Showing papers on "Fertility published in 2004"

Web-based survey of fertility issues in Young women with breast cancer

Abstract: Purpose Young women with breast cancer often seek advice about whether treatment will affect their fertility. We sought to gain a better understanding of women’s attitudes about fertility and how these concerns affect decision making. Patients and Methods We developed a survey about fertility issues for young women with a history of early-stage breast cancer. The survey was e-mailed to all registered Young Survival Coalition survivor members (N = 1,702). E-mail reminders were used. Results Six hundred fifty-seven eligible respondents completed the survey. Mean age at breast cancer diagnosis was 32.9 years; mean current age was 35.8 years. Ninety percent of women were white; 62% were married; 76% were college graduates. Stages at diagnosis were as follows: 0, 10%; I, 27%; II, 47%; III, 13%. Sixty-two percent of women were within 2 years of diagnosis. Fifty-seven percent recalled substantial concern at diagnosis about becoming infertile with treatment. In multivariate logistic regression, greater concern ab...

Changing fertility rates in developed countries. The impact of labor market institutions

Abstract: During the last two decades fertility rates have decreased and have become positively correlated with female participation rates across OECD countries. I use a panel of 23 OECD nations to study how different labor market arrangements shaped these trends. High unemployment and unstable contracts, common in Southern Europe, depress fertility, particularly of younger women. To increase lifetime income though early skill-acquisition and minimize unemployment risk, young women postpone (or abandon) childbearing. Further, both a large share of public employment, by providing employment stability, and generous maternity benefits linked to previous employment, such as those in Scandinavia, boost fertility of the 25–29 and 30–34 year old women.

Patterns of low and lowest-low fertility in Europe.

Abstract: In this paper we conduct descriptive aggregate analyses to revisit the relationship of low and lowest-low period fertility to cohort fertility and key fertility-related behaviour such as leaving the parental home, marriage, and women's labour force participation. Our analyses show that the cross-country correlations in Europe between total fertility and the total first marriage rate, the proportion of extramarital births, and the labour force participation of women reversed during the period from 1975 to 1999. By the end of the 1990s there was also no longer evidence that divorce levels were negatively associated with fertility levels. We argue that lowest-low fertility has been particularly associated with a 'falling behind' of cohort fertility at higher birth orders and later ages. From these analyses we conclude that the emergence of lowest-low fertility during the 1990s was accompanied by a disruption or even a reversal of many well-known relationships that have been used to explain cross-country differences in fertility patterns.

Advanced maternal age--how old is too old?

Abstract: How realistic is it for a young woman today to expect to delay her childbearing while she pursues her career? Dr. Linda J. Heffner examines how old is too old.

Can assisted reproduction technology compensate for the natural decline in fertility with age? A model assessment

Abstract: BACKGROUND: Maternal age is an important factor in reproduction. Can assisted reproduction technologies (ART) fully compensate for the decline in fertility with age? METHODS: We used a computer simulation (Monte Carlo) model of reproduction, combining the monthly probabilities of conceiving, the risk of miscarriage and the probability of becoming age-dependently permanently sterile. RESULTS: Under natural conditions, 75% of women starting to try to conceive at age 30 years will have a conception ending in a live birth within 1 year, 66% at age 35 years and 44% at age 40 years. Within 4 years the success rates will be respectively 91, 84 and 64%. If women turn to ART after 4, 3 or 2 years respectively without conception, and if the rate of success is as observed after two cycles of insemination in IVF, ART makes up for only half of the births lost by postponing a first attempt of pregnancy from age 30 to 35 years, and <30% after postponing from 35 to 40 years. CONCLUSIONS: Even if we relax some of the assumptions, ART in its present form cannot make up for all births lost by the natural decline of fertility after age 35 years.

When Does Religion Influence Fertility

Abstract: Religious affiliation as a determinant of demographic behavior was once at the forefront of demographic research especially in studies of differential fertility. Particular attention was paid to the high fertility of Catholic populations in countries such as the United States. But with the changes that swept through Catholic communities in many industrialized societies in the wake of the Second Vatican Council Catholic fertility patterns came to resemble more closely those of other major religious denominations. Westoff and Jones succinctly captured this change in the title of their article on the end of Catholic fertility. Not surprisingly with the narrowing of fertility differences among religious groups came a withering of interest among demographers in understanding the sources of religious influence on demographic behavior. Several recent developments in the field would seem to justify renewed interest in this old question. The empirical findings of the Princeton studies of the decline of fertility in Europe helped touch off a wave of interest in ascertaining how cultural beliefs and practices including religious ones influenced the fertility transitions in Europe and elsewhere. More recently this concern has extended to attempts to account for variation in the pace of the second demographic transition. Another source of interest in religion centers on fertility patterns in the Muslim world. Countries with large Muslim populations have been generally slower to experience fertility decline and they figure prominently among the shrinking number of societies that continue to experience high rates of fertility. Yet considerable disagreement surrounds the role Islam plays in the fertility patterns of these societies reflecting in part the difficulty demographers have had in conceptualizing the influence of religion on demographic behavior. It thus seems opportune to revisit the question of religion and fertility in the light of a generation of new theoretical and empirical work. (excerpt)

Infecundity, infertility, and childlessness in developing countries

Abstract: For many couples the inability to bear children is a tragedy. The conflux of personal interpersonal social and religious expectations brings a sense of failure loss and exclusion to those who are infertile. Relationships between couples can become very strained when children are not forthcoming. One partner may seek to blame the other as being defective or unwilling. Socially most societies are organized especially in the developing countries such that children are necessary for care and maintenance of older parents. Even in developed countries with social support systems children and family are expected to provide much of the care for the elderly. Childless couples are also excluded from taking leading roles in important family functions and events such as birthdays christenings confirmations bar mitzvahs and weddings of their children. Moreover many religions assign important ceremonial tasks to the couple’s children. The incidence of infertility in a population has important demographic and health implications as well. Because high infertility has a dampening effect on overall fertility and the rate of population growth improvements in the ability to bear children may impede efforts to lower the fertility rate. For example it has been estimated that a reduction in infertility in sub-Saharan Africa to “normal” levels would increase fertility in that region by 15 percent. Similarly Bongaarts Frank and Lesthaeghe (1984) found that infertility accounts for 60 percent of the variation in total fertility in 18 sub-Saharan countries and that fertility decreases by one birth for each increase in 9 percentage points in the proportion of women age 45 to 49 who have no children. In Cameroon a country with an unusually high level of infertility Larsen and Menken estimated that the then current total fertility rate of 5.5 children would rise to 7.3 in the absence of sterility. Reports from Demographic and Health Surveys (DHS) data have provided up-to-date measurements of levels and trends in fertility in conjunction with data on important fertility determinants such as first marriage and union first birth contraception breastfeeding and infant and child mortality. Outside of sub-Saharan Africa no major attention has been paid to the DHS data relating to infecundity although there is no doubt that infecundity is also an important determinant of fertility there. (excerpt)

Large breasts and narrow waists indicate high reproductive potential in women

Abstract: Physical characteristics, such as breast size and waist-to-hip ratio (WHR), function as important features used by human males to assess female attractiveness. Males supposedly pay attention to these features because they serve as cues to fecundity and health. Here, we document that women with higher breastto-underbreast ratio (large breasts) and women with relatively low WHR (narrow waists) have higher fecundity as assessed by precise measurements of daily levels of 17-β-oestradiol (E2) and progesterone. Furthermore, women who are characterized by both narrow waists and large breasts have 26% higher mean E2 and 37% higher mean mid-cycle E2 levels than women from three groups with other combinations of body-shape variables, i.e. low WHR with small breasts and high WHR with either large or small breasts. Such gains in hormone levels among the preferred mates may lead to a substantial rise in the probability of conception, thus providing a significant fitness benefit.

Accounting for Fertility Decline During the Transition to Growth

Abstract: In every developed country, the economic transition from pre-industrial stagnation to modern growth was accompanied by a demographic transition from high to low fertility. Even though the overall pattern is repeated, there are large cross-country variations in the timing and speed of the demographic transition. What accounts for falling fertility during the transition to growth? To answer this question, this paper develops a unified growth model that delivers a transition from stagnation to growth, accompanied by declining fertility. The model is used to determine whether government policies that affect the opportunity cost of education can account for cross-country variations in fertility decline. Among the policies considered, education subsidies are found to have only minor effects, while accounting for child labor regulation is crucial. Apart from influencing fertility, the policies also determine the evolution of the income distribution in the course of development.

Fertility issues for young adult survivors of childhood cancer

Abstract: Background. The effects of cancer and its treatment on reproduction and fertility are well-documented, yet knowledge of the psychosocial and behavioral ramifications of these outcomes for young adult survivors of childhood cancer is limited. As a qualitative exploratory study, this work identifies concerns, attitudes, and behaviors that may be associated with childhood cancer survivors' reproductive capacity. Procedure. As part of a semi-structured interview assessing the impact of cancer on long-term survivors' quality of life, a convenience sample of 32 childhood cancer survivors between the ages of 19–37 and at least five years beyond diagnosis were asked if they had physical limitations as a result of their cancer or treatment, and if having cancer has affected their ability to have children. Results. These data are organized around two major themes: (1) survivors' reproductive capacity and (2) their attitudes, experiences and concerns about children and parenting. Fifty-nine percent of survivors reported that they are uncertain about their fertility status, and half recall a parent or health care provider ever mentioning potential reproductive problems associated with their past cancer treatment. Conclusions. While some survivors profess to know nothing about their risks for infertility, others possess and recall information that influences their personal relationships, their beliefs about having children, and possibly subsequent decisions and behaviors with regard to having children. Copyright © 2004 John Wiley & Sons, Ltd.

Global demographic change: dimensions and economic significance

Abstract: Transitions from high mortality and fertility to low mortality and fertility can be beneficial to economies as large baby boom cohorts enter the workforce and save for retirement, while rising longevity has perhaps increased both the incentive to invest in education and to save for retirement. We present estimates of a model of economic growth that highlights the positive effects of demographic change during 1960-95. We also show how Ireland benefited from lower fertility in the form of higher labor supply per capita and how Taiwan benefited through increased savings rates. We emphasize, however, that the realization of the potential benefits associated with the demographic transition appears to be dependent on institutions and policies, requiring the productive employment of the potential workers and savings the transition generates. Economic projections based on an "accounting" approach that assumes constant age-specific behavior are likely to be seriously misleading.

Is lowest-low fertility in Europe explained by the postponement of childbearing?

Abstract: In 2001, more than half of Europe's population lived in countries with a total fertility rate (TFR) at or below 1.3. Use of the adjusted TFR proposed by Bongaarts and Feeney, which takes into account the effects of the ongoing fertility postponement, changes the European fertility map considerably. All 27 countries analyzed had adjusted TFRs in 1995–2000 above 1.4. Thus, the “lowest-low” fertility in Europe may be interpreted as a temporary consequence of the increasing age at motherhood. However, substantial regional differences in fertility level across Europe persist even when the differential pace of fertility postponement is taken into account. The estimated adjusted TFRs in Europe (1.63) and in the 25-member European Union (1.71) contrast with the TFR levels of 1.40 and 1.46, respectively. These seemingly small differences have vastly different implications in terms of the potential long-term pace of population decline.

Childbearing after migration : Fertility patterns of foreign-born women in Sweden

Abstract: The present study provides an investigation of patterns in child¬bearing among foreign-born women in Sweden during the 1960s to 1990s. Event-history techniques are applied to longitudinal populatio ...

Cheap Children and the Persistence of Poverty

Abstract: This Paper develops a theory of fertility and child educational choice that offers an explanation for the persistence of poverty within and across countries. The joint determination of the quality (education) and quantity of children in the household is studied under the key assumption that individuals' productivity as teachers increases with their own human capital. As a result, the poor choose high fertility rates with low education investment and therefore, their offspring are poor as well. Furthermore, the high fertility rates in poor economies dilute physical capital accumulation and amplify the effect of child quality choice on economic growth. The model generates multiple steady states even though the technologies employed in the production of human capital and output are convex and preferences are convex and homothetic.

HIV and sexual behaviour among young South Africans: a national survey of 15-24 year olds.

Abstract: South Africa is in the grips of a devastating HIV/AIDS epidemic in which the peak incidence occurs among 15-24 year olds. loveLife is the largest youth focused intervention aimed at HIV prevention in South Africa. It is a national initiative of unprecedented scale combining a sustained multi-media awareness and education campaign with comprehensive youth-friendly sexual health services in public clinics nationwide and countrywide outreach and support programmes. This joint initiative between government non-government organisations (NGOs) and academic institutions aims to reduce HIV other sexually transmitted infections and unwanted pregnancy among South African youth. It is difficult to attribute the impact of loveLife as distinct from the effects of other national HIV prevention campaigns. For this reason there are two main objectives of this National Evaluation. The first objective is to identify trends in HIV infection and related determinants of infection among young people. The second objective is to try and gauge the relative impact of loveLife on HIV and related risk behaviours. This National Youth Survey is the first of three such studies to be conducted at approximately two year intervals over the expected duration of the loveLife initiative to track changes in HIV prevalence and sexual behaviour among South African youth. The aims of this initial study are to: 15- 24 years establish the prevalence of HIV and related behaviours among young people aged; assess young peoples sexual attitudes; examine the extent of young peoples exposure to loveLife; undertake this data collection with sufficient accuracy to permit monitoring of trends over time. (excerpt)

Polycystic ovary syndrome.

Abstract: Polycystic ovary syndrome (PCOS) is a common condition characterised by menstrual abnormalities and clinical or biochemical features of hyperandrogenism. Features of PCOS may manifest at any age ranging from childhood (premature puberty) teenage years (hirsutism menstrual abnormalities) early adulthood and middle life (infertility glucose intolerance) to later life (diabetes mellitus and cardiovascular disease). While pelvic ultrasound examination is useful many women without PCOS have polycystic ovaries; ultrasound evidence is not necessary for the diagnosis. Testing for glucose intolerance and hyperlipidaemia is wise especially in obese women as diabetes mellitus is common in PCOS. Lifestyle changes as recommended in diabetes are fundamental for treatment; addition of insulin-sensitising agents (eg metformin) may be valuable in circumstances such as anovulatory infertility. Infertility can be treated successfully in most women by diet and exercise clomiphene citrate with or without metformin ovarian drilling or ovulation induction with gonadotrophins; in-vitro fertilisation should be avoided unless there are other indications. (authors)

Reproductive functions of the ageing male

Abstract: Delayed childbearing is a common phenomenon in industrialized countries. This review focuses on age-associated alterations of male fertility and genetic risks. Semen volume, sperm motility and sperm morphology decrease with age, whereas the data concerning sperm concentration are conflicting. The age-related changes of semen parameters reflect the histological modifications which are found to varying degrees in individual testes. Men aged >40 years contribute to reduced fertility and fecundity of a couple, especially when the female partner is also of advanced age. Because relatively few children are born to older fathers and genetic diseases are rare, there is little statistical power supporting an association of genetic diseases in the offspring with advancing paternal age. Nevertheless, autosomal dominant diseases and some diseases of complex aetiology, such as schizophrenia, are associated with advancing paternal age. The single point mutations in sperm which are responsible for achondroplasia and Apert's syndrome, two autosomal dominant diseases, increase with the man's age. In case of Apert's syndrome this increase is believed to be due to a pre-meiotic selection of mutant spermatogonia. Although structural chromosome anomalies and disomies of certain chromosomes increase in sperm with the man's age, paternal age is, with the exception of trisomy 21, not associated with numerical or de novo structural chromosomal aberrations in newborns. However, even if the genetic risk for progeny from older fathers is slightly increased, the risk to the individual is low.

Perpetual postponers? Women's, men's and couple's fertility intentions and subsequent fertility behaviour.

Abstract: In this article data from the British Household Panel Study (BHPS) are used to analyse gender differences in fertility intentions, and the correspondence between fertility intentions and subsequent fertility behaviour. By exploiting couple-level data, we examine whether partners have conflicting preferences for future fertility. Focusing on women who remain childless in their thirties we look at socio-demographic factors related to the intention to remain childless, or to start a family later on in life. By following up women over time, the characteristics of women who go on to have a child later on in life are considered. The importance of having a partner and the fertility intention of that partner in predicting whether a birth will occur are also examined.

The Impact of Education on Fertility and Child Mortality: Do Fathers Really Matter Less Than Mothers?

Abstract: This paper takes advantage of a massive school construction program that took place in Indonesia between 1973 and 1978 to estimate the effect of education on fertility and child mortality. Time and region varying exposure to the school construction program generates instrumental variables for the average education in the household and the difference in education between husband and wife. We show that female education is a stronger determinant of age at marriage and early fertility than male education. However female and male education seem equally important factors in reducing child mortality. We suggest that the OLS estimate of the differential effect of women’s and men’s education may be biased by failure to take in to account assortative matching. (authors)

Second Births and the Second Shift: A Research Note on Gender Equity and Fertility

Abstract: In a set of propositions on fertility transition, Peter McDonald recently proposed that the decline from replacement-level fertility to low fertility is associated with a combination of high levels of gender equity in individual-oriented institutions, such as education and market employment, and low levels of gender equity in the family and family-oriented institutions. Similarly, the “second shift,” or the share of domestic work performed by formally employed women, forms a critical piece of current cross-national explanations for low fertility. Building on this scholarship, the authors explore whether there is empirical evidence at the individual level for a relationship between gender equity at home, as indicated by the division of housework among working couples with one child, and the transition to a second birth. Results, based on a sample of US couples, indicate a U-shaped relationship between gender equity and fertility. Both the most modern and the most traditional housework arrangements are positively associated with fertility. This empirical test elaborates the family-fertility relationship and underscores the need to incorporate family context, including gender equity, into explanations for fertility change.

‘You are a man because you have children’: experiences, reproductive health knowledge and treatment‐seeking behaviour among men suffering from couple infertility in South Africa

Abstract: BACKGROUND: In Africa, infertility traditionally has been viewed as a female problem. This study explores reproductive health knowledge, health-seeking behaviour and experiences related to involuntary childlessness in men suffering from couple infertility. METHODS: Twenty-seven men from a diverse cultural urban community in South Africa participated in in-depth interviews at the time of their first visit to an infertility clinic in a tertiary referral centre. RESULTS: Men had little knowledge about the physiology of human fertility, causes of infertility and modern treatment options. Awareness of male factor infertility was, however, high. Most men appeared involved in the health-seeking process. Men described their emotional reactions to childlessness and the impact of infertility on marital stability, and many reported that infertile men suffered from stigmatization, verbal abuse and loss of social status. CONCLUSIONS: These findings improve our understanding of the reproductive health needs of men suffering from couple infertility in Africa. This understanding is essential for the effective integration of male partners into modern infertility management. The need for appropriate counselling of men and, most particularly, for education of the community is recognized.

Women's fertility across the cycle increases the short-term attractiveness of creative intelligence compared to wealth

Abstract: Male provisioning ability may have evolved as a “good dad” indicator through sexual selection, whereas male creativity may have evolved partly as a “good genes” indicator. If so, women near peak fertility (midcycle) should prefer creativity over wealth, especially in short-term mating. Forty-one normally cycling women read vignettes describing creative but poor men vs. uncreative but rich men. Women’s estimated fertility predicted their short-term (but not long-term) preference for creativity over wealth, in both their desirability ratings of individual men (r=.40, p<.01) and their forced-choice decisions between men (r=.46, p<.01). These preliminary results are consistent with the view that creativity evolved at least partly as a good genes indicator through mate choice.

Low-Income Fathers

Abstract: This article reviews recent literature on low-income fathers, including the transition to fatherhood for young unmarried fathers and levels of father involvement among married, cohabiting, and nonresident low-income fathers. I discuss predictors of father involvement as well as available evidence concerning their effects on children's well-being. Although mounting qualitative evidence argues that unmarried low-income men may be more favorably disposed to fatherhood than previously recognized and that such intentions may greatly influence subsequent fathering behavior, studies of fertility intention remain largely separate from those of father involvement. I propose that subsequent research should also pay greater attention to the effects of fatherhood on low-income men.

The risk of adverse reproductive and developmental disorders due to occupational pesticide exposure: an overview of current epidemiological evidence

Abstract: The epidemiological studies presented in this paper refer to the association between agricultural occupation of parents and the incidence of infertility, congenital malformations, miscarriage, low birthweight, small-for-gestational-age (SGA) birth, preterm delivery and stillbirth. The results of the analyses showed that employment in agriculture increases the risk of specific morphological abnormalities in sperm, including the decreased sperm count per ejaculate and declined percentage of viable sperm. In general, no effect of exposure to pesticides on sexual hormones was observed. The data on the effect of employment in agriculture on the time to pregnancy are unequivocal, but most of them suggest that there is a relationship between the decreased fecundability ratio and pesticide exposure. Nor does the research on the sex ratio of offspring provide explicit results. The analyses indicate that parental employment in agriculture could increase the risk of congenital malformations in the offsprings, particularly such as orofacial cleft, birthmarks in the form of hemangioma as well as musculoskeletal and nervous system defects. The data on the effect of occupational exposure to pesticides on birthweight are inconsistent. Although most of epidemiological studies do not reveal a significantly increased risk of SGA, a slower pace of fetal development corresponding to SGA in the population of women exposed to pyrethroids has been recently reported. There are also some indications that exposure to pesticides may contribute to stillbirth and female infertility. The literature review suggests a great need to increase awareness of workers who are occupationally exposed to pesticides about their potential negative influence on fertility and pregnancy outcome. In the light of existing although still limited evidence of adverse effects of pesticide exposure on fertility during the preconceptual period, it is necessary to reduce the exposure to pesticides.

Fertility, Taxation and Family Policy

Abstract: Historically, there is clear evidence of an inverse relationship between female labour supply and fertility. However, the relationship across countries is now positive. Countries like Germany and Italy, with the lowest fertility, also have the lowest female participation rates. This paper analyses the extent to which this can be explained by public policy, in particular taxation and the system of child support. The results suggest that countries which have individual rather than joint taxation, and which support families through child care facilities rather than child payments, are likely to have both higher female labour supply and higher fertility.