Showing papers on "Fertility published in 2009"

Births : final data for 2006

Abstract: Objectives—This report presents 2006 data on U.S. births according to a wide variety of characteristics. Data are presented for maternal demographic characteristics including age, live-birth order, race, Hispanic origin, marital status, and educational attainment; maternal lifestyle and health characteristics (medical risk factors, weight gain, and tobacco use); medical care utilization by pregnant women (prenatal care, obstetric procedures, characteristics of labor and/or delivery, attendant at birth, and method of delivery); and infant characteristics (period of gestation, birthweight, Apgar score, con­ genital anomalies, and multiple births). Also presented are birth and fertility rates by age, live-birth order, race, Hispanic origin, and marital status. Selected data by mother’s state of residence are shown, as well as data on month and day of birth, sex ratio, and age of father. Trends in fertility patterns and maternal and infant characteristics are described and interpreted. Methods—Descriptive tabulations of data reported on the birth certificates of the 4.3 million births that occurred in 2006 are presented. Denominators for population-based rates are postcensal estimates derived from the U.S. 2000 census. Results—In 2006, births and fertility rates increased for most states, age groups, and race and Hispanic origin groups. A total of 4,265,555 births were registered in the United States in 2006, 3 percent more than in 2005, and the largest number of births in more than four decades. The crude birth rate was 14.2, up slightly from the previous year; the general fertility rate was 68.5, up 3 percent. Birth rates increased for women in nearly all age groups, with the largest increases for teenagers and for women aged 20–24 and 40–44 years. Teenage childbearing increased, interrupting the 14-year decline from 1991– 2005. The mean age at first birth for U.S. women was down in 2006, to 25.0 years. The total fertility rate increased to 2,100.5 births per 1,000 women. All measures of unmarried childbearing reached record levels in 2006. Women were less likely to receive timely prenatal care in 2006. The cesarean delivery rate climbed to 31.1 percent, another all-time high. Preterm and low birthweight rates continued to rise; the twin birth rate was unchanged for the second consecutive year; the rate of triplet and higher order multiple births declined 5 percent. 2006 1996

Ovarian Aging: Mechanisms and Clinical Consequences

Abstract: Menopause is the final step in the process referred to as ovarian ageing. The age related decrease in follicle numbers dictates the onset of cycle irregularity and the final cessation of menses. The parallel decay in oocyte quality contributes to the gradual decline in fertility and the final occurrence of natural sterility. Endocrine changes mainly relate to the decline in the negative feedback from ovarian factors at the hypothalamo-pituitary unit. The declining cohort of antral follicles with age first results in graduallyelevatedFSHlevels,followedbysubsequentstagesofovertcycleirregularity.Thegradualdecline in the size of the antral follicle cohort is best represented by decreasing levels of anti-Mullerian hormone. The variability of ovarian ageing among women is evident from the large variation in age at menopause. The identificationofwomenwhohaveseverelydecreasedovarianreservefortheirageisclinicallyrelevant.Ovarian reserve tests have appeared to be fairly accurate in predicting response to ovarian stimulation in the assisted reproductive technology (ART) setting. The capacity to predict the chances for spontaneous pregnancy or pregnancy after ART appears very limited. As menopause and the preceding decline in oocyte quality seem to have a fixed time interval, tests that predict the age at menopause may be useful to assess individual reproductive lifespan. Especially genetic studies, both addressing candidate gene and genome wide association, have identified several interesting loci of small genetic variation that may determine fetal follicle pool development and subsequent wastage of his pool over time. Improved knowledge of the ovarian ageing mechanisms may ultimately provide tools for prediction of menopause and manipulation of the early steps of folliculogenesis for the purpose of contraception and fertility lifespan extension. (Endocrine Reviews 30: 465–493, 2009)

Culture: an empirical investigation of beliefs, work, and fertility

Abstract: We study the effect of culture on important economic outcomes by using the 1970 census to examine the work and fertility behavior of women born in the U.S. but whose parents were born elsewhere. We use past female labor force participation and total fertility rates from the country of ancestry as our cultural proxies. These variables should capture, in addition to past economic and institutional conditions, the beliefs commonly held about the role of women in society (i.e., culture). Given the different time and place, only the beliefs embodied in the cultural proxies should be potentially relevant. We show that these cultural proxies have positive and significant explanatory power for individual work and fertility outcomes, even after controlling for possible indirect effects of culture. We examine alternative hypotheses for these positive correlations and show that neither unobserved human capital nor networks are likely to be responsible.

Advances in development reverse fertility declines

Abstract: During the twentieth century, the global population has gone through unprecedented increases in economic and social development that coincided with substantial declines in human fertility and population growth rates. The negative association of fertility with economic and social development has therefore become one of the most solidly established and generally accepted empirical regularities in the social sciences. As a result of this close connection between development and fertility decline, more than half of the global population now lives in regions with below-replacement fertility (less than 2.1 children per woman). In many highly developed countries, the trend towards low fertility has also been deemed irreversible. Rapid population ageing, and in some cases the prospect of significant population decline, have therefore become a central socioeconomic concern and policy challenge. Here we show, using new cross-sectional and longitudinal analyses of the total fertility rate and the human development index (HDI), a fundamental change in the well-established negative relationship between fertility and development as the global population entered the twenty-first century. Although development continues to promote fertility decline at low and medium HDI levels, our analyses show that at advanced HDI levels, further development can reverse the declining trend in fertility. The previously negative development-fertility relationship has become J-shaped, with the HDI being positively associated with fertility among highly developed countries. This reversal of fertility decline as a result of continued economic and social development has the potential to slow the rates of population ageing, thereby ameliorating the social and economic problems that have been associated with the emergence and persistence of very low fertility.

Preservation of Fertility in Patients with Cancer

Abstract: The increasing number of young survivors of cancer who have favorable outcomes necessitates planning for the preservation of fertility, which may mean modifying the strategy for oncologic treatment. In addition to in vitro fertilization in women and sperm banking in men, new methods on the horizon include in vitro follicle maturation and techniques for tissue transplantation.

How Does Parental Leave Affect Fertility and Return to Work? Evidence from Two Natural Experiments

Abstract: This paper analyzes the effects of changes in the duration of paid, job-protected parental leave on mothers' higher-order fertility and postbirth labor market careers. Identification is based on a major Austrian reform increasing the duration of parental leave from one year to two years for any child born on or after July 1, 1990. We find that mothers who give birth to their first child immediately after the reform have more second children than prereform mothers, and that extended parental leave significantly reduces return to work. Employment and earnings also decrease in the short run, but not in the long run. Fertility and work responses vary across the population in ways suggesting that both cash transfers and job protection are relevant. Increasing parental leave for a future child increases fertility strongly but leaves short-run postbirth careers relatively unaffected. Partially reversing the 1990 extension, a second 1996 reform improves employment and earnings while compressing the time between births.

The End of “Lowest‐Low” Fertility?

Abstract: Period fertility rates fell to previously unseen low levels in a large number of countries beginning in the early 1990s. The persistence of Total Fertility Rates under 1.3 raised the possibility of dramatic, rapid population aging as well as population decline. In an analysis of recent trends, we find, however, a widespread turn-around in so-called "lowest-low" fertility countries. The reversal has been particularly vigorous in Europe. The number of countries with period total fertility rates less than 1.3 fell from 21 in 2003 to five in 2008, of which four (Hong Kong, Korea, Singapore and Taiwan) are in East Asia. Moreover, the upturn in the period TFR was not confined to lowest-fertility countries, but affected the whole developed world. We explore the demographic explanations for the recent rise in fertility stemming from fertility timing effects as well as economic, policy, and social factors. Although the current economic crisis may push down fertility in the short-run, we conclude that formerly lowest-low fertility countries should continue to see further increase in fertility as the transitory effects of shifts to later motherhood become less and less important.

Fertility of Female Survivors of Childhood Cancer: A Report From the Childhood Cancer Survivor Study

Abstract: Purpose This study was undertaken to determine the effect, if any, of treatment for cancer diagnosed during childhood or adolescence on fertility. Patients and Methods We reviewed the fertility of female participants in the Childhood Cancer Survivor Study (CCSS), which consisted of 5-year survivors, and a cohort of randomly selected siblings who responded to a questionnaire. Medical records of all members of the cohort were abstracted to obtain chemotherapeutic agents administered; the cumulative dose of drug administered for several drugs of interest; and the doses, volumes, and dates of administration of all radiation therapy. Results There were 5,149 female CCSS participants, and there were 1,441 female siblings of CCSS participants who were age 15 to 44 years. The relative risk (RR) for survivors of ever being pregnant was 0.81 (95% CI, 0.73 to 0.90; P < .001) compared with female siblings. In multivariate models among survivors only, those who received a hypothalamic/pituitary radiation dose ≥ 30 Gy ...

Fertility, Female Labor Force Participation, and the Demographic Dividend

Abstract: We estimate the effect of fertility on female labor force participation in a panel of countries using abortion legislation as an instrument for fertility. We find that removing legal restrictions on abortion significantly reduces fertility and estimate that, on average, a birth reduces a woman’s labor supply by almost 2 years during her reproductive life. Our results imply that behavioral change, in the form of increased female labor supply, contributes significantly to economic growth during the demographic transition when fertility declines.

Physician Referral for Fertility Preservation in Oncology Patients: A National Study of Practice Behaviors

Abstract: Purpose Cancer survival rates are improving, and the focus is moving toward quality survival. Fertility is a key aspect of quality of life for cancer patients of childbearing age. Although cancer treatment may impair fertility, some patients may benefit from referral to a specialist before treatment. However, the majority of studies examining patient recall of discussion and referral for fertility preservation (FP) show that less than half receive this information. This study examined the referral practices of oncologists in the United States. Methods This study examined oncologists' referral practice patterns for FP among US physicians using the American Medical Association Physician Masterfile database. A 53-item survey was administered via mail and Internet to a stratified random sample of US physicians. Results Forty-seven percent of respondents routinely refer cancer patients of childbearing age to a reproductive endocrinologist. Referrals were more likely among female physicians (P = .004), those wi...

Are Tests of Sperm DNA Damage Clinically Useful? Pros and Cons

Abstract: The advent of assisted reproductive technologies, particularly intracytoplasmic sperm injection (ICSI), has revolutionized the treatment of male-factor infertility. However, there are many unanswered questions regarding the safety of these techniques. These safety concerns are relevant because 1) these technologies often bypass the barriers to natural selection; 2) infertile men, particularly those with severe male-factor infertility, possess substantially more sperm DNA damage than do fertile men; and 3) experimentally, sperm DNA damage has been shown to adversely affect the developing embryo. This review discusses the etiology of sperm DNA damage, describes the individual tests of sperm DNA damage, and explores the relationship between sperm DNA damage and pregnancy outcomes. Based on a systematic review of the literature, sperm DNA damage is associated with lower natural, intrauterine insemination (IUI), and in vitro fertilization (IVF) pregnancy rates, but not with ICSI pregnancy rates. The literature also suggests that that sperm DNA damage is associated with an increased risk of pregnancy loss in those couples undergoing IVF or ICSI. Nonetheless, the true clinical utility of sperm DNA damage tests remains to be established, because the available studies are small and few in number and the study characteristics are heterogeneous. Although current data suggest that impaired sperm DNA integrity may have the greatest effect on IUI pregnancy rates and pregnancy loss by IVF and ICSI, further prospective studies are needed before testing should become a routine part of patient management.

Impact of radiotherapy on fertility, pregnancy, and neonatal outcomes in female cancer patients

Abstract: Purpose: Radiation has many potential long-term effects on cancer survivors. Female cancer patients may experience decreased fertility depending on the site irradiated. Oncologists should be aware of these consequences and discuss options for fertility preservation before initiating therapy. Methods and Materials: A comprehensive review of the existing literature was conducted. Studies reporting the outcomes for female patients treated with cranio-spinal, abdominal, or pelvic radiation reporting fertility, pregnancy, or neonatal-related outcomes were reviewed. Results: Cranio-spinal irradiation elicited significant hormonal changes in women that affected their ability to become pregnant later in life. Women treated with abdomino-pelvic radiation have an increased rate of uterine dysfunction leading to miscarriage, preterm labor, low birth weight, and placental abnormalities. Early menopause results from low-dose ovarian radiation. Ovarian transposition may decrease the rates of ovarian dysfunction. Conclusions: There is a dose-dependent relationship between ovarian radiation therapy (RT) and premature menopause. Patients treated with RT must be aware of the impact of treatment on fertility and explore appropriate options.

A systematic review of factors influencing fertility desires and intentions among people living with HIV/AIDS: implications for policy and service delivery.

Abstract: With availability of antiretroviral treatments, HIV is increasingly recognised as a chronic disease people live with for many years. This paper critically reviews the current literature on fertility desires and reproductive intentions among people living with HIV/AIDS (PLHIV) and critiques the theoretical frameworks and methodologies used. A systematic review was conducted using electronic databases: ISI Web of Knowledge, Science Direct, Proquest, Jstor and CINAHL for articles published between 1990 and 2008. The search terms used were fertility desire, pregnancy, HIV, reproductive decision making, reproductive intentions, motherhood, fatherhood and parenthood. Twenty-nine studies were reviewed. Fertility desires were influenced by a myriad of demographic, health, stigma-associated and psychosocial factors. Cultural factors were also important, particularly in Sub-Saharan Africa and Asia. Future research that examines fertility desires among PLHIV should include cultural beliefs and practices in the theoretical framework in order to provide a holistic understanding and to enable development of services that meet the reproductive needs of PLHIV.

Pregnancy and Fertility Following Bariatric Surgery: A Systematic Review

Abstract: Context Use of bariatric surgery has increased dramatically during the past 10 years, particularly among women of reproductive age. Objectives To estimate bariatric surgery rates among women aged 18 to 45 years and to assess the published literature on pregnancy outcomes and fertility after surgery. Evidence Acquisition Search of the Nationwide Inpatient Sample (1998-2005) and multiple electronic databases (Medline, EMBASE, Controlled Clinical Trials Register Database, and the Cochrane Database of Reviews of Effectiveness) to identify articles published between 1985 and February 2008 on bariatric surgery among women of reproductive age. Search terms included bariatric procedures, fertility, contraception, pregnancy, and nutritional deficiencies. Information was abstracted about study design, fertility, and nutritional, neonatal, and pregnancy outcomes after surgery. Evidence Synthesis Of 260 screened articles, 75 were included. Women aged 18 to 45 years accounted for 49% of all patients undergoing bariatric surgery (>50 000 cases annually for the 3 most recent years). Three matched cohort studies showed lower maternal complication rates after bariatric surgery than in obese women without bariatric surgery, or rates approaching those of nonobese controls. In 1 matched cohort study that compared maternal complication rates in women after laparoscopic adjustable gastric band surgery with obese women without surgery, rates of gestational diabetes (0% vs 22.1%, P Conclusion Rates of many adverse maternal and neonatal outcomes may be lower in women who become pregnant after having had bariatric surgery compared with rates in pregnant women who are obese; however, further data are needed from rigorously designed studies.

Fertility intentions and reproductive health care needs of people living with HIV in Cape Town, South Africa: implications for integrating reproductive health and HIV care services.

Abstract: Tailoring sexual and reproductive health services to meet the needs of people living with the human immuno-deficiency virus (HIV) is a growing concern but there are few insights into these issues where HIV is most prevalent. This cross-sectional study investigated the fertility intentions and associated health care needs of 459 women and men, not sampled as intimate partners of each other, living with HIV in Cape Town, South Africa. An almost equal proportion of women (55%) and men (43%) living with HIV, reported not intending to have children as were open to the possibility of having children (45 and 57%, respectively). Overall, greater intentions to have children were associated with being male, having fewer children, living in an informal settlement and use of antiretroviral therapy. There were important gender differences in the determinants of future childbearing intentions, with being on HAART strongly associated with women’s fertility intentions. Gender differences were also apparent in participants’ key reasons for wanting children. A minority of participants had discussed their reproductive intentions and related issues with HIV health care providers. There is an urgent need for intervention models to integrate HIV care with sexual and reproduction health counseling and services that account for the diverse reproductive needs of these populations.

Cohort Fertility Patterns in the Nordic Countries

Abstract: Previous analyses of period fertility suggest that the trends of the Nordic countries are sufficiently similar to speak of a common "Nordic fertility regime". We investigate whether this assumption ...

Good semen quality and life expectancy: a cohort study of 43,277 men.

Abstract: Fertility status may predict later mortality, but no studies have examined the effect of semen quality on subsequent mortality. Men referred to the Copenhagen Sperm Analysis Laboratory by general practitioners and urologists from 1963 to 2001 were, through a unique personal identification number, linked to the Danish central registers that hold information on all cases of cancer, causes of death, and number of children in the Danish population. The men were followed until December 31, 2001, death, or censoring, whichever occurred first, and the total mortality and cause-specific mortality of the cohort were compared with those of all age-standardized Danish men or according to semen characteristics. Among 43,277 men without azospermia referred for infertility problems, mortality decreased as the sperm concentration increased up to a threshold of 40 million/mL. As the percentages of motile and morphologically normal spermatozoa and semen volume increased, mortality decreased in a dose-response manner (P(trend) < 0.05). The decrease in mortality among men with good semen quality was due to a decrease in a wide range of diseases and was found among men both with and without children; therefore, the decrease in mortality could not be attributed solely to lifestyle and/or social factors. Semen quality may therefore be a fundamental biomarker of overall male health.

Psychological aspects of fertility preservation in men and women affected by cancer and other life-threatening diseases

Abstract: BACKGROUND: With advances in treatment, the number of young cancer survivors who may benefit from fertility preservation is growing. The aim of this study was to review the literature investigating psychological aspects of fertility issues and fertility preservation in patients undergoing fertility-compromising therapy for cancer or other life-threatening diseases, previous to or during their reproductive lifespan. METHODS: Articles were identified in PubMed, Embase and PsycLIT as well as manually retrieved from literature citations for the time period from 1999 to 2008. Inclusion criteria were (i) qualitative or quantitative design, (ii) focus on patients previous to or during their reproductive lifespan and (iii) dealing with aspects such as (1) impact of fertility issues in cancer patients or (2) health professionals' and/or patients' attitudes towards fertility preservation or (3) counselling. RESULTS: Twenty-four studies were identified. According to the studies on aspect (1), fertility is an important issue for cancer patients. Health professionals as well as patients and parents consider fertility preservation as an important option for young cancer patients; all parties involved, however, were noted to have knowledge and information deficits. Patients recalling counselling about the impact of cancer treatment on fertility ranged from 34% to 72%. Counselling is far from being offered globally to all patients at risk, and providing information seems to be selective. CONCLUSIONS: The existing literature demonstrates the need for and the limits of current counselling. Future research should target the means to facilitate the decision-making process for patients and health professionals.

When and why do subfertile couples discontinue their fertility care? A longitudinal cohort study in a secondary care subfertility population

Abstract: BACKGROUND: A substantial number of subfertile couples discontinues fertility care before achieving pregnancy. Most studies on dropouts are related to IVF. The aim here is to examine dropout rates at all stages of fertility care. METHODS: We analysed a consecutive cohort of 1391 couples, referred to our secondary care hospital between January 2002 and December 2006. Discontinuation rates were studied at six stages. Stage I: immediately after first visit, Stage II: during diagnostic workup, Stage III: after finishing diagnostic workup but before treatment, Stage IV: during or after non-IVF treatment, Stage V: during IVF, Stage VI: after at least 3 cycles of IVF. Reasons to discontinue and spontaneous pregnancy rates after discontinuation were secondary outcomes. RESULTS: In our cohort 319 couples dropped out of fertility care, 76.8%, [95% confidence interval (CI): 72.2-81.4] on their own initiative and 23.2% (95% CI: 18.6-27.8) on doctor's advice. Percentage (95% CI) of couples discontinuing per stage were: Stage I 6.0% (3.4-8.6), Stage II 3.4% (1.5-5.5), Stage III 35.7% (30.5-41.0), Stage IV 23.5% (18.9-28.2), Stage V 17.9% (13.7-22.1) and Stage VI 13.5% (9.7-17.2). Main reasons for dropout (%, 95% CI) were 'emotional distress' (22.3%, 17.7-26.8), 'poor prognosis' (18.8%, 14.5-23.1) and 'reject treatment' (17.2%, 13.1-21.4). The spontaneous ongoing pregnancy rate after discontinuation was 10% (6.7-13.3). CONCLUSION: About half of the couples stopped before any fertility treatment was started and one-third stopped after at least one IVF cycle. The main reasons for withdrawal were emotional distress and poor prognosis. This insight may help to improve quality of patient care by making care more responsive to the needs and expectations of subfertile couples.

Fear and fertility in inflammatory bowel disease: a mismatch of perception and reality affects family planning decisions.

Abstract: BACKGROUND: Smaller family size and voluntary childlessness has been reported in IBD; however the disease-related reasons for this from a patient viewpoint are not described. The aims were to 1) determine whether IBD patients perceptions of the issues surrounding IBD pregnancy and childbearing influence their reproductive behavior and 2) describe these specific perceptions and concerns related to fertility and pregnancy. METHODS: All contactable subjects between 18-50 years of age from a hospital-based IBD database were surveyed by postal questionnaire. Data were obtained regarding age gender IBD diagnosis and treatment body image and sexual relationships as well as both objective and subjective data regarding fertility and pregnancy. Comparisons were made to community norms where data were available. Contingency tables with Fishers exact test were used. RESULTS: Of 365 subjects 255 responded (70%). The mean age was 35.5 years overall 34.7 years for women. In all 34% of participants were male 127 had Crohns disease (CD) 85 ulcerative colitis (UC) and 5 indeterminate colitis (IC). The average fertility rate was no different between women with CD and UC (1.0 and 1.2 births/woman respectively; P = 0.553) compared with 1.81 for all Australian women. Although 42.7% of IBD patients reported a fear of infertility patients only sought medical fertility advice at the same rate as the general population. Fear of infertility was most evident in women those with CD and those reporting previous surgery. Specific patient concerns which appear to have decreased patients family size included IBD heritability the risk of congenital abnormalities and medication teratogenicity. CONCLUSIONS: The unusually high response rate indicates the centrality of reproductive issues to IBD patients. "Voluntary" childlessness in this group appears to result from concerns about adverse reproductive outcomes that may not be justified. Patients require accurate counseling addressing fertility and pregnancy outcomes in IBD to assist in their decision making.

Chronic Disease Burden and the Interaction of Education, Fertility, and Growth.

Abstract: This study considers the eradication of hookworm disease from the American South (circa 1910) as a test of the quantity-quality (Q-Q) framework of fertility. Eradication was principally a shock to the price of quality because of three factors: hookworm (i) depresses the return to human capital investment, (ii) had a very low case-fatality rate, and (iii) had negligible prevalence among adults. Consistent with the Q-Q model, we find a significant decline in fertility associated with eradication.

The fertility-related concerns, needs and preferences of younger women with breast cancer: a systematic review

Abstract: Breast cancer is the most commonly diagnosed type of cancer in reproductive aged women. Adjuvant systemic therapy is recommended in most women and has been demonstrated to reduce the risk of recurrence and increase survival. However, there may be a negative impact of adjuvant systemic therapy on fertility as well as on subsequent quality of life. There are a number of fertility preservation options currently available and relevant information regarding these options should be provided prior to commencing adjuvant treatment. The aim of the review is to identify the fertility-related needs, concerns and preferences of young women with early breast cancer. The databases MEDLINE and EMBASE were searched from 1988 onwards using keywords, and examining reference lists. Of the 499 articles identified, 20 met eligibility criteria and were reviewed. Multiple fertility-related information needs specific to this group regarding menstrual changes and potential infertility attitudes to, and actual decisions made regarding, pregnancy breastfeeding and contraception emerged. Information on fertility-related decisions was rated as important, and the preferred methods for obtaining this information was consultation with a specialist or a decision aid early in the treatment plan. There is limited research about fertility-related needs, and even less on contraceptive preferences and the attitudes of health care providers towards fertility-related issues. No studies describing the development of tools to assist with decisions about fertility-related choices were identified. Young women with early breast cancer have specific fertility- and menopause-related needs and concerns, which are commonly not adequately addressed or discussed prior to commencing adjuvant therapy.

Induction of spermatogenesis and fertility during gonadotropin treatment of gonadotropin-deficient infertile men: predictors of fertility outcome.

Abstract: Background: The induction of spermatogenesis and fertility with gonadotropin therapy in gonadotropin-deficient men varies in rate and extent. Understanding the predictors of response would inform clinical practice but requires multivariate analyses in sufficiently large clinical cohorts that are suitably detailed and frequently assessed. Design, Setting, and Participants: A total of 75 men, with 72 desiring fertility, was treated at two academic andrology centers for a total of 116 courses of therapy from 1981–2008. Outcomes: Semen analysis and testicular examination were performed every 3 months. Results: A total of 38 men became fathers, including five through assisted reproduction. The median time to achieve first sperm was 7.1 months [95% confidence interval (CI) 6.3–10.1]) and for conception was 28.2 months (95% CI 21.6–38.5). The median sperm concentration at conception for unassisted pregnancies was 8.0 m/ml (95% CI 0.2–59.5). Multivariate correlated time-to-event analyses show that larger testis v...

Subsidized Contraception, Fertility, and Sexual Behavior

Abstract: We examine the impact of recent state-level Medicaid policy changes that expanded eligibility for family planning services to higher-income women and to Medicaid clients whose benefits would expire otherwise. We show that the income-based policy change reduced overall births to non-teens by about 2% and to teens by over 4%; estimates suggest a decline of 9% among newly eligible women. The reduction in fertility appears to have been accomplished via greater use of contraception. Our calculations indicate that allowing higher-income women to receive federally funded family planning cost on the order of $6,800 for each averted birth.

The Evolution of Fertility Expectations Over the Life Course

Abstract: In low-fertility contexts, how many children people have is largely a product of how many children they want. However, the social, institutional, and individual factors that influence how many children people want are not well understood. In particular, there is scant evidence about how fertility expectations change over the life course. This article provides an empirical description of changes in women's expected fertility over the entire span of childbearing years. Using data from the National Longitudinal Survey of Youth, 1979 cohort, group-based trajectory analysis illuminates common patterns in the evolution of fertility intentions and identifies individual characteristics associated with these patterns. Factors related to family formation, such as marriage and whether a woman has a child at an early age, are found to be the most consistent correlates of patterns of change in expected family size.