STUDY QUESTION
What do older women understand of the relationship between age and fertility prior and subsequent to delivering their first child?
SUMMARY ANSWER
Women who were first-time parents over ...the age of 40 did not accurately perceive the relationship between age and fertility prior to conceiving with IVF.
WHAT IS KNOWN ALREADY
While increases in women's age at their first birth have been most pronounced in relatively older women, the rapidity of fertility decline is not appreciated by most non-infertility specialist physicians, the general public or men and women who are delaying childbearing.
STUDY DESIGN, SIZE AND DURATION
Qualitative retrospective interviews were conducted from 2009 to 2011 with 61 self-selected women who were patients in one of two fertility clinics in the USA.
PARTICIPANTS/MATERIALS, SETTING, METHODS
All participants had delivered their first child following IVF when the woman was 40 years or older. The data include women's responses to the semi-structured and open-ended interview questions ‘What information did you have about fertility and age before you started trying to get pregnant?’ and ‘What did you learn once you proceeded with fertility treatment?’
MAIN RESULTS AND THE ROLE OF CHANCE
Of the women, 30% expected their fertility to decline gradually until menopause at around 50 years and 31% reported that they expected to get pregnant without difficulty at the age of 40. Reasons for a mistaken belief in robust fertility included recollections of persistent and ongoing messaging about pregnancy prevention starting in adolescence (23%), healthy lifestyle and family history of fertility (26%), and incorrect information from friends, physicians or misleading media reports of pregnancies in older celebrity women (28%). Participants had not anticipated the possibility that they would need IVF to conceive with 44% reporting being ‘shocked’ and ‘alarmed’ to discover that their understanding of the rapidity of age-related reproductive decline was inaccurate’. In retrospect, their belated recognition of the effect of age on fertility led 72% of the women to state that they felt ‘lucky’ or had ‘beaten the odds’ in successfully conceiving after IVF. Of the women, 28% advocated better fertility education earlier in life and 23% indicated that with more information about declining fertility, they might have attempted conception at an earlier age. Yet 46% of women acknowledged that even if they had possessed better information, their life circumstances would not have permitted them to begin childbearing earlier.
LIMITATIONS AND REASONS FOR CAUTION
Both the self-selected nature of recruitment and the retrospective design can result in biases due to memory limitations or participant assimilation and/or contrast of past events with current moods. The cohort did not reflect broad homogeneity in that the participants were much more likely to be highly educated, Caucasian and better able to pay for treatment than national population norms. As attitudes of older women who were unsuccessful after attempting IVF in their late 30s or early 40s are not represented, it is possible (if not likely) that the recollections of women who did not conceive after IVF would have been more strongly influenced by feelings of regret or efforts to deflect blame for their inability to conceive.
WIDER IMPLICATIONS OF THE FINDINGS
While the failure to appreciate the true biological relationship between aging and fertility may be common and may reflect inaccessibility or misinterpretation of information, it is not sufficient to explain the decades-long socio-demographic phenomenon of delayed childbearing.
STUDY FUNDING/COMPETING INTEREST(S)
This study was funded by the US National Institute of Child and Human Development (NICHD, RO1-HD056202).
BACKGROUND
As ages at first birth have steadily risen in the industrial west over the last several decades, the phenomenon of ‘delayed childbearing’ has come under research scrutiny by demographers, ...medical specialists and social scientists. In this study, we specifically explore the perceived advantages and disadvantages of postponed conception as well as participants’ retrospective opinions on the ‘optimal age’ for parenting.
METHODS
To this end, we examined a cohort purposely chosen to epitomize delayed childbearing, i.e. men and women who used IVF to conceive at the very end of their reproductive capability. In-depth qualitative interviews were conducted between 2009 and 2011 with 46 couples and 15 individual self-selected US women and men who had used IVF to conceive their first child when the woman was aged 40 or older at the time of delivery. Although the demographics of this cohort were consistent with others who use IVF in the USA, their median income was 3–4 times higher than that of the average US family, which may bias their largely positive parenting experiences.
RESULTS
Most women and men believed that childbearing later in life resulted in advantages for themselves and their families. These included having established careers with financial security and career-time flexibility, enhanced emotional preparedness, committed co-parenting relationships and a positive overall family experience. The main disadvantage was the unexpected difficulty in conceiving that culminated in the use of IVF and resulted in a smaller family than desired, although many expressed feeling ‘lucky’ to have children at all. Other disadvantages were lack of energy for parenting, less available lifetime to spend with children and anticipated stigma as older parents.
CONCLUSIONS
These disadvantages appear to have influenced conception and parenting experiences so that in hindsight the majority of participants identified the optimal age for first-time parenting as 5–10 years earlier than they had conceived. This age range was imagined to maximize the financial and emotional advantages of later parenting while minimizing the impact of age-related infertility, diminished energy, anticipated health issues and the social stigma of appearing too old to parent.
To review the incidence of breast cancer in a continuous 22-year study of conjugated estrogen-medroxyprogesterone acetate hormone replacement therapy.
Eighty-four pairs of continuously hospitalized ...postmenopausal women who were matched for age, smoking history, and medical diagnosis were treated with estrogen-progestin hormone replacement therapy or placebo in a prospective and double-blind manner for 10 years. In the subsequent 12 years, the women were offered the choice of starting, stopping, or continuing hormone replacement therapy.
After the initial 10 years, the incidence of breast cancer in the placebo group was 4.8%, whereas no cancers were found in the hormone replacement therapy group (P = .12). After an additional 12 years of follow-up, the overall incidence of breast cancer in the women who had never taken hormone replacement therapy was 11.5%, whereas no breast cancers had developed in the women who had ever taken hormone replacement therapy (P < .01).
These data suggest that the 22-year administration of estrogen-progestin hormone replacement therapy did not increase the incidence of breast cancer in a small group of continuously hospitalized postmenopausal women.
The Tunka-HiSCORE detector follows the concept of a non-imaging wide-angle EAS Cherenkov array, designed to search for γ-ray sources above 10 TeV and to investigate the spectrum and composition of ...cosmic-rays above 100 TeV. A prototype array with 9 stations has been deployed in October 2013 at the site of the Tunka experiment in Russia. We describe design and performance of the array data acquisition system DAQ-2, focusing on its timing system based on the White Rabbit technology for sub-nsec time-synchronization over ethernet. First results of EAS arrival direction reconstruction, compared with MC simulations, and tests with artifical light sources verify an excellent performance of the system.
The new large-area (100 km 2) wide-angle (0.9 sr) air Cherenkov detector HiSCORE (Hundred) i Square-km Cosmic ORigin Explorer) aims at the exploration of the cosmic ray and gamma - ray sky ...(accelerator sky) in the so far poorly covered energy range from 10 TeV to 1 EeV. The main motivation for observations in this energy regime is to solve the origin of Galactic cosmic rays. Other questions of astroparticle and particle physics can be addressed in this energy regime. Furthermore, new physics questions might arise by opening the last remaining observation window of gamma - ray astronomy (TeV/PeV).
In response to concerns from feminists, demographers, bioethicists, journalists, and health care professionals, the Indian government passed legislation in 1994 and 2003 prohibiting the use of sex ...selection technology and sex-selective abortion. In contrast, South Asian families immigrating to the United States find themselves in an environment where reproductive choice is protected by law and technologies enabling sex selection are readily available. Yet there has been little research exploring immigrant Indian women’s narratives about the pressure they face to have sons, the process of deciding to utilize sex selection technologies, and the physical and emotional health implications of both son preference and sex selection. We undertook semi-structured, in-depth interviews with 65 immigrant Indian women in the United States who had pursued fetal sex selection on the East and West coasts of the United States between September 2004 and December 2009. Women spoke of son preference and sex selection as separate though intimately related phenomena, and the major themes that arose during interviews included the sociocultural roots of son preference; women’s early socialization around the importance of sons; the different forms of pressure to have sons that women experienced from female in-laws and husbands; the spectrum of verbal and physical abuse that women faced when they did not have male children and/or when they found out they were carrying a female fetus; and the ambivalence with which women regarded their own experience of reproductive “choice.” We found that 40% of the women interviewed had terminated prior pregnancies with female fetuses and that 89% of women carrying female fetuses in their current pregnancy pursued an abortion. These narratives highlight the interaction between medical technology and the perpetuation of this specific form of violence against women in an immigrant context where women are both the assumed beneficiaries of reproductive choice while remaining highly vulnerable to family violence and reproductive coercion.
► Although sex selection has been prohibited in India, it is available to South Asian families who have emigrated to the U.S. ► The cultural roots of son preference include the socioeconomic value of sons and the fear of raising daughters in the U.S. ► Eighty-nine percent of sex-selecting women terminated their pregnancy after discovering they were carrying a female fetus. ► Son preference was at times accompanied by verbal and physical abuse toward women who carried a female fetus to term. ► The proliferation of reproductive technology frequently has unanticipated cultural and gender-based ethical implications.
Hardware and first results of TUNKA-HiSCORE Kunnas, M.; Brückner, M.; Budnev, N. ...
Nuclear instruments & methods in physics research. Section A, Accelerators, spectrometers, detectors and associated equipment,
04/2014, Letnik:
742
Journal Article
Recenzirano
Odprti dostop
As a non-imaging wide-angle Cherenkov air shower detector array with an area of up to 100km2, the HiSCORE (Hundred⁎i Square km Cosmic ORigin Explorer) detector concept allows measurements of gamma ...rays and cosmic rays in an energy range of 10TeV up to 1EeV. In the framework of the Tunka-HiSCORE project we have started measurements with a small prototype array, and planned to build an engineering array (1km2) on the site of the Tunka experiment in Siberia. The first results and the most important hardware components are presented here.
To determine if differences could be distinguished between men's and women's emotional response to infertility based on the assignment of a gender-specific diagnosis.
Gender-specific diagnoses were ...examined in relation to stigma, perception of loss, role failure, and self-esteem, using structured interviews.
Tertiary clinical care in private practice settings.
Thirty-six self-selected volunteer couples undergoing infertility treatment.
Stigma, perception of loss, role failure, and lowered self-esteem emerged from content analysis of structured interview data.
No differences were found among women in their emotional response to infertility regardless of whether a female or male infertility factor was present, whereas men with a male factor experienced more negative emotional response to infertility than men without a male factor.
Although both women and men are affected by infertility, their emotional response is significantly influenced by a gender-specific diagnosis. Men's response to infertility closely approximates that of women if the infertility has been attributed to a male factor but differs considerably if a male factor is not found.
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