime. The association remained significant (β = -0.088, 95% CI: -0.160, -0.015, P = .020) after adjusting for confounding factors. However, no association was observed between TFR and the prevalence of male PSW (β = -0.011, 95% CI: -0.094, 0.073, P = .801) or DSS (β = 0.357, 95% CI: -0.171, 0.884, P = .189). In conclusion, male RSW, rather than PSW and DSS, may reduce TFR. Further studies are needed to validate our findings.

Clinicians' Perceptions of Norwegian Women's Experiences of Infertility Diseases

BACKGROUND

Norway has one of the best health systems in the world. However, it has a low birth rate, which decreased by 21.2% between 2009 and 2018, and one of the highest rates of infertility prevalence. The aim of this study is to understand how Norwegian doctors perceive female infertility diseases, namely those that are more difficult to diagnose and to treat, and that are more common in their practice.

METHOD

Descriptive qualitative study was conducted with gynecologists and general practitioners. The sample resulted from the establishment of five criteria and on the doctors' acceptance to participate in this study. Our sample comprised thirteen highly qualified and experienced doctors. Qualitative content analysis was the method chosen to analyze the collected data.

RESULTS

Clinical diseases (polycystic ovary syndrome, endometriosis and vulvodynia) and consequences of these diseases were the pinpointed themes. These led to a set of sub-themes: the main symptoms and the treatment of the diseases, from the perspective of both women and doctors (stigmatization, disturbances in women's daily life, diagnostic delay, and governmental support).

CONCLUSIONS

The three most relevant disorders mentioned were polycystic ovary syndrome, endometriosis and vulvodynia. These diseases cause several impacts on the lives of women, because they feel stigmatized and limited in their daily life and sexuality, and the diagnosis of these diseases takes too much time. Governments should better redistribute the financing of women's health and allocate resources to specialized centers.

Epidemiologic methods for investigating male fecundity

Fertility is a couple concept that has been measured since the beginning of demography, and male fecundity (his biological capacity to reproduce) is a component of the fertility rate. Unfortunately, we have no way of measuring the male component directly, although several indirect markers can be used. Population registers can be used to monitor the proportion of childless couples, couples who receive donor semen, trends in dizygotic twinning, and infertility diagnoses. Studies using time-to-pregnancy (TTP) may identify couple subfecundity, and TTP data will correlate with sperm quality and quantity as well as sexual activity and a number of other conditions. Having exposure data available for couples with a fecund female partner would make TTP studies of interest in identifying exposures that may affect male fecundity. Biological indicators such as sperm quality and quantity isolate the male component of fertility, and semen data therefore remain an important source of information for research. Unfortunately, often over half of those invited to provide a sperm sample will refuse, and the study is then subject to a selection that may introduce bias. Because the most important time windows for exposures that impair semen production could be early fetal life, puberty, and the time of ejaculation; longitudinal data over decades of time are required. The ongoing monitoring of semen quality and quantity should continue, and surveys monitoring fertility and waiting TTP should also be designed.

Swedish high school students' knowledge and attitudes regarding fertility and family building

BACKGROUND

Infertility is a serious problem for those who suffer. Some of the risks for infertility are preventable and the individual should therefore have knowledge of them. The purposes of this study were to investigate high-school students' knowledge about fertility, plans for family building and to compare views and knowledge between female and male students.

METHODS

A questionnaire containing 34 items was answered by 274 students. Answers from male and female students were compared using student's t-test for normally distributed variables and Mann-Whitney U-test for non-normal distributions. The chi-square test was used to compare proportions of male and female students who answered questions on nominal and ordinal scales. Differences were considered as statistically significant at a p-value of 0.05.

RESULTS

Analyses showed that 234 (85%) intended to have children. Female students felt parenthood to be significantly more important than male students: p = <0.01. The mean age at which the respondents thought they would like to start to build their family was 26 (± 2.9) years. Men believed that women's fertility declined significantly later than women did: p = <0.01. Women answered that 30.7% couples were involuntarily infertile and men answered 22.5%: p = <0.01. Females thought it significantly more likely that they would consider IVF or adoption than men, p = 0.01. Men felt they were more likely to abstain from having children than women: p = <0.01. Women believed that body weight influenced fertility significantly more often than men: p = <0.01 and men believed significantly more often that smoking influenced fertility: p = 0.03. Both female and male students answered that they would like to have more knowledge about the area of fertility.

CONCLUSIONS

Young people plan to start their families when the woman's fertility is already in decline. Improving young people's knowledge about these issues would give them more opportunity to take responsibility for their sexual health and to take an active role in shaping political change to improve conditions for earlier parenthood.