Emily Koert

Childless women's knowledge of fertility and assisted human reproduction: identifying the gaps.

OBJECTIVE To determine the knowledge about fertility and assisted human reproduction (AHR) treatments of a large sample of childless women. DESIGN Self-report questionnaire comprising two self-ratings of current fertility and AHR knowledge, and 16 knowledge questions related to fertility and AHR. SETTING Online. PATIENT(S) A total of 3,345 childless women between the ages of 20 and 50. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Knowledge of fertility and AHR. RESULT(S) The majority of participants rated themselves as having some knowledge or being fairly knowledgeable about fertility and AHR. However, on the 16 knowledge questions, overall knowledge was low, with 50% or more of the sample answering only 6 of 16 questions correctly. CONCLUSION(S) The data suggest that the women in the study have no coherent body of knowledge regarding age-related fertility and AHR treatment options. With an increasing number of women electing to delay childbearing, there is a critical need for public education regarding age-related fertility declines and the availability, costs, and limitations of AHR. This study offers important mental health contributions to infertility prevention and public health education efforts.

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 mens 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.

Childless Canadian men's and women's childbearing intentions, attitudes towards and willingness to use assisted human reproduction

STUDY QUESTION What are the childbearing intentions of currently childless men and women? What is their attitude towards, and willingness to use, assisted human reproduction (AHR) treatments and family-building options should they be faced with fertility challenges in the future? SUMMARY ANSWER Men and women expect to become parents significantly later in life than they believe is ideal. If faced with future fertility challenges, respondents were open to using IVF, but were not positively predisposed to third-party family-building options. WHAT IS KNOWN ALREADY Delayed childbearing is an increasing worldwide phenomenon that has considerable health and fertility-related implications. Research to date has focused primarily on women, and indicates a lack of knowledge about the fertility life span and the limitations of AHR in fully compensating for age-related fertility declines. STUDY DESIGN, SIZE, DURATION Cross-sectional study of 2000 childless women and 599 childless men, conducted between April 2010 and May 2011. PARTICIPANTS/MATERIALS, SETTING, METHODS A total of 2599 childless, presumed fertile individuals between the ages of 20 and 50 years. An online questionnaire assessed fertility beliefs and intentions and willingness to use AHR. MAIN RESULTS AND THE ROLE OF CHANCE The findings indicate that men and women expect to become parents significantly later in life than they believe is ideal. If faced with fertility challenges in the future, both men and women were open to using IVF. Men were significantly more willing to consider using donated eggs and embryos, gestational surrogacy and fertility preservation. Women were significantly more willing to consider using home fertility testing, IVF, ICSI and donor sperm. Overall, the childless respondents were not positively predisposed to third party-family-building options. LIMITATIONS The geographic specificity of the sample, the online format and recruitment methods may limit the generalizability of these findings. WIDER IMPLICATIONS OF THE FINDINGS Given the worldwide trend towards delayed childbearing, and the widespread availability of AHR, it is likely that these findings could extend to the wider North American, European and Australasia populations of English- and French-speaking childless men and women. However, it should be noted that international differences exist, especially concerning regulations governing the funding of AHR and payment for gametes and surrogacy. It is significant that women and men in this study indicated a lack of willingness to consider the use of third third-party treatments--the very options they may need to use in building their families, if the increasing trend towards delayed childbearing continues. STUDY FUNDING/COMPETING INTERESTS This research was funded by a grant from the Canadian Institutes of Health Research and Assisted Human Reproduction Canada #PAH-103594, 2009/10. No competing interests.

Childless women's beliefs and knowledge about oocyte freezing for social and medical reasons.

STUDY QUESTION What factors inform a womans decision-making about oocyte freezing to preserve fertility for social and medical reasons? SUMMARY ANSWER Women lacked knowledge about the costs and viability of oocyte freezing as a fertility preservation option for social and medical reasons, and identified health consequences, costs, and viability as being particularly influential in their decision-making. WHAT IS KNOWN ALREADY Having only recently become a viable fertility preservation option, relatively little is known about childless womens beliefs or knowledge about oocyte freezing for social or medical reasons. STUDY DESIGN, SIZE, DURATION A cross sectional study of 500 childless women was conducted in August, 2015. PARTICIPANTS/MATERIALS, SETTING, METHODS A total of 500 childless, presumed fertile, women from 18 to 38 years of age completed an online, self-report questionnaire assessing beliefs and knowledge about oocyte freezing to preserve fertility for social or medical reasons. MAIN RESULTS AND THE ROLE OF CHANCE Financial costs (85.6%), health risks to themselves (86.4%) or their offspring (87.8%), and success rates (82%) were the primary factors that women felt would influence their decision to freeze their oocytes. Partners feelings (88.6%), prognosis for a full recovery (85.4%), and concerns about the health effects of the hormones or oocyte retrieval procedure (85.4%) were identified as being particularly important when considering oocyte freezing for medical reasons. Consistent with their perceptions of having little or no knowledge about oocyte freezing, there was an overall correct response rate of 33% to the 12 knowledge questions. LIMITATIONS, REASONS FOR CAUTION The online format and use of a survey company to recruit participants may have increased the risk of self-selection bias and limit the generalizability of these findings. The findings may also be limited by the fact that the participants were not facing cancer treatments, and the younger participants were not nearing the end of their reproductive lifespan, and therefore would not have had reason to learn about, or consider, fertility preservation for medical or social reasons. WIDER IMPLICATIONS OF THE FINDINGS Given the worldwide trend towards delaying childbearing and the increasing availability of oocyte freezing as an option to preserve womens fertility, it is likely these results could be extended to wider North American, European, and Australasian populations of English speaking childless women. STUDY FUNDING/COMPETING INTERESTS No specific funding. No competing interests.

Sexual Transitions in the Lives of Adult Women

Sexuality is an important and complex aspect of life. It encompasses “physical, psychological, social, emotional, spiritual, cultural, and ethical dimensions of human experience” (Duplassie and Daniluk 2007, p. 263). Sexual expression involves “the sensual pleasure that comes from the stimulation of the body, often with the anticipation of an enjoyable, erotic feeling” (Westheimer and Lopater 2005, p. 24). Sexuality includes attitudes, beliefs, and expectations about self and others. These are inevitably shaped by external forces such as societal and cultural norms, media portrayals of sexuality, and relationships with others who are important. Women’s sexuality at all stages of the course of life is developed through and influenced by interactions with others based on a woman’s age, life stage, and significant roles (Daniluk 1998). How women experience their sexuality changes and shifts across the lifespan, especially during key transitions such as infertility, pregnancy, mothering, menopause, and physical illness and disability. Not only do these transitions involve biological processes and changes, but the meanings that women attribute to these events and experiences also have implications for women’s sexual self-perceptions, expression, and satisfaction (Daniluk 1998).

When time runs out: reconciling permanent childlessness after delayed childbearing

Abstract Objective: This study aimed to examine the experience of permanent childlessness after delayed childbearing. Background: More women are delaying childbearing while they pursue a career, gain financial stability and seek an appropriate partner. However, given that fertility declines with age, there is concern that more women will end up permanently, unintentionally childless after postponing childbearing. There is little known about this growing and invisible group. Methods: An interpretive phenomenological analysis was used to conduct the study. A purposive sample of 15 women who identified as being permanently childless after delaying childbearing participated in the study. Data were collected using in-depth semi-structured interviews. Results: Themes included feelings of grief, loss and isolation; a need to make sense of their childlessness; and a need to rebuild and refocus their lives and identities regardless of whether they had actually tried to conceive during their childbearing years. Women struggled with feelings of regret and the need to reconcile the reality of their choice to delay childbearing based on their values and beliefs about the ideal conditions within which to raise a child with feelings of powerlessness to pursue motherhood when they were likely still fertile. Conclusion: Women who are permanently childless after delaying childbearing experience similar feelings to those who are childless after infertility and failed fertility treatments regardless of whether they tried to conceive during their reproductive years. However, this group has unique needs based on their feelings of regret, powerlessness and responsibility for their childlessness.