Infertile or childless by choice? A multipractice survey of women aged 35 and 50.

Eleven general practitioners examined the medical records of all women on their lists born in 1950 (617 patients) and 1935 (533 patients) to determine the prevalence of childlessness and specialist consultations about infertility. Eighty eight (14.3%) of the women born in 1950 and 41 (7.7%) of those born in 1935 were childless. Sixty eight women born in 1950 (11.0%) and 17 born in 1935 (3.2%) were considered childless by choice. Involuntary childlessness was found in 20 (3.3%) of the women born in 1950 and 24 (4.5%) born in 1935. Forty two (6.8%) of the women born in 1950 had consulted a specialist about infertility as compared with 19 (3.6%) born in 1935. This study found a significant increase in voluntary childlessness among the younger women; there was no evidence of a change in the prevalence of involuntary childlessness despite the increasing demand for specialist referral, which appeared to be made by women who were parous or destined to become so.     

Who remains childless?

Who are the men and women who are childless in their mid-30s? Life history data for a British cohort born in 1946 show that age at marriage and marital breakdown were clearly associated with childlessness. Women who were only children were more likely to be childless than those with siblings. Further, early menarcheal age, being highly qualified and having a high status occupation were indirectly related to childlessness. For men, particularly amongst those who had experienced a broken marriage, it was the most ambitious, the highly educated and those in professional occupations who were relatively more likely to be childless.     

Structural determinants of childlessness: A nonrecursive analysis of 1970 U.S. rates

Abstract

This study tests two theories accounting for observed relationships between U.S. rates of childlessness and sociodemographic characteristics using data on Black and white women aged 30–44 from the 1970 U.S. census. Traditional theory sees the observed correlations as spuriously caused by involuntary sterility, while voluntaristic theory interprets the associations as evidence of influences on the decisions of fecund couples to remain childless. We examine the two positions by estimating and then comparing the aggregate causal structures of childless rates and cumulative fertility rates of women with proven fecundity. The traditional approach expects little if any relationship, while the voluntaristic approach predicts high similarity between the two estimated structures. Results support the voluntaristic position and thus offer indirect substantiation of the voluntaristic theory of areal variation in childless rates.     

Season of birth and reproductive performance: an analysis of family reconstitutions of 800 women born in The Netherlands at the end of the 19th century

Background: Several studies have reported associations between season of birth and reproductive characteristics such as menarcheal age, fecundability, and twinning, but the results are inconsistent with respect to the location of high- and low-risk seasons. To assess whether this disagreement could be due to the use of populations from different geographic areas and time frames instead of different etiologic pathways, we investigated the season-of-birth dependency of a variety of reproductive outcomes within one time- and arealimited population. Methods: In a historic follow-up study, the reconstituted families of 800 women born between 1873 and 1887 in or near Rotterdam, The Netherlands, were used to determine eight types of reproductive outcome: childlessness, interval to first pregnancy, pregnancy interval, stillbirth, neonatal death, postneonatal death, multiple birth, and gender of offspring. The relation of these outcomes with season of birth was modeled using cosinor functions with periods of 1 year or a half year. Data were analyzed by use of logistic regression or general estimation equations (GEE), dependent on whether outcomes could occur more than once per woman. Results: Peaks in the model-based risks of reproductive failure were found within two small temporal ranges, January 1 to February 11 and July 1 to August 11 for all outcomes except gender. The picture did not change after controlling for known and possible risk factors, including age, offspring's birth cohort, and some social variables. Conclusions: This study reconfirms the idea that seasonal factors around conception or birth influence later reproductive characteristics. Observing the consistency of the location of high-risk seasons across a variety of outcomes, the explanation of season-of-birth dependency of different reproductive outcomes need not involve multiple etiological pathways. (Chronobiology International, 18(3), 525-539, 2001)     

Pathways into childlessness: evidence of gendered life course dynamics

Using data from the first wave of the Netherlands Kinship Panel Study (NKPS) for 2867 women and 2195 men aged 40 to 79, this study examines to what extent educational, employment and marital pathways shape the likelihood of remaining childless, and whether these pathways are gendered. The findings indicate that women and men have distinctive pathways into childlessness. Educational attainment increases the likelihood of remaining childless among women only. A stable career increases the likelihood of remaining childless among women, but it increases the likelihood of entering fatherhood. Years without a partner is positively associated with childlessness among both women and men. Not having had a partnership and having had multiple partnerships are strong determinants of childlessness, especially among men.     

Fecundity of daughters born after short, intermediate, or long birth intervals. An analysis of family reconstitutions from The Netherlands, late 19th-early 20th century

In an historical cohort study, we compared the reproductive performances of women born after short (< 14 completed months), intermediate (21-32 completed months), and long (> 39 completed months) birth intervals. Of the initial study base, comprising family reconstitutions of 1,425 women born between 1873 and 1902 in or around Rotterdam (The Netherlands) and married before age 45, a large portion (data of 1,001 women born between 1888 and 1902) was uninformative because of (unintended) selection on birth control behavior. Among the remaining 424 women, those born after very short birth intervals (less than 1 year) showed higher likelihood of childlessness and stillbirth in the offspring than those born after intermediate intervals (adjusted odds ratios (OR) and 95%-confidence intervals: 7.7 [1.8-33.0] and 3.3 [1.3-8.3], respectively). The latter association, however, nearly disappeared after restriction to women whose preceding sibling lived at least 1 year. Women born after modestly short intervals (12-13 months) exhibited longer interpregnancy intervals. So did women born after long birth intervals, but this might well be attributable to intergenerational transmission of reproductive behavior. These results indicate that fecundability is reduced in women born after short birth intervals.     

Risk factors for gastroschisis

The prevalence at birth of gastroschisis, a rare abnormality of the abdominal wall, appears to have increased over the past decade. To characterize risk factors that might explain this increase, birth certificates for Washington State residents were compared for 62 infants born with gastroschisis during the years 1984 to 1987 and 617 randomly selected unaffected infants matched for birth year. After simultaneously adjusting for 14 potential risk factors, 4 factors stood out. Infants born during January, February, or March were at greater risk than infants born in any other months (odds ratio 2.2, 95% confidence interval 1.1, 4.1). Mothers less than 25 years old were at greater risk than mothers 25 years and older, with the highest risk to mothers less than 20 years old (odds ratio 4.1, 95% confidence interval 1.4, 12.0). Women who smoked during pregnancy were at greater risk than women who did not smoke (odds ratio 2.0, 95% confidence interval 1.03, 3.8). Finally, mothers receiving inadequate prenatal care were at greater risk than mothers receiving adequate prenatal care (odds ratio 2.1, 95% confidence interval 0.99, 4.6). Unidentified behavioral and environmental exposures may explain the associations with month of birth, maternal age, and prenatal care. However, smoking during pregnancy is a plausible risk factor that should be examined further as an explanation of the apparently increasing prevalence at birth of gastroschisis in developed nations.     

Effects of maternal birth season on birth seasonality in the Canadian population during the seventeenth and eighteenth centuries

Birth records of the French-Canadian population for the period 1621-1765 were analyzed retrospectively to examine the effect of maternal birth season on the seasonal distribution of births. Preliminary examination indicated that there was a bimodal pattern in birth seasonality: a major peak in early spring, a trough in early summer, a minor peak in autumn, and a trough around December. Because this seasonality was strongly biased at the level of the first birth by the month of marriage, which was concentrated in November, the seasonality of nonfirst births (n = 32,926) was examined in relation to the four seasons of maternal birth. Mothers born in May-July showed a flatter monthly distribution of nonfirst births at a maternal age of 28 years or more. Analysis of marriage-first birth intervals indicated that mothers who married in August-October showed a lower percentage of immediate conception (intervals of 8-10 months), whereas those mothers born in May-July had a higher percentage of immediate conception. This difference in birth seasonality shown by mothers born in May-July is similar to results from early twentieth-century Japan. Some seasonal infertility factors could have affected the embryos at the earliest stage of pregnancy, modifying a part of the seasonal variation in birth rate.     

Childlessness drives the sex difference in the association between income and reproductive success of modern Europeans

The association between reproductive success and income in economically developed societies remains a controversial and understudied topic. The commonly made statement that individuals with a higher income have fewer children defies evolutionary explanation. Here we present results from an analyses of the association between lifetime reproductive success (LRS) and income for modern Europeans from 13 countries. We examine the relationships among income, partner income, sex and LRS, and the role of childlessness in driving the relationships. For women, we find a negative association between LRS and income, while for men, we find a flat or slightly positive one. The sex difference in the association appears to be driven by income's sex-specific association with childlessness; men with a low income have a relatively high risk of childlessness, while women with a low income have a low risk of childlessness. Consequently, once childless people are excluded from the analysis, LRS is negatively associated with income for both sexes. We argue that the observed LRS–income associations may be an outcome of evolved behavioural predispositions operating in modern environments and conclude that, even though humans fail to maximise LRS at all income levels in modern settings, evolutionary theory can still help to explain sex differences in LRS.     

Chromosome abnormalities and season of birth

Summary p A study of seasonality has been made of birth of individuals with chromosome abnormalities registered in the Danish Cytogenetic Central Register before January 1, 1981. Significant seasonal variation in birth was found for males with Klinefelter's syndrome born before 1946, but not for those born later, and not for any other sex chromosome abnormality.No significant monthly variation was found for any autosomal abnormality, except a significant increase in the frequency of conceptions for Down's syndrome during the first 4 months of the year, using a chi square with 2 degrees of freedom.     

Month of birth predicted reproductive success and fitness in pre-modern Canadian women

Conditions experienced during early development affect human health and survival in adulthood, but whether such effects have consequences for fitness is not known. One surrogate for early conditions is month of birth, which is known to influence health and survival in many human populations. We show that in nineteenth century Canada, month of birth predicted a woman's fitness measured by the number of grandchildren produced, with the genetic contribution to the following generations by women born in different months differing by over seven grandchildren. This difference was mainly caused by differences in the reproductive rates of both mothers and their offspring, rather than differences in their survival. Women born in the best months of the year had longer reproductive lifespans, larger numbers of live births and raised more offspring to adulthood than those who were born in the worst months. Furthermore, the offspring of those women born in the best months also had greater reproductive rates, suggesting that month of birth also influenced a mother's ability to invest in her offspring. Our results suggest that early conditions may have important consequences for human lifetime reproductive performance within and between generations, and that timing of birth had large effects on fitness in this rural community.     

SEASON OF BIRTH AND REPRODUCTIVE PERFORMANCE: AN ANALYSIS OF FAMILY RECONSTITUTIONS OF 800 WOMEN BORN IN THE NETHERLANDS AT THE END OF THE 19TH CENTURY

Background: Several studies have reported associations between season of birth and reproductive characteristics such as menarcheal age, fecundability, and twinning, but the results are inconsistent with respect to the location of high- and low-risk seasons. To assess whether this disagreement could be due to the use of populations from different geographic areas and time frames instead of different etiologic pathways, we investigated the season-of-birth dependency of a variety of reproductive outcomes within one time- and arealimited population. Methods: In a historic follow-up study, the reconstituted families of 800 women born between 1873 and 1887 in or near Rotterdam, The Netherlands, were used to determine eight types of reproductive outcome: childlessness, interval to first pregnancy, pregnancy interval, stillbirth, neonatal death, postneonatal death, multiple birth, and gender of offspring. The relation of these outcomes with season of birth was modeled using cosinor functions with periods of 1 year or a half year. Data were analyzed by use of logistic regression or general estimation equations (GEE), dependent on whether outcomes could occur more than once per woman. Results: Peaks in the model-based risks of reproductive failure were found within two small temporal ranges, January 1 to February 11 and July 1 to August 11 for all outcomes except gender. The picture did not change after controlling for known and possible risk factors, including age, offspring's birth cohort, and some social variables. Conclusions: This study reconfirms the idea that seasonal factors around conception or birth influence later reproductive characteristics. Observing the consistency of the location of high-risk seasons across a variety of outcomes, the explanation of season-of-birth dependency of different reproductive outcomes need not involve multiple etiological pathways. (Chronobiology International, 18(3), 525–539, 2001)     

Childlessness among American women

Abstract

The rate of childlessness in the United States has increased over the last two decades. Changing or differential rates by different segments of society have important implications for society. Most previous studies have relied on unrepresentative opportunistic samples to identify those segments of society with lower or higher rates of childlessness. These types of samples may misestimate both the number of women planning to remain childless and the magnitude of the correlates of childlessness. The present study uses these previous studies to identify predictor variables, but tests their significance using a recent national representative sample of women in the United States, aged 20–44: Cycle III of the National Survey for Family Growth, collected in 1982. The most important demographic factors are marital status and fecundity status, followed by age, race or ethnicity, education of the respondent, labor force status, and region. Father's education and mother's education are slightly, but not significantly, related to childlessness. Contrary to findings from less representative samples, urban‐rural differences and religion are not related to childlessness.     

Role of seasonal factors in pre- and postnatal ontogenesis for etiology of type 1 diabetes mellitus

Type 1 diabetes mellitus is a chronic disease characterized by autoimmune degradation of insulin-producing beta-cells. It was shown in a number of epidemiological studies of seasonality of birth in children with type 1 diabetes that the autoimmune process began during fetal and postnatal development. No such studies were carried out in the former Soviet Union countries. The aim of the present study is to compare the seasonal birth month pattern in patients with type 1 diabetes (10780 men and 9337 women) born in 1960-2002 to that in the total population of Ukraine (14 785601 men and 13 911370 women) born during the same period. Significant differences were found between these two populations: chi-squared = 103.97, p < 0.0001 and 135.17, p < 0.0001 in men and women, respectively. The results of cosinor analysis showed similar sinusoidal birth patterns of patients with type 1 diabetes in all sub-groups, irrespective of the age of clinical disease expression: 0-9, 10-19, or 20-29 years. In all cases, the highest and lowest predispositions to type 1 diabetes were inherent in the people born in spring and autumn, respectively. We propose that seasonal differences in the birth pattern in the two above populations could be due to long-term programming of glucose-insulin metabolism determined by the effect of certain seasonal factors during early ontogenesis.     

Early growth and death from cardiovascular disease in women.

OBJECTIVE--To determine whether the link suggested between growth in utero and during infancy and death from cardiovascular disease in men is also present in women. DESIGN--Follow up study of women and men whose birth weight and weight at 1 year of age had been recorded. SETTING--Hertfordshire, England. SUBJECTS--5585 women and 10,141 men born during 1911-30. MAIN OUTCOME MEASURES--Standardised mortality ratios for cardiovascular disease. RESULTS--Among women and men death rates from cardiovascular disease fell progressively between the low and high birth weights groups (chi 2 = 4.3, p = 0.04 for women, chi 2 = 8.5, p < 0.005 for men). Cardiovascular deaths in men but not women were also strongly related to weight at 1 year, falling progressively between the low and high weight groups (chi 2 = 27.5, p < 0.0001). The highest cardiovascular death rates in women were among those with below average birth weight but above average weight at 1 year. In men the highest rates were among those with below average birth weight and below average weight at 1 year. CONCLUSION--Relations between cardiovascular disease and birth weight are similar in men and women. In men cardiovascular disease is also related to weight gain in infancy.     

Seasonal characteristics of and age at menarche

Data from approximately 600 U.S. women were analyzed for seasonality in menarche. Data were converted to the ratio of observed (O) to expected (E) cases, based on an equal distribution of events over the year, per considered time span of the year. The greatest O/E ratio in menarche (1.55) occurred during January, followed by August (1.43) and July (1.24). The lowest O/E ratio in menarche occurred in February and May (0.68). Seasonal patterns in menarche were detected for the separate cohorts of women born during the 1940s, 1950s, and 1960s, with a shift from a December-January peak in menarche for those born in the 1940s and 1950s to an August-September peak for those born in the 1960s. Girls who were younger (8-14 yrs) at menarche exhibited a seasonal difference in the peak number of menarches by about 6 months in comparison to the pattern for girls who were older (15-17 yrs). Girls who experienced menarche during August-October were statistically significantly younger (p less than 0.05) than those born during the other three seasons. Season of birth was not statistically significantly associated with season of menarche. Overall, no 12-month pattern was substantiated by cosinor analysis in the month of menarche. However, a 6-month rhythm was detected in menarche for women born between 1940 and 1960 (p = 0.004, A = 29% M, phi = January and July).     

Factors in the incidence of childlessness in Canada: an analysis of census data

Due to the difficulties involved in attempting to determine the relative proportion of involuntary childlessness and of voluntary childlessness in a given population, many investigators insist that the problem can only be examined in small-scale studies using intensive psychological interviewing techniques. A method for assessing the causes of childlessness in a population using census materials is described. If a distinction is made between psychological and physiological causes, instead of between intentional and unintentional causes, it is possible to assess the relative importance of these causes using large-scale investigation techniques. Physiological causes include all physiological conditions which produce sterility. Psychological causes include both psychosomatic infertility and the voluntary decision not to have children. The method involves using the minimum rate of childlessness in a population group known to place a high value on fertility as an estimate of the rate of physiological childlessness in the population. This estimate is then subtracted from the childlessness rate observed in other population groups in the same society in order to determine the degree of psychological childlessness in these other population groups. This method was used to assess the causes of childlessness in Canada. Census materials were used to determine the minimum rate of childlessness among rural women in Quebec. Since this group is primarily Catholic and places a high value on children, its childlessness rate provides an estimate of the proportion of sterile couples in the population. This rate was then subtracted from the childlessness rates for urban Canadian women, and the remainder provided an estimate of psychological childlessness among urban women. Age of marriage was controlled for since rural women married at younger ages. Study findings were 1) the proportion of childlessness among urban women declined over the years as 15.2% of the women over 45 years old were childless while only 10.8% of the women, aged 30-44, were childless; 2) the proportion of physiological childlessness declined from 6.6% among women over 45 years old to 4.6% among women, aged 30-44; and 3) approximately 50% of the cases of childlessness among urban women were due to psychological factors. These findings do not support the contentions of some investigators that 10% of the population is sterile and that psychological childlessness is rare. Study findings were presented in tabular form.     

Seasonal programming of adult longevity in Ukraine

Longevity was significantly associated with season of birth in 101,634 individuals who died in Kiev during the period 1990-2000. The relationship between age at death and month of birth showed a very similar pattern for both men and women. Mean values for the age at death were lowest for subjects born in April-July, and highest for individuals born at the beginning and end of the year. Minimum and maximum ages at death, analysed according to month of birth, differed by 2.6 years in men and 2.3 years in women. For all major causes of death causes, the mean age at death for persons born in the fourth quarter was the highest. These results suggest that, in this population, longevity is affected by prenatal or early postnatal seasonal factors. This is consistent with the hypothesis that the rate of ageing may be programmed in response to environmental influences at critical periods of early development.     

Role of seasonal factors in pre-and postnatal ontogenesis in etiology of type 1 diabetes mellitus

Type 1 diabetes mellitus is a chronic disease characterized by autoimmune degradation of insulinproducing β-cells. Seasonality of birth of children with type 1 diabetes has been shown in a number of epidemiological studies. It could testify that autoimmune process began during fetal and postnatal development. No such studies were carried out in the former Soviet Union countries. The aim of the present study is to compare the seasonal birth month pattern in patients with type 1 diabetes (10780 men and 9337 women) born in 1960–2003 to that in the total population of Ukraine (14 995768 men and 14 109792 women) born during the same period. Significant differences were found between these two populations: χ ² = 103.97, p < 0.0001 and 135.17, p < 0.0001 in men and women, respectively. The results of cosinor analysis showed similar sinusoidal birth patterns of patients with type 1 diabetes in all subgroups, irrespective of the age of clinical disease manifestation: 0–9, 10–19, or 20–29 years. In all cases, the highest and lowest predispositions to type 1 diabetes were inherent in the people born in spring and autumn, respectively. In all groups, the highest incidence rate was in persons born in spring and early summer and the lowest ones, in those born in autumn and early winter. We propose that seasonality of birth of patients with type 1 diabetes in the two above populations could be due to long-term programming of glucose-insulin metabolism caused by the effect of certain seasonal factors during early ontogenesis.     

Characteristics of voluntarily and involuntarily childless wives.

Using data from the 1965 U.S. National Fertility Study, white childless wives 30-54 years old were categorized as voluntarily, involuntarily, or temporarily childless. These 3 groups were then compared along many demographic, socioeconomic, marital, and religious lines. It was found that voluntarily and involuntarily childless wives were similar across most characteristics and both groups were different from the temporarily childless women. This last group is considerably younger than either of the other 2 groups; this fact may account for the differences between this and the other 2 groups. Other literature on childlessness is cited and compared. The difficulties with categorization of childless wives are discussed. Before it is generally concluded that differences do not exist between voluntarily and involuntarily childless wives, it will be necessary to study data from younger women who benefited from the "new fertility regime" of recent years.