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Delayed childbearing has led more individuals and couples to seek medical help for conception in many European countries. In accordance with a stratified reproduction perspective, there is evidence of social disparities concerning who seeks medical help to become pregnant. However, it remains unclear whether and how disparities vary across different stages of the help‐seeking process. This article provides novel evidence on the degree of disparities and associated factors involved in the process of medical help‐seeking to have a child by stage, distinguishing between consulting a doctor, receiving medication, and getting more advanced treatments such as in vitro fertilization. Using wave 1 of the German Family Demographic Panel Study (FReDA), a novel and large data source, we examine women and men aged 18–50 using partial proportional odds models. Women reported a higher lifetime prevalence of help‐seeking (12.3%) than men (8.0%), primarily due to greater use of medication. We found that two of four indicators of social stratification were associated with help‐seeking (income and marital status, but not education and migration background). Women and men with higher household income and those who were married were more likely to seek medical help. Less‐intensive infertility treatment is free, but advanced treatments are expensive, and only married couples are eligible for partial reimbursement. We had therefore expected to find stronger associations for both variables for advanced treatments, which was not the case. This suggests that, even though financial considerations were important, selection into treatment may also be related to other factors, including cultural and knowledge‐based factors.

The COVID-19 pandemic has affected all areas of our lives. Among other outcomes, the academic literature and popular media both discuss the potential effects of the pandemic on fertility. As fertility is an important determinant of population development and population forecasts are important for policy decisions and planning, we need to address to which extent fertility forecasts performed before the pandemic still apply. Using Monte Carlo forecasting based on principal components of fertility rates, we quantify the effects of the pandemic on fertility for 22 countries and discuss whether forecasts made prior to the pandemic need adjustment based on more recent data. Among the studied countries, 14 countries show no significant effect of the pandemic at all, while six countries have significantly lowered numbers of births in comparison to counterfactual trajectories that assume that past trends will hold. These countries are primarily in the Mediterranean and East Asia. For Finland and South Korea, there is statistical evidence for increased fertility in the early phases of the pandemic. In all cases with statistically significant fertility differentials caused by the pandemic, reproductive behavior normalized quickly. Therefore, we find no evidence for long-term effects of the pandemic on fertility, leading to the conclusion that pre-pandemic fertility forecasts still apply.

Women have many reproductive options, but little is known about their regrets regarding prior reproductive choices and outcomes. Guided by the life-course and stratified reproduction perspectives, this study draws on an open-ended question about reproductive regrets from wave I of the National Survey of Fertility Barriers, a representative telephone survey of reproductive aged U.S. women conducted from 2004 to 2006. The authors classified regrets into five broad categories: (1) none, (2) problematic fertility, (3) unfulfilled fertility desires, (4) family, and (5) pregnancy experiences. The authors conducted the analyses separately by motherhood status. Logistic regression analysis revealed that regardless of parental status, those who were older, had infertility, or were experiencing economic hardship were more likely to report reproductive regrets. The authors also investigated factors associated with the likelihood of expressing specific reproductive regrets. In general, the present findings confirm expectations based on the life-course and stratified reproduction perspectives.

Several theories of fertility behavior assume that planning is important to women. Is this a reasonable assumption? To answer this question, the authors used the National Survey of Fertility Barriers. Among women with unsure or positive fertility intentions at wave 1, most (75 percent) agreed with the statement “It is important to plan my pregnancies.” Logistic regression, adjusted for control variables, indicated that fertility intentions are a distinct construct from pregnancy planning attitudes. Multinomial regression of retrospective pregnancy attitude three years later among a subsample of women who had pregnancies during that period indicated that women who felt that it was more important to plan pregnancies had higher odds of describing their intentions at the time of a subsequent pregnancy as “trying to” become pregnant compared with “okay either way.” Therefore, it is useful to measure and include pregnancy planning attitude, in addition to intentions, in fertility research.

BACKGROUND Existing reviews on the prevalence of use of medically assisted reproduction (MAR) are relatively old and include mainly studies from the 1980s and 1990s. Since then, MAR has developed at a rapid pace, public awareness and acceptance of medical solutions to infertility problems has increased, and, consequently, the use of MAR has risen in developed countries. OBJECTIVE AND RATIONALE This study provides a comprehensive overview of the state of research on the prevalence of MAR use in women and men, as well as a critique of methodology used in studies of the use of MAR, and suggestions for moving forward. SEARCH METHODS Articles were located via the databases Academic Search Complete, Biomed Central, FirstSearch, Google Scholar, Medline, Health and Medical Collection, Medline and Social Science Citation Index using the key words ‘infertile’, ‘infertility’, ‘subfecund’, ‘subfecundity’, ‘treatment’, ‘help-seeking’, ‘service use’, ‘service utilization’, ‘ART use’ and ‘MAR use’ separately and in various combinations. The focus was on studies from developed countries, published between 1990 and 2018, in English, German or French. OUTCOMES In this article, we have reviewed 39 studies covering 13 countries or regions; approximately half of these covered the USA. Ten studies were published in the 1990s, 10 in the 2000s and 19 since 2010. Studies report different types of prevalence rates such as lifetime and current prevalence rates of MAR use. Prevalence rates are based on very different denominators: women who tried to become pregnant for at least 12 months without success, women who experienced at least 12 months of unprotected intercourse without success, women of reproductive age from the general population or women with a life birth. There are few studies that report help-seeking rates for men or make direct comparisons between genders. Knowledge on medical help-seeking across different stages, such as seeing a doctor, undergoing tests, having operations to restore fertility or ART, has started to accumulate in recent years. There are conceptual reasons for being cautious about drawing conclusions about gender, regional, country level and differences over time in help-seeking rates. LIMITATIONS, REASONS FOR CAUTION In a narrative review, the risk of bias in the interpretation of findings cannot be completely eliminated. The literature search was limited to languages the authors speak: English, French and German. WIDER IMPLICATIONS In line with earlier reviews, we found that studies on help-seeking are not comparable across time and space, preventing researchers and healthcare providers from understanding the relation between social change, social policy, social structure and help-seeking for infertility. The discussion in this article should assist future researchers in designing better studies on the prevalence of MAR use. We provide suggestions for producing better estimates of the prevalence of MAR use. More cross-country and cross-gender comparisons are needed. Studies that treat help-seeking as a continuum and report on different stages are preferable compared to choosing arbitrary cutoff points, as is common practice in the studies reviewed. STUDY FUNDING/COMPETING INTEREST(S) None.

Reproductive events such as infertility, abortion, or unintended pregnancies are often framed as discrete outcomes in scholarly research. This silo-ed approach is quite distinct from how people experience their reproductive lives as embodied and interconnected throughout the life course. In this analysis, we build on and further a “reproductive careers” framework to better account for the number (density) and distinct types (complexity) of reproductive events that cisgender women experience across their life course. We incorporate insights from scholarship on stratified reproduction, cumulative (dis)advantage, and health to conceptualize and empirically examine how women’s reproductive careers are potentially unequally patterned. Using reproductive history data on 4351 U.S. women from the National Survey of Fertility Barriers, we find that Black and Hispanic women, women of lower socioeconomic status, and women with limited healthcare access have both denser and more complex reproductive careers than their more structurally advantaged peers. As summary indicators, density and complexity may offer proxies for the “reproductive load” that subgroups of women differentially experience across the life course.

Evidence of group differences in reproductive control and access to reproductive health care suggests the continued existence of \"stratified reproduction\" in the United States. Women of color are overrepresented among people with infertility but are underrepresented among those who receive medical services. The authors employ path analysis to uncover mechanisms accounting for these differences among black, Hispanic, Asian, and non-Hispanic white women using a probability-based sample of 2,162 U.S. women. Black and Hispanic women are less likely to receive services than other women. The enabling conditions of income, education, and private insurance partially mediate the relationship between race-ethnicity and receipt of services but do not fully account for the association at all levels of service. For black and Hispanic women, social cues, enabling conditions, and predisposing conditions contribute to disparities in receipt of services. Most of the association between race-ethnicity and service receipt is indirect rather than direct.

Proximate determinants theory considers infertility rates a risk factor for lower fertility rates, but the assumption that people who perceive infertility will have fewer children has not been tested. This study investigates the association of self-perceived infertility with the number of children people have had after 11 years. Infertility implies reduced chances of conception (rather than sterility), but people do not always consistently perceive infertility over time. If people who think they are infertile at one time can later report no infertility, then does self-perceived infertility necessarily lead to having fewer children? We answer this question by analyzing 11 waves of the German family panel (pairfam) data using negative binomial growth curve models for eight core demographic subgroups created by combinations of gender (men/women), parity (0/1+children), and initial age groups (25–27 and 35–37). Those who repeatedly perceived themselves to be infertile (three times or more) had fewer children than those who perceived themselves to be infertile once or twice in only four of eight gender by initial parity by age groups. Only in four groups did people who perceived themselves to be infertile once or twice have fewer children than those who never perceived themselves to be infertile in both the unadjusted and adjusted models. Thus, self-perceived infertility does not necessarily result in fewer children. Rather, the association depends upon life course context and gender.

In this article, we show that social science research on fertility and infertility consists of largely separate research traditions, despite shared interest in pregnancies and births (or lack thereof). We describe four ways these two traditions differ: (1) publication trajectories and outlets, (2) fields of study and major theoretical frameworks, (3) degree of attention to the other topic, and (4) language and definitions used. We then discuss why future integration of these bodies of research would be beneficial, outline potential steps toward rapprochement, and provide common areas of dialogue that could facilitate and enrich these bodies of research. We offer a more holistic framework using the reproductive career as an extension of existing lifecourse approaches in both fertility and infertility research. We conclude with a brief empirical example and discussion of methodological issues for measuring and modeling reproductive careers.

Little is known about how “reproductive orientation” (i.e., trying to get pregnant, ambivalent about pregnancy, trying to avoid pregnancy, or having had a sterilization surgery) is associated with sexual satisfaction among women of childbearing age. Using data from the National Survey of Fertility Barriers ( N  = 2811), we examined the association of reproductive orientation with sexual satisfaction, adjusting for relationship characteristics including union type (cohabitation versus marriage), quality, and length; infertility history; and demographic characteristics including age, parity, and race/ethnicity. Results indicated that women who were ambivalent or trying to get pregnant reported significantly higher levels of sexual satisfaction than women who were sterile in the unadjusted model, but not in the models that included relationship quality. The association of reproductive orientation and sexual satisfaction depended upon relationship quality; among women with lower relationship quality, “trying” was associated with higher, and among those with higher relationship quality, with lower sexual satisfaction.