Fertility/Infertility

Sex and Gender-based Analysis of this topic

Definition

Fertility is the ability of a couple to conceive through normal sexual activity. Conversely, infertility is defined as the inability to conceive after a year of regular intercourse or carry a baby to term [1,2]. There are several different measures of fertility.  One common measure is the crude birth rate, which indicates the number of live births in a population in a given area, expressed per 1000 population per year. Another measure is the total fertility rate, which refers to the average number of children a woman is expected to have in her lifetime.

The Canadian total fertility rate has steadily decreased since the late 1980s but has experienced a slight upward trend since 1996 [3]. The upward trend in fertility may account for the fact that the echo generation (those born from the mid 1980s to early 1990s) has reached childbearing years [3]. The current Canadian total fertility rate is 1.6, the highest it has been since 1996. However, this rate is below the replacement rate (2.1) that is needed to replace the current Canadian population (disregarding migration) [4]. 

 
 
Sex Issues

In Canada, it is estimated that 7-9% of people are infertile [5]. About one third of infertility cases are due to male factors, one third are due to female factors, and the remainder are caused by a combination of male and female factors. In females, problems with ovulation are the most common causes of infertility. Other causes of infertility include: blocked fallopian tubes resulting from pelvic inflammatory disease (PID) or endometriosis; surgery from ectopic pregnancy, uterine fibroids; and problems with the uterus. Factors that increase women’s risk of infertility include: age, stress, poor diet, athletic training, being overweight or underweight, tobacco smoking, alcohol, sexually transmitted infections (STIs), hormonal problems, and age [2]. Women’s fertility rates decline steadily with age and drop dramatically after reaching the mid-thirties [6-7].

 
 
Gender Issues

Recent decreases in fertility rates in part reflect socioeconomic changes as women are postponing childbirth to further their education, in addition to establishing and maintaining their careers[8]. The overall drop in fertility rates does not seem to reflect a shifting preference towards smaller families because younger Canadian women report that they intend to have about the same number of children as younger women 20 years ago [9].

The average age of first birth, however, has steadily increased from 20 years in 1986 to 29 years in 1996. For the first time, the fertility rate of women aged 30-34 is higher than women between the ages of 20-24 [10]. A decline in fertility, paired with an increased risk of birthing complications after the age of 30, may decrease women’s total fertility rates and overall fertility trends.  However, many women are turning to fertility drugs and assisted reproductive technologies to increase their fertility [2].

 
 
Diversity

A 2001 study revealed that in general, immigrants exhibit higher total fertility rates than the general Canadian population. However, the total fertility rates of immigrants decline over time to resemble the fertility rates of the general population [11]. Demographic data from 2001 show the total fertility rates of visible minorities vary widely by group: Korean (1.3) and Chinese (1.2) groups had lower total fertility rates compared to the general population (1.6), whereas Black (1.7), Filipino (1.7), Latin American (1.8) and Arab and West Asian (2.2) groups had higher total fertility rates. During this time, the Aboriginal population had the highest fertility rate of 2.6 [12].

 
 
Critique

Observed fertility rates reflect both the ability to conceive, as well as the reproductive desires of couples. However, it is difficult to disentangle the proportion due to reproductive desires and the proportion due to prevalence of infertility. Currently, there are no reliable measures of infertility in Canada as no comprehensive measurements have been undertaken.  Furthermore, factors such as increased number of couples seeking assisted reproduction after delaying childbirth may fuel the misconception that the infertility rate is increasing [5].

 
 
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