BackgroundDelayed childbearing in European countries has resulted in an increase in the number of women having children later in life. Thus more women face the problem of age-related infertility and cannot achieve their desired number of children. Childbearing postponement is one of the main reasons for the increasing use of assisted reproductive technology (ART) and conversely, the latter may be one of the factors contributing to the rise in female childbearing age. The research goal of our article is to evaluate the demographic importance of ART increased use and to examine its impact on both the fertility rate and birth timing.MethodsComparative analysis based on demographic and ART data collected by the European IVF-monitoring (EIM) Consortium for the European Society of Human Reproduction and Embryology (ESHRE).ResultsMost countries with a higher total fertility rate (TFR) also registered a higher number of treatment cycles per 1 million women of reproductive age. Despite the positive relationship between the postponement rate and the demand for ART among women aged 35 and older, the highest share of children born after ART was not found in countries characterized by a “delayed” fertility schedule. Instead, the highest proportion of ART births was found in countries with fertility schedules concentrated on women aged between 25 and 34. Accordingly, the effective use of ART can be expected in populations with a less advanced postponement rate.ConclusionsART can have a demographic relevancy when women take advantage of it earlier rather than later in life. Furthermore it is suggested that the use of ART at a younger age increases women’s chance of achieving their reproductive goals and reduces the risk of age-related infertility and failed ART. Based on a demographic approach, reproductive health policy may become an integral part of policies supporting early childbearing: it may keep women from delaying too long having children and increase the chance of diagnosing potential reproductive health problems requiring a timely ART application.

In 2012, the Czech Republic established the women's age limit for access to assisted reproduction techniques at age 49 years. In this paper, the acceptability of this age limit from the children's perspective in the Czech Republic is assessed. Although the necessity of balancing the interests of parents and children is acknowledged, little research has taken children's interests into account. We have attempted to map out 'children's interests', asking older children and adolescents (aged 11-25 years) how old they would prefer their parents to be: Czech respondents would prefer to have younger parents. This finding is consistent with the optimal biological childbearing age rather than with the current postponement to a later age. So far, assisted reproduction techniques have been largely regarded as a medical treatment justifying the current women's age limit of 49 years. Had the children's perspective been taken into account, this age limit might have been lower than 49 years. We propose that reproductive health policy should adequately reflect multiple perspectives as an integral part of a multi-layered support system of a society.

No abstract

No abstract

No abstract

Abstract Background: The key demographic trend concerns the postponement of parenthood to later ages. Moreover, the number of Czech women of reproductive age is decreasing, which will lead to a decrease in the number of live births even with higher fertility. The aims are to assess recent trends concerning using ART in Czechia and to estimate the impact of using ART on the future development of the number of live births. Methods: Based on data on the number of ART cycles involving the transfer of embryos in the period 2007–2012, the number of deliveries following ART was converted to the number of live births following ART by the maternal age at birth for the period 2008-2012. Subsequently, age-specific fertility rates following ART and models of the potential future development of live births following ART treatment were calculated. These models were based on a combination of two potential fertility development variants and four variants for the estimation of the future share of ART fertility of total fertility by age (V1-V4). Results: If the use of ART methods remains unchanged, there will be a decrease in the number of live births following ART in the period up to 2030 (V1 and V2) due to the declining reproductive potential of women. An increase in the number of live births following ART would occur only if there were an increase in the use of ART methods. Depending on the expected level of the increase in the use of ART, the number of live births following ART would increase by 2030 to 4.9 thousand (V3) and 6.5 thousand (V4). In relative terms, this would represent an increase from the initial 3.2% of the total number of live births to 5.0% and 6.8% respectively. Conslusions : We can expect an increase in the importance of ART for demographic trends in the future. The projection models assumed that the future development of the use of ART would be affected not only by the intensity of fertility postponement and different levels of fertility, but also by advances in reproductive medicine and the increasing availability of ART.

No abstract

Study question What is the contribution of ART usage to the recent fertility trends - the total fertility rate (TFR) and birth timing - in Czechia? Summary answer The results revealed the contribution of the increasing use of ART to the ongoing childbearing postponement process. What is known already The demographic importance of the use of ART has increased substantially over the last two decades in the context of the ongoing fertility postponement process. The use of ART is likely to reduce involuntary childlessness and helps to offset part of the effect of increasing infertility due to fertility postponement. However, its use cannot make up for all births lost by the natural decline in fertility after age 35. The use of ART pushes the age limits of childbearing to extremely late ages. Moreover, ART may serve to create the illusion that childbearing can be postponed until late reproductive ages. Study design, size, duration The study is based on anonymised individual data from national health registers managed by the Institute of Health Information and Statistics and data available from the Czech Statistical Office. A unique database of individual data on each child born in the years 2013-2018 in Czechia allows the construction of detailed demographic fertility indicators in terms of the use/non-use of ART. Participants/materials, setting, methods The study employs demographic indicators characterising the level of fertility and its timing (total fertility rate, age-specific fertility rates, mean age of mothers at childbirth). These indicators are constructed using data for live births and are further disaggregated by whether or not the mother has undergone ART. Main results and the role of chance Both the number and the proportion of live births following ART increased steadily between 2013 and 2018. The proportions of ART-live births increased significantly with the age of the mothers (around 5% of children were born following ART to mothers aged 35-39 years, less than 10% to mothers aged 40-44, almost 40% to mothers aged 45-49 years). The ART-total fertility rate between 2013 and 2018 increased from 0.045 to 0.058 and the relative impact of ART on the TFR increased from 3.1% to 3.4%. Concerning childbearing timing, fertility after ART is significantly shifted towards the age of 39 years when the possibility of the financial contribution of health insurance companies ends in Czechia. The mean age of mothers at childbirth following ART reached 34.5 years in 2018, which was significantly higher than the non-ART mean age at childbirth (30.0 years). The difference in the ART and non-ART mean age at childbirth increased from less than 4 years in 2013 to 4.6 years in 2018. Therefore, the increase in ART usage is, on the one hand, a consequence of the fertility postponement process, but on the other hand, ART can be seen also as one of the “drivers” of fertility postponement. Limitations, reasons for caution Information on the use of ART was estimated based on information on ART cycles performed in Czechia; women who underwent ART abroad were classified as non-ART. Given that Czechia is more likely to be a destination country for cross-border reproductive care, we did not anticipate significant bias in the results. Wider implications of the findings The contribution of the increasing use of ART to the ongoing childbearing postponement process remains significant. Trial registration number not applicable