Choi Stephanie K Y, Lazzari Ester, Venetis Christos, Chambers Georgina M
National Perinatal Epidemiology and Statistics Unit (NPESU), Centre for Big Data Research in Health and School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia.
Department of Demography, University of Vienna (Wittgenstein Centre for Demography and Global Human Capital (IIASA, OeAW, University of Vienna)), Austria.
Lancet Reg Health West Pac. 2023 Jan 31;33:100686. doi: 10.1016/j.lanwpc.2023.100686. eCollection 2023 Apr.
With declining total fertility rates to below replacement levels amongst all high-, middle- and low-income countries, coupled with increasing use of medically assisted reproduction (MAR) treatments globally, we describe the impact of these treatments on completed family size and childbearing timing in a country with unlimited publicly funded access to MAR.
We utilised a unique longitudinal propensity score-weighted population-based birth cohort that included nulliparous mothers who gave birth after all major forms of MAR treatments (assisted reproductive technologies [ART], ovulation induction [OI], and intrauterine insemination [IUI]) and after natural conception (reference category) in Australia, 2003-2017. We followed first-time mothers over their reproductive lifespan (15-50 years). The primary outcome was completed family size (i.e., the mean cumulative number of children per mother of our cohort) and the fertility gap (i.e., adjusted difference in completed family size between MAR conceptions and the reference).
Our cohort includes 481,866 first-time mothers, mean follow-up of 13.8 years. ART mothers (n = 25,296) were six years older (mean age: 34.6 years) than mothers who conceived naturally (28.7 years (reference)) while OI/IUI mothers were only 2.2 years older (31.0 years) than the reference. ART mothers had up to 27% smaller completed family size (2.54 children) compared to OI/IUI mothers (2.98 children) and natural conception mothers (3.23 children). ART mothers who resided in the lower socioeconomic areas were less likely to reach a similar family size to the natural conception mothers (fertility gap of 0.83 fewer children per ART mother compared to natural conception mothers) than ART mothers who resided in the higher socioeconomic areas (0.43 fewer children).
Greater awareness of the limitations of MAR treatment to resolve childlessness and achieve desired family size is needed. Furthermore, with policymakers increasingly turning to MAR treatment as a tool to reverse declining fertility rates, their potential impact should not be overestimated.
Australian National Health and Medical Research Council.
随着所有高收入、中等收入和低收入国家的总和生育率降至更替水平以下，再加上全球范围内医学辅助生殖（MAR）治疗的使用增加，我们描述了这些治疗对一个可无限获得公共资金支持的MAR治疗的国家中家庭规模和生育时间的影响。
我们利用了一个独特的基于人群的纵向倾向评分加权出生队列，其中包括在澳大利亚2003 - 2017年间接受所有主要形式的MAR治疗（辅助生殖技术[ART]、促排卵[OI]和宫内人工授精[IUI]）后分娩的未生育母亲以及自然受孕（参考类别）后的未生育母亲。我们追踪首次生育母亲的整个生育期（15 - 50岁）。主要结局是家庭规模（即我们队列中每位母亲的子女累计平均数）和生育差距（即MAR受孕与参考组之间家庭规模的调整差异）。
我们的队列包括481,866名首次生育母亲，平均随访13.8年。接受ART治疗的母亲（n = 25,296）比自然受孕的母亲（28.7岁（参考值））大6岁（平均年龄：34.6岁），而接受OI/IUI治疗的母亲仅比参考值大2.2岁（31.0岁）。与接受OI/IUI治疗的母亲（2.98个孩子）和自然受孕的母亲（3.23个孩子）相比，接受ART治疗的母亲的家庭规模小27%（2.54个孩子）。与居住在较高社会经济地区的接受ART治疗的母亲（少0.43个孩子）相比，居住在较低社会经济地区的接受ART治疗的母亲达到与自然受孕母亲相似家庭规模的可能性较小（每位接受ART治疗的母亲与自然受孕母亲相比生育差距少0.83个孩子）。
需要更清楚地认识到MAR治疗在解决不孕和实现期望家庭规模方面的局限性。此外，随着政策制定者越来越多地将MAR治疗作为扭转生育率下降的工具，其潜在影响不应被高估。
澳大利亚国家卫生与医学研究委员会。
