When time runs out: reconciling permanent childlessness after delayed childbearing.

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.

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 men's 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 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 experience of spontaneous pregnancy loss for infertile women who have conceived through assisted reproduction technology.

BACKGROUND: The purpose of this qualitative, phenomenological study was to explore the subjective experiences of infertile women who conceived through the use of assisted reproduction technology--ovarian stimulation, intrauterine insemination or IVF--only to lose their pregnancy at 2-16 weeks gestation. METHODS: Ten women participated in in-depth, tape-recorded interviews. After initial content analysis, a phenomenological analysis was undertaken to identify common themes in the participants' stories. RESULTS: Nine common themes were identified. These included: a sense of profound loss and grief; diminished control; a sense of shared loss with their partners; injustice or lack of fairness; ongoing reminders of the loss; social awkwardness; fear of re-investing in the treatment process or a subsequent pregnancy; the need to make sense of their experience; and feelings of personal responsibility for what had happened. CONCLUSIONS: Participants' experiences of pregnancy loss were embedded within their experiences of infertility and medical treatment, and shaped by their significant investment in having a child. A significant feature was their marked ambivalence regarding future reproductive options after their pregnancy loss, reflecting a unique overlay of prominent anxiety in their grief experience.