This article reviews research on the effects of economic recessions on fertility in the developed world. We study how economic downturns, as measured by various indicators, especially by declining GDP levels, falling consumer confidence, and rising unemployment, were found to affect fertility. We also discuss particular mechanisms through which the recession may have influenced fertility behavior, including the effects of economic uncertainty, falling income, changes in the housing market, and rising enrollment in higher education, and also factors that influence fertility indirectly such as declining marriage rates. Most studies find that fertility tends to be pro-cyclical and often rises and declines with the ups and downs of the business cycle. Usually, these aggregate effects are relatively small (typically, a few percentage points) and of short durations; in addition they often influence especially the timing of childbearing and in most cases do not leave an imprint on cohort fertility levels. Therefore, major long-term fertility shifts often continue seemingly uninterrupted during the recession—including the fertility declines before and during the Great Depression of the 1930s and before and during the oil shock crises of the 1970s. Changes in the opportunity costs of childbearing and fertility behavior during economic downturn vary by sex, age, social status, and number of children; childless young adults are usually most affected. Furthermore, various policies and institutions may modify or even reverse the relationship between recessions and fertility. The first evidence pertaining to the recent recession falls in line with these findings. In most countries, the recession has brought a decline in the number of births and fertility rates, often marking a sharp halt to the previous decade of rising fertility rates.
This analysis of fertility transition is conducted among 69 developing countries during 1960-90. It is argued that the relationship between socioeconomic development and the timing and pace of fertility decline is related to level of development regional progress in fertility decline and social interaction. The empirical test is based on the theoretical framework of Notestein and successors. Analysis is based on the UN human development index (HDI) during 1960-85 (life expectancy GDP and literacy). Findings indicate that there is a highly significant negative and nonlinear relationship between HDI and fertility. Fertility was highest among countries with low HDI scores. When HDI was over 0.7 all countries were in transition but there was no fixed threshold for entry into transition. Fertility varied widely among countries at any given level of development. Statistically significant findings and graphic presentation indicate that countries with levels of development over 0.3 in 1960-65 had higher fertility than countries with an HDI of 0.3 in 1985-90. The relationship between fertility and development shifted over time. Transition occurred first in the most industrialized literate and urban provinces of a macroregion and then other provinces in geographic proximity followed regardless of HDI level. Logistic models indicate that development level and years since the beginning of transition in the region were good predictors of transition status in Asia Latin America and Europe. The most rapid declines in fertility occurred in countries that had high levels of development at the onset of transition. How family planning affects the pace and timing of fertility decline cannot be determined. It is posited that the addition of social interaction (ideas evaluation of the merits of ideas social influence and local national and global channels of social interaction) measures to the empirical model would further explain the timing and pace of fertility transition.
Demographers have known since the 1940s that standard measures of period fertility, such as the widely used total fertility rate, are distorted by changes in the timing of childbearing. Period fertility rates are depressed during years in which women delay childbearing and inflated in years when childbearing is accelerated. This problem is usually ignored because there has been no generally accepted method for solving it. This study proposes a method for removing the tempo distortions from the total fertility rate. The key assumption of the method is that period effects, rather than cohorts effects, are the primary force in fertility change, an assumption supported by past research. An application of the adjustment procedure to fertility trends in United States shows that concern over below-replacement fertility in the past 25 years has been largely misplaced. Without the distortion induced by the rising age at childbearing, the underlying level of fertility was essentially constant at very close to two children per woman throughout this period. Below-replacement fertility in Taiwan since the mid-1980s is also largely attributable to tempo effects.
PURPOSE: To develop guidance to practicing oncologists about available fertility preservation methods and related issues in people treated for cancer. METHODS: An expert panel and a writing committee were formed. The questions to be addressed by the guideline were determined, and a systematic review of the literature from 1987 to 2005 was performed, and included a search of online databases and consultation with content experts. RESULTS: The literature review found many cohort studies, case series, and case reports, but relatively few randomized or definitive trials examining the success and impact of fertility preservation methods in people with cancer. Fertility preservation methods are used infrequently in people with cancer. RECOMMENDATIONS: As part of education and informed consent before cancer therapy, oncologists should address the possibility of infertility with patients treated during their reproductive years and be prepared to discuss possible fertility preservation options or refer appropriate and interested patients to reproductive specialists. Clinician judgment should be employed in the timing of raising this issue, but discussion at the earliest possible opportunity is encouraged. Sperm and embryo cryopreservation are considered standard practice and are widely available; other available fertility preservation methods should be considered investigational and be performed in centers with the necessary expertise. CONCLUSION: Fertility preservation is often possible in people undergoing treatment for cancer. To preserve the full range of options, fertility preservation approaches should be considered as early as possible during treatment planning.
Purpose To provide current recommendations about fertility preservation for adults and children with cancer. Methods A systematic review of the literature published from January 2013 to March 2017 was completed using PubMed and the Cochrane Library. An Update Panel reviewed the identified publications. Results There were 61 publications identified and reviewed. None of these publications prompted a significant change in the 2013 recommendations. Recommendations Health care providers should initiate the discussion on the possibility of infertility with patients with cancer treated during their reproductive years or with parents/guardians of children as early as possible. Providers should be prepared to discuss fertility preservation options and/or to refer all potential patients to appropriate reproductive specialists. Although patients may be focused initially on their cancer diagnosis, providers should advise patients regarding potential threats to fertility as early as possible in the treatment process so as to allow for the widest array of options for fertility preservation. The discussion should be documented. Sperm, oocyte, and embryo cryopreservation are considered standard practice and are widely available. There is conflicting evidence to recommend gonadotrophin-releasing hormone agonists (GnRHa) and other means of ovarian suppression for fertility preservation. The Panel recognizes that, when proven fertility preservation methods are not feasible, and in the setting of young women with breast cancer, GnRHa may be offered to patients in the hope of reducing the likelihood of chemotherapy-induced ovarian insufficiency. GnRHa should not be used in place of proven fertility preservation methods. The panel notes that the field of ovarian tissue cryopreservation is advancing quickly and may evolve to become standard therapy in the future. Additional information is available at www.asco.org/survivorship-guidelines .
Ninety percent of the differences across countries in total fertility rates are accounted for solely by differences in women's reported desired fertility. Using desired fertility constructed from both retrospective and prospective questions, together with instrumental variables estimation, it is shown this strong result is not affected by either ex-post rationalization of births nor the dependence of desired fertility on contraceptive access or cost. Moreover, despite the obvious role of contraception as a proximate determinant of fertility, the additional effect of contraceptive availability or family planning on fertility is quantitatively small and explains very little cross country variation. These empirical results are consistent with theories in which fertility is determined by parent's choices about children within the social, educational, economic, and cultural environment that parents, and especially women, face. They contradict theories that assert a large causal role for expansion of contraception in the reduction of fertility.
The association between fertility and womens labor force activity reflects the incompatibility between caring for the children and participating in economically productive work that typifies industrialized societies. Women who wish to participate in the labor force must either limit their fertility or make alternative arrangements for the care of their children. As a result fertility rates in most countries are below the level needed for population replacement and rising proportion of children are in non-maternal care while their mothers work. In the assumption that women either limit their fertility to accommodate their force activity or they adjust their labor force behavior to their fertility evidence suggests that women do both. A substantial body of individual-level research describes the various strategies by which women in industrialized settings accommodate their employment patterns to their fertility and their fertility to their labor force participation. The evidence also suggests that strategies vary across national settings and that the ability to combine labor force participation and motherhood varies across countries.
PURPOSE: To update guidance for health care providers about fertility preservation for adults and children with cancer. METHODS: A systematic review of the literature published from March 2006 through January 2013 was completed using MEDLINE and the Cochrane Collaboration Library. An Update Panel reviewed the evidence and updated the recommendation language. RESULTS: There were 222 new publications that met inclusion criteria. A majority were observational studies, cohort studies, and case series or reports, with few randomized clinical trials. After review of the new evidence, the Update Panel concluded that no major, substantive revisions to the 2006 American Society of Clinical Oncology recommendations were warranted, but clarifications were added. RECOMMENDATIONS: As part of education and informed consent before cancer therapy, health care providers (including medical oncologists, radiation oncologists, gynecologic oncologists, urologists, hematologists, pediatric oncologists, and surgeons) should address the possibility of infertility with patients treated during their reproductive years (or with parents or guardians of children) and be prepared to discuss fertility preservation options and/or to refer all potential patients to appropriate reproductive specialists. Although patients may be focused initially on their cancer diagnosis, the Update Panel encourages providers to advise patients regarding potential threats to fertility as early as possible in the treatment process so as to allow for the widest array of options for fertility preservation. The discussion should be documented. Sperm and embryo cryopreservation as well as oocyte cryopreservation are considered standard practice and are widely available. Other fertility preservation methods should be considered investigational and should be performed by providers with the necessary expertise.
Lowest‐low fertility, defined as a period total fertility rate at or below 1.3, has rapidly spread in Europe during the 1990s. This article traces the emergence of this new phenomenon to the interaction of five factors. First, tempo and compositional distortions reduce the total fertility rate below the associated level of cohort fertility. Second, socioeconomic changes—including increased returns to human capital and high economic uncertainty in early adulthood—have made late childbearing a rational response for individuals and couples. Third, social interaction effects reinforce this behavioral adjustment and contribute to large and persistent postponement in the mean age at birth. Fourth, institutional settings favor an overall low quantum of fertility. Fifth, postponement–quantum interactions amplify the consequences of this institutional setting when combined with ongoing delays of child‐bearing. The article concludes with speculations about future trends in current and prospective lowest‐low‐fertility countries.
Recent theoretical discussion has postulated that low fertility in advanced countries is attributable to low levels of gender equity. Low gender equity is evidenced in the lack of support for women to combine paid employment and childrearing; tax‐transfer systems that remain based on the male‐breadwinner model of the family; and the retention of gender‐oriented roles within the family. Hence, it is argued that an increase in gender equity is a precondition of a rise in fertility from very low levels. At the same time, theorists argue that, in less developed countries, higher levels of gender equity are a necessary condition for achieving lower fertility. The article addresses this apparent contradiction by distinguishing two types of gender equity: gender equity in individual‐oriented institutions and gender equity in family‐oriented institutions. The argument is made that the transition from very high fertility to replacement‐level fertility has been associated with a gradual increase in gender equity primarily within the family itself. In contrast, the further movement to very low fertility is associated with a rapid shift toward high levels of gender equity in individual institutions such as education and market employment, in combination with persistent low levels of gender equity within the family and in family‐oriented institutions.
In this essay, I suggest that the crisis in our understanding of fertility transitions is more apparent than real. Although most existing theories of fertility transition have been partially or wholly discredited, this reflects a tendency to assume that all fertility transitions share one or two causes, to ignore mortality decline as a precondition for fertility decline, to assume that pretransitional fertility is wholly governed by social constraints rather than by individual decision-making, and to test ideas on a decadal time scale. I end the essay by suggesting a perceptual, interactive approach to explaining fertility transitions that is closely allied to existing theories but focuses on conditions that lead couples to switch from postnatal to prenatal controls on family size.
Agricultural soils in the southeastern U.S. Coastal Plain region have meager soil fertility characteristics because of their sandy textures, acidic pH values, kaolinitic clays, low cation exchange capacities, and diminutive soil organic carbon contents. We hypothesized that biochar additions will help ameliorate some of these fertility problems. The study objectives were to determine the impact of pecan shell-based biochar additions on soil fertility characteristics and water leachate chemistry for a Norfolk loamy sand (fine-loamy, kaolinitic, thermic typic Kandiudults). Soil columns containing 0, 0.5, 1.0, and 2.0% (wt/wt) biochar were incubated at 10% (wt/wt) moisture for 67 days. On days 25 and 67, the columns were leached with 1.2 to 1.4 pore volumes of deionized H2O, and the leachate chemical composition determined. On days 0 and 67, soil samples were collected and analyzed for fertility. The biochar had a pH of 7.6, contained 834.2 and 3.41 g kg−1 of C and N, respectively, and was dominated by aromatic C (58%). After 67 days and two leaching events, biochar additions to the Norfolk soil increased soil pH, soil organic carbon, Ca, K, Mn, and P and decreased exchangeable acidity, S, and Zn. Biochar additions did not significantly increase soil cation exchange capacity. Leachates contained increasing electrical conductivity and K and Na concentrations, but decreasing levels of Ca, P, Mn, and Zn. These effects reflect the addition of elements and the higher sorption capacity of biochar for selective nutrients (especially Ca, P, Zn, and Mn). Biochar additions to the Norfolk soil caused significant fertility improvements.
Sub-Saharan Africa may offer greater resistance to fertility decline than any other world region as a result of a lineage-based traditional belief system. Traditional African religious values have sustained high fertility in 2 ways: 1stthey have acted directly to equate fertility with virtue and reproductive failure with sin and 2nd they have provided support for a system of upward flows of wealth. The African family structure generally places reproductive decision making in the hands of the husband and the economic burden for the support of children on the shoulders of the wife. Because of the weakness of the conjugal bond men tend not to realize the full burden of reproductive decisions. Thus reproductive decisions and behavior are only loosely related to the subsequent dependency burden. On the other hand there are signs of a destabilization of this high fertility system. At the individual level growing numbers of women in sub-Sahara Africa are facing economic difficulties and would like to take defensive action to limit births. At the national level there are recurrent problems with faltering economic growth and uncertain food supplies. Secular influences such as models of the family taught by the media and the schools may help make the conjugal family more dominant than homage to living ancestors. The demand for female contraceptive methods in sub-Sahara Africa is likely to grow. The pill and the IUD will probably be most employed but a demand for injectables and implants can be expected as well. However the authors predict that radical fertility declines should not be expected in sub-Saharan Africa during this century. In the absence of radical change in government attitudes toward family planning the crude birth rate is not likely to fall from its present level of 47/1000 to much less than 45/1000 by the year 2000.
Data on the natural fertility (complete absence of birth control) of 13 populations are examined with the study restricted to legitimate birthrates and those of unmarried women in a stable union. Very different fertility levels were found among these populations despite a similar pattern of fertility as it varies from 1 age group to another. Where the fertility rates for European populations are greater than for the non-European differences can be attributed to variation in birth spacing. It is hypothesized that differences in fertility level are either the result of variations in behavior related to resumption of sexual relations and the duration of lactation or to the differences of a physiological nature related to frequency and duration of anovulation during lactation.
The standard formulation of the microeconomic theory of fertility, which emphasizes the demand for children and, to a lesser extent, the costs of fertility control, is too limited in its scope for use by most demographers and sociologists. The approach advanced in this paper adds to the usual theory a more explicit and formal treatment of the production of children, including the possibility of shifts in production independent of demand conditions. This more comprehensive framework is compared with the usual approach in the analysis of several empirical problems-non-marital fertility, premodern fertility fluctuations and differentials, and the secular fertility decline-and is shown to be better suited for incorporating the concepts and hypotheses of noneconomists along with those of economists.
The sperm chromatin structure assay (SCSA) was used to measure over 500 human semen samples from two independent studies: Study I, 402 samples from 165 presumably fertile couples wishing to achieve pregnancy over 12 menstrual cycles; Study II, samples from 115 patients seeking fertility counselling. The SCSA measures susceptibility to DNA denaturation in situ in spermatozoa exposed to acid for 30 s, followed by acridine orange staining. SCSA data from the male partners of 73 couples (group 1) achieving pregnancy during months 1-3 of Study I were used as the standard of 'sperm chromatin compatible with high fertility' and were significantly different from those of 40 couples (group 3) achieving pregnancy in months 4-12 (P < 0.01) and those of male partners of 31 couples (group 4) not achieving pregnancy (P < 0.001). Group 2 contained couples who had a miscarriage. SCSA values for Study II were almost twice that of the Study I fertility standards. Within-couple repeatability tended to be less for group 3 than for groups 1, 2 or 4. Based on logistic regression, spermatozoa with denatured DNA (cells outside the main population, COMP alpha t) were the best predictor for whether a couple would not achieve pregnancy. Some 84% of males in group 1 had COMP alpha t < 15%, while no couples achieved pregnancy in group 1 with > or = 30% COMP alpha t, a threshold level considered not compatible with good fertility. Using selected cut-off values for chromatin integrity, the SCSA data predicted seven of 18 miscarriages (39%).
Flow cytometry of heated sperm nuclei revealed a significant decrease in resistance to in situ denaturation of spermatozoal DNA in samples from bulls, mice, and humans of low or questionable fertility when compared with others of high fertility. Since thermal denaturation of DNA in situ depends on chromatin structure, it is assumed that changes in sperm chromatin conformation may be related to the diminished fertility. Flow cytometry of heated sperm nuclei may provide a new and independent determinant of male fertility.
STUDY QUESTION: What updates of the International Glossary on Infertility and Fertility Care are required, to reflect contemporary scientific knowledge, social needs, and inclusive definitions, while harmonizing international communication across clinical, research, policy, and public domains? SUMMARY ANSWER: This 4th edition presents 348 consensus-based terms and definitions, including numerous revisions from the previous edition and 79 newly introduced definitions reflecting advances in reproductive science, technology, and evolving social contexts. WHAT IS KNOWN ALREADY: Previous glossary editions (2006, 2009, 2017) established internationally recognized definitions related to clinical practice, research, and policy. The 2017 edition comprised 283 terms and, among many others, expanded the concept of infertility to include not only its recognition as a disease, but also as an impairment of function generating disability. The glossary has been extensively used worldwide and has contributed to international standardization of data collection, appropriate comparison of outcome measures, and provided a reference for all stakeholders including policy makers. STUDY DESIGN, SIZE, DURATION: Under guidance of the organizing committee, 21 professionals from across the world, and representing expertise in different sub-specialties, formed five working groups: clinical definitions; outcome measures; embryology laboratory; clinical and laboratory andrology; and epidemiology, public health and gender related definitions. The definitions from the previous glossary were evaluated and new terms identified. All definitions were then reviewed by an international advisory panel of nine experts that evaluated the glossary from scientific, ethical, cultural, and policy perspectives. PARTICIPANTS/MATERIALS, SETTING, METHODS: Between November 2024 and October 2025, periodical virtual meetings were held within and between working groups and the organizing committee. Following circulation of the first consensually agreed draft, a one-day in-person meeting with representatives of all working groups and members of the international advisory panel was held at ESHRE, June 2025. Most terms and definitions were discussed and agreed. In the absence of agreement, further discussions were held between the organizing committee, working group chairs and members of the advisory panel. It had been determined at the outset that final disagreement would be resolved via a two-third majority vote. All terms and definitions were, however, reached by consensus and adopted following a final round of review and approval by all authors. MAIN RESULTS AND THE ROLE OF CHANCE: The glossary now includes 348 terms. Compared to the previous edition, 14 terms were deleted, numerous terms modified and 79 new terms were added. Modifications reflect current scientific knowledge, technological advancements, and inclusivity related to gender and family structures. Chance does not play a role, as all definitions are consensus-based. LIMITATIONS, REASONS FOR CAUTION: Some terms may require future refinement as scientific knowledge evolves and societal contexts change. The glossary reflects consensus rather than empirical testing of all definitions. WIDER IMPLICATIONS OF THE FINDINGS: This glossary provides a global reference for standardized terminology, supporting clinical care, research, international comparisons, policy making, patient communication, and reproductive health literacy. STUDY FUNDING/COMPETING INTEREST(S): Neither ICMART, responsible for conducting this project, nor any of the participants received specific financial support for their activities in this project. Ferring provided ICMART with a fixed amount to cover venue costs and a one-day hotel accommodation for participants attending the in-person meeting held prior to the ESHRE Congress in June 2025. Disclosures were provided by all authors, and none reported any conflict of interest related to this manuscript. TRIAL REGISTRATION NUMBER: N/A.
We estimate the effect of television on fertility in Brazil, where soap operas portray small families. We exploit differences in the timing of entry into different markets of Globo, the main novela producer. Women living in areas covered by Globo have significantly lower fertility. The effect is strongest for women of lower socioeconomic status and in the central and late phases of fertility, consistent with stopping behavior. The result does not appear to be driven by selection in Globo entry. We provide evidence that novelas, and not just television, affected individual choices, based on children's naming patterns and novela content. (JEL J13, J16, L82, O15, Z13)
THE inability of demographers to predict western birth rates accurately in the postwar period has had a salutary influence on demographic research. Most predictions had been based either on simple extrapolations of past trends or on extrapolations that adjusted for changes in the agesex-marital composition of the population. Socio-economic considerations are entirely absent from the former and are primitive and largely implicit in the latter. As long as even crude extrapolations continued to give fairly reliable predictions, as they did during the previous half century, there was little call for complicated analyses of the interrelation between socio-economic variables and fertility. However, the sharp decline in birth rates during the thirties coupled with the sharp rise in rates during the postwar period swept away confidence in the view that future rates could be predicted from a secularly declining function of population compositions. Maithus could with some justification assume that fertility was determined primarily by two primitive variables, age at marriage and the frequency of coition during marriage. The development and spread of knowledge about contraceptives during the last century greatly widened the scope of family size decision-making, and contemporary researchers have been forced to pay greater attention to decision-making than either Maithus or the forecasters did. Psychologists have tried to place these decisions within a framework suggested by psychological theory; sociologists have tried one suggested by sociological theory, but most persons would admit that neither framework has been particularly successful in organizing the information on fertility. Two considerations encouraged me to analyze family size decisions within an economic framework. The first is that Maithus' famous discussion was built upon a strongly economic framework; mine can be viewed as a generalization and development of his. Second, although no