Fertility Desires Research Articles

Why do pregnant women with fear of birth prefer vaginal birth? A qualitative study in China.

Fear of birth (FOB) is becoming increasingly recognized as a mental health issue that may endanger maternal and infant health and affects women's subsequent fertility desires. It has also been shown to be related to the choice of delivery mode. Given the differences in healthcare systems and policies between countries, and the gaps in the exploration of women's experience of fear of birth and its association with the delivery mode in the Chinese cultural context, this study thus attempt to understand Chinese women's experience with fear of birth and their preferences for delivery mode through a qualitative study. A descriptive qualitative research was performed among twenty pregnant women from the obstetric outpatient of a tertiary hospital in China. Colaizzi's method was used to analyze the participants' data. We proposed three themes and nine subthemes on the participants' experience with fear of birth: (1) an invisible dilemma: trapped in lingering fear (fear of all sides, the untold loneliness, and ambivalence with mixed feelings); (2) an unexpected decision: choose to give birth naturally (initiative selection and passive acceptance); and (3) A strength to confront challenges head-on: move forward with fear (awaken of maternal spirit, hope in bloom, Chinese tolerance culture, and obstetric analgesia). Fear of birth is a complex emotion, accompanied by feelings of loneliness and ambivalence in addition to fear. We found that women with fear of birth in this study prefer vaginal birth, and it was revealed to be the result of a combined action of intrinsic and extrinsic factors.

Fertility trends by HIV status in a health and demographic surveillance study in Magu District, Tanzania, 1994-2018.

Sub-Saharan Africa (SSA) has the highest fertility rates and highest HIV disease burden globally. However, it is not clear how the rapid expansion of anti-retroviral therapy (ART) for HIV has impacted the fertility gap between HIV-infected and uninfected women. We used data from a Health and Demographic Surveillance System (HDSS) in north-western Tanzania to explore trends in fertility rates and the relationship between HIV and fertility over the 25-year period. From 1994 to 2018, births and population denominators from the HDSS population were used to obtain age-specific fertility rates (ASFRs) and total fertility rates (TFRs). HIV status was extracted from eight rounds of epidemiologic serological surveillances (1994-2017). Fertility rates by HIV status and in different levels of ART availability were compared over time. Independent risk factors for fertility changes were examined using Cox proportional hazard models. There were 24,662 births from 36,814 women (15-49) who contributed a total of 145,452.5 Person-Years of follow-ups. The TFR declined from 6.5 births per woman in 1994-1998 to 4.3 births per woman in 2014-2018. The number of births per woman was 40% lower in women living with HIV than in HIV-uninfected women (4.4 vs. 6.7), although this difference narrowed over time. The fertility rate in HIV-uninfected women was 36% lower in 2013-2018 than in 1994-1998(age-adjusted HR = 0.641; 95% CI 0.613-0.673). In contrast, the fertility rate in women living with HIV was relatively unchanged over the same follow up period (age-adjusted HR = 1.099; 95% CI 0.870-1.387). There was a notable fertility decline among women in the study area from 1994 to 2018. Fertility remained lower in women living with HIV than in HIV-uninfected women, but the difference continued to narrow over time. These results highlight the need for more research into fertility changes, fertility desire and family planning use in Tanzanian rural communities.

Fertility Desire and Associations with Condomless Sex, Antiretroviral Adherence, and Transmission Potential in a Cohort of Kenyan Women Living with HIV in Sero-discordant Relationships: A Mixed Methods Study

For women living with HIV (WLH) in serodiscordant partnerships, decisions about childbearing can challenge condom use and antiretroviral adherence. In a prospective cohort of 148 WLH in serodiscordant partnerships, 58 (39%) wanted more children in the future but were not currently trying to conceive (fertility desire), and 32 (22%) were currently trying to become pregnant (fertility intent). Detection of prostate specific antigen (PSA) in vaginal secretions, a marker for recent condomless sex, was lowest in women with fertility desire and highest in women with fertility intent. Detectable viral load followed a similar pattern. Risk of HIV transmission, when condomless sex and PSA detection occurred concurrently, was three to fourfold higher at visits with fertility intent compared to visits with fertility desire. Qualitative interviews underscored the importance women place on childbearing and suggested that they had limited information about the role of antiretroviral therapy in reducing sexual HIV transmission.

Measuring the effect of employment uncertainty on fertility in low-fertility contexts: an overview of existing measures

Numerous studies aim to connect negative fertility desires and outcomes with employment conditions deemed to be uncertain. However, there is a lack of consensus about how to define, conceptualise, and measure employment uncertainty. This paper considers issues surrounding the conceptualisation of employment uncertainty. It then reviews existing measures of employment uncertainty in the context of fertility decisions. Finally, it raises considerations about their use. While some aspects of employment uncertainty are well studied, there are still gaps between theory and empirical evidence. Researchers should be aware of existing population heterogeneity, contextual factors, and model selection when considering their conceptualisation of employment uncertainty.

Qualitative study of the fertility information support experiences of young breast cancer patients.

This qualitative study aimed to deeply understand the current experience of fertility information support for young breast cancer patients and to provide further evidence supporting the development of a fertility information support project. Using purposive sampling, 18 young breast cancer patients were selected for in-depth interviews from June to September 2022. Colaizzi's seven step analysis method and NVivo software were used to analyze and organize the interview data. Three themes and 10 subthemes were summarized from the interview data: Information anxiety (strong information demand, insufficient information support, information explosion, and information security); reproductive concerns (desire for fertility, anxiety about their children's health, denial of one's health, multiple burdens of emotional interweaving); and family support (the importance of good family relations, the need for a positive marital relationship). Medical staff should realize the importance of information support for young breast cancer patients and correctly identify the obstacles to insufficient information support. By establishing a fertility information support program, patients' awareness and the quality of fertility information support can be improved to reduce fertility anxiety in breast cancer patients.

Who Places High Value on the Uterus? A Cross-sectional Survey Study Evaluating Predictors for Uterine Preservation

ABSTRACT The prevalence of inpatient hysterectomy, a common surgical procedure in the United States, decreased by 36.4% between 2002 and 2010 in women with benign gynecologic conditions. One major factor contributing to the decline in inpatient hysterectomies was the growing number of uterine-preserving treatment options. Alternatives to hysterectomy include hormonal management, endometrial ablation, myomectomy, or uterine artery embolization. Additional reasons for desiring uterine preservation among women who do not desire future fertility may include the belief that the uterus provides improved sense of self, relationship, and femininity. There are ethnic and racial disparities in the number and route of hysterectomies performed. Rates are higher among Black women than among White women. Variations in hysterectomy rates are likely exacerbated in marginalized racial groups who have less access to uterine-sparing treatments or delayed care at earlier disease states. Although patient preferences may influence the choice of hysterectomy or uterine-preserving therapy, the contribution of race and socioeconomic status to one's preference for uterine preservation is unknown. The aim of this cross-sectional survey was to determine predictors for uterine preservation among patients who no longer desire fertility. A secondary aim was to identify reasons for placing high value on the uterus. The study was conducted at 3 hospital-based clinics in a large health care system in the United States. Participants were new patients 45 years or older seeking care for benign gynecologic conditions (including abnormal uterine bleeding, uterine fibroids, pelvic organ prolapse, endometriosis, or pelvic pain). The primary study outcome was the summative score of the VALUS ( Value of Uterus) instrument in predicting that a woman will undergo uterine preservation. The VALUS, a validated and reliable instrument, measures patient preferences and value placed on uterine preservation. Respondents placed either “low value” versus “high value” for the uterus in ovarian preservation. Secondary outcomes included individual questions within the VALUS instrument to determine drivers of uterine preservation. There were no prior data. Of the 230 surveys distributed, 206 (89.6%) were returned for analysis, and 163 of these (79.2%) met the criteria for completion. Using the VALUS cutoff, 64 patients (45.7%) were considered to have low value for their uterus (VALUS score <14), whereas 76 patients (54.3%) were considered to have high value for their uterus (VALUS score ≥14). Among women who wanted to be sexually active in the future, the likelihood of a high value for the uterus was substantially higher compared with those who did not; the adjusted odds ratio was 5.06, with a 95% confidence interval (CI) of 1.55 to 16.52, P = 0.01. Sexually active patients were substantially more likely to place a higher value on the uterus compared with those not sexually active or those who did not wish to be (adjusted odds ratio, 3.94; 95% CI, 1.36–11.43; P = 0.01). Non-White race, religion, and personal history of cancer were not statistically significant. These findings show that sexually active women and those who desire future sexual activity have 5- and 4-times higher odds of placing high value on the uterus compared with patients who are not sexually active. Patients who highly value the uterus believe that it is important for sexual function, sexual pleasure, sense of self, and staying complete as a woman. Future large-scale studies are needed to determine whether patient preferences contribute to the racial disparities in hysterectomy rates.

Fertility intention among married women in Ethiopia: a multilevel analysis of Ethiopian demographic health survey 2016

BackgroundFertility intention is the central aspect of countries which determine their population demography. Therefore, proportion and factors associated with fertility intention should be studied at different level of community for designing of appropriate policies, strategies, and programs. Despite its importance, information is scarce about proportion and predictors of fertility intention among women of reproductive age in Ethiopia, in 2016.MethodsA secondary data analysis was done on 2016 Ethiopian Demographic and Health Survey/EDHS/ in this study. A total of 1423 fecund, married, and sexually active women were included this study. Multilevel mixed-effect logistic regression model was done to show association between fertility desire and explanatory variables. Adjusted Odds Ratio with 95% Confidence Interval (CI) was computed to assess the strength and significance of association.ResultsPrevalence of fertility intention was 63.5% (95%CI:62.2%,64.8%) in Ethiopia, in 2016. The response rate of this study was 100%. The odd of fertility desire was higher among women of age 20-34 years (AOR=2.5,95%CI:1.5,4.0), women of age 35-49 years (AOR= 9,95%CI:12.2,45.4), Muslim followers (AOR=5.4,95%CI:3.6,7.9), other religions followers (AOR= 1.8,95%CI:1.2,3.0), women who did not want to use modern contraceptive (AOR=3.1,95%CI:2.2,4.3). However, the likelihood of fertility intention was low among women who owned mobile phone (AOR=0.6,95%CI:0.4,0.87), and women with more than one partner (AOR=0.5,95%CI:0.41,0.8). At the community level factors like: Community education status (AOR= 1.67,95%CI:1.26,2.2) and region were factors strongly linked to fertility intention.ConclusionsIn this study, prevalence of fertility desire was higher compared to other countries. Participants age, religion, intention to use modern contraceptive, own mobile, and having multiple partners were individual factors associated with fertility preference. Furthermore, educational status and region were community factor associated significantly with intention of fertility. Hence, expansion of mobile networking and family planning messages through mobile. Furthermore, religious teaching should be enhanced to control family size among followers. Finally, the Ethiopian government should also work strongly to improve community education.

Society Under the Newly Issued Double-Reduction Policy: a Review of the Short- and Long-Term Social, Economic, Educational, and Livelihood Impacts and the Comparisons with the Similar Educational Policies in South Korea

Along with the rapid global development, the course load of primary and secondary school students increases proportionally as well as the time input of students on their studies. The workload from school and the after-school tutoring burden the students at the compulsory education stage just to gain better resources for future education. Thus, they lose a significant amount of their time which is supposed to be an opportunity for them to pursue their interests and discover their potential. More seriously, the overwhelming workload may also significantly affect their physical and mental health. Moreover, this “exploitation” of students can socially stimulate educational involution as well, decreasing fertility desire due to the difficulty of raising children. Under this background, the Chinese government issued the Double Burden Reduction Policy to reduce students' workload from school and outside studying. The policy aims to cool down and avoid overheated social involution through the partial closure of out-school tutoring as a primary means. This paper analyzes these existing short-term effects and gives probable predictions of long-term impacts.

Evolving Fertility Goals and Behaviors in Current U.S. Childbearing Cohorts.

In the post-Recession era, U.S. fertility rates have continued to fall. It is unclear if these declines are driven by shifts in fertility goals or growing difficulty in achieving goals. In this paper, we construct synthetic cohorts of men and women to examine both cross-cohort and within-cohort changes in fertility goals using multiple cycles of the National Survey of Family Growth. Although more recent cohorts exhibit lower achieved fertility at younger ages than earlier cohorts at the same age, intended parity remains around two children, and intentions to remain childless rarely exceed 15%. There is weak evidence of a growing fertility gap in the early 30s, suggesting more recent cohorts will need considerable childbearing in the 30s and early 40s to 'catch up' to earlier goals, yet low-parity women in their early 40s are decreasingly likely to have unfulfilled fertility desires or intentions to have children. Low-parity men in their early 40s, though, are increasingly likely to intend children. Declines in U.S. fertility thus seem to be largely driven not by changes in early-life fertility goals so much as either a decreasing likelihood of achieving earlier goals or, perhaps, shifts in the preferred timing of fertility that depress period measures.

Fertility desire among HIV-positive individuals in the Chinese sociocultural context: A qualitative study.

China's recent change from a one-child policy to a two-child policy has urged many couples/families to consider having a child or an additional child. However, little is known about such fertility desire among heterosexual couples with at least one human immunodeficiency virus (HIV)-positive partner. The objective of this qualitative study was to describe fertility desire and its motivating factors and barriers among people living with HIV (PLHIV). We conducted in-depth semi-structured interviews in 31 patients at an antiretroviral therapy (ART) clinic in Kunming, China, from October to December 2020. We included only patients in a sexually active heterosexual relationship with no more than one child. Participants gave verbal informed consent before participation. Interview recordings were transcribed verbatim, translated into English, and then analyzed using thematic analysis. Participants who reported fertility desire were mostly male, while participants who reported no fertility desire were mostly female. Study participants reported motivating factors and barriers that were identical to HIV-negative persons such as 1) social norms, 2) Chinese sociocultural factors, 3) the government's two-child policy, and 4) the financial burden of having children. However, study participants also reported motivating factors and barriers unique to human immunodeficiency virus (HIV)-positive individuals that included 1) the availability of ART and prevention of mother-to-child HIV transmission services, 2) health-related concerns, 3) stigma and discrimination against PLHIV, and 4) the additional cost of child-rearing when HIV-positive. The study findings highlighted major areas of concern for relevant stakeholders. The development of PLHIV-specific health policy should consider the PLHIV-specific motivating factors and barriers reported in this study. However, social desirability and lack of generalizability should also be considered in the interpretation of this study's findings.

Sexuality and fertility desire in a large cohort of individuals with 46, XY differences in sex development

ObjectiveTo analyze aspects of sexual life and fertility desire among 46, XY DSD people, including those who changed their gender. MethodsIt is a cross-sectional study including 127 adults (> 16 years of age) with 46, XY DSD (83 females; 44 males) from a Single Brazilian Tertiary-Care Medical Center. ResultsSexual fantasies and masturbation were more frequent in 46, XY DSD males, whereas orgasm and sexual life satisfaction were similar in both genders. More 46, XY DSD men than women had a long-term romantic relationship. 46, XY DSD women with prenatal androgen exposure reported more fear of being romantically rejected. External genitalia appearance at birth did not impact the sexuality of 46, XY DSD women after surgical genital treatment had been completed. Overall, the sexual life was similar between 46, XY men assigned as males and those who changed to the male gender. Regarding sexual orientation, most self-reported as heterosexual (91% and 92% of women and men, respectively). The desire for fertility had a similar prevalence in both genders, but more women than men considered infertility a barrier to a long-term romantic relationship. Twelve individuals (7 males) had children; 10 out of 12 have adopted children. ConclusionFertility desire was shared among 46, XY DSD people, regardless of gender. Prenatal androgen exposure reduced the desire for motherhood in 46, XY women. 46, XY DSD people who changed from female to male gender presented similar sexual parameters as those assigned as males. Among females, virilized genitalia at birth did not affect sexuality once the surgical treatment is completed.

Couple Asymmetries and Modern Contraceptive Use among Young Married Women in Nigeria

Nigeria is faced with high fertility, maternal and child mortality, and a rapid population growth rate. The uptake of modern methods of contraception is crucial to reduce the high fertility rate, halt population growth, lessen child mortality, and enhance maternal health. This study assessed partners' socio-economic and demographic asymmetries as barriers to modern contraceptive use among young married women in Nigeria. This study used data for 5,772 young married women aged 15-34 years from the Nigerian Demographic and Health Survey 2018. Frequency distributions and binomial logistic regression were carried out using STATA v12. Findings show that 20.4% of young married women use modern contraceptives. Respondents whose partners desire more children were less likely to use modern contraceptives (AOR= 0.712, CI 0.603-0.840). Also, contraceptive use is less likely when the respondent's partner is more educated than the respondent compared to if both have the same level of education (AOR= 0.721, CI 0.607-0.857). Differences in partners' fertility desires and educational status are associated with the use of modern contraceptives among married women aged 15-34 years in Nigeria.

Women’s Education and Birth Control in Rwanda

This study examined the role of women’s education in birth control in Rwanda from 1995 to 2000. It was conducted in four provinces, including Kigali City, using a survey questionnaire to collect data using a descriptive methodological approach. The population size is estimated to be 1067 n, comprised of women aged 15 to 49. Results indicated that younger women with fertility desire between 2–3 children are 75.07%; the rural area cohabitation rate among college students is 37.82%, while the Western model cohabitation in urban areas and universities is 19.23%; and contraceptive use is 46.3% among young women and 72.34%; among married women. Therefore, there was a significantly higher correlation between women with a high level of education and a lower fertility desire, which resulted in an increase in the age of first marriage.

Contraceptive use and associated factors among women of reproductive age on antiretroviral therapy in Awabel Woreda health centers, Northwest Ethiopia.

The family planning options for reproductive-age women who are in antiretroviral therapy should consider different types of contraceptive methods including condom use. There is a high unmet need and unplanned pregnancies in Ethiopia among HIV-positive women. Attention was not given towards contraceptive use for HIV women in Ethiopia including the study area. The study aimed to assess contraceptive use and associated factors among women of reproductive age (15-49 years) on Antiretroviral therapy in Awabel Woreda, Northwest Ethiopia. A facility-based cross-sectional study was conducted among 572 women of reproductive age who were receiving HIV care and treatment. Data were collected using interviewer-administered questionnaire, entered by Epidata3.1 and exported to IBM SPSS for statistics version 20 for analysis.Multivariable logistic regression was used to identify factors associated with contraceptive use and the presence of significant association was declared at p-value <0.05 and 95% confidence level. A total of 526 out of 572 women have responded, with a response rate of 91.9%. Two-thirds (66.5% (95% CI: 63.5, 69.5)) of the study participants were using contraceptive methods at the time of the survey. Women living in areas (Adjusted Odds Ratio = 1.95; 95% CI: 1.16, 3.72), and those who disclosed their HIV status to their partner (Adjusted Odds Ratio = 2.61; 95% CI: 1.37, 4.95) were more likely to use contraceptives. While Women (Adjusted Odds Ratio = 0.41; 95% CI: 0.24, 0.69) and their partners (Adjusted Odds Ratio = 0.57; 95% CI: 0.34, 0.97) who had desire to have a child were less likely to use contraceptives. The prevalence of contraceptive use among reproductive-age women who were on antiretroviral therapy (ART) was lower than a systematic review done in Ethiopia and higher than the national target. Intervention targeting on implementation of contraceptive methods, and counseling about contraceptives to address their question of fertility desire and knowledge were recommended.

从家庭角度探究全面二孩政策下女性生育意愿不高原因：经济成本、健康状况和婚姻变迁

从家庭角度探究全面二孩政策下女性生育意愿不高原因：经济成本、健康状况和婚姻变迁

Demographic and fertility transition in Nigeria; the progress made so far: a literature review

Background: Nigeria, since its inception as a sovereign nation, has been plagued by population explosion. This may be due to factors that need to be addressed by the government and individuals alike such as fertility desires. Main body: In the course of this review, we drew our resource information from the Nigerian Demographic and Health survey of 2018, PubMed, and African Journals Online (AJOL, Scholarly publications on sub-Saharan Africa and Nigeria in particular that dwell on the area under review. The total fertility rate (TFR) meaning the number of children a woman would bear in her lifetime is high, at a rate of 5.3 Children per woman. Population explosion is also a consequence of the low contraceptive use in Nigeria which stands at a rate of 17 % amongst married couples. Other factors that could be responsible for this population explosion include a lack of good population policies and few or non-existent national family planning programs. These negative effects on the Nigerian population made it grow at an annual rate of 2 %. Fifty percent (50%) of the Nigerian age distribution is under 19 years. This means that the Nigerian demography may not transit (change) readily. Conclusion: A community or country is said to undergo demographic transition when the death rate and fertility rate balance each other, and the age distribution is made of working-class people against the young and the aged who are dependent on others for a living. The economy of such a country is industrialized, with good health systems and a long life span for its citizens. Fertility transition on the other hand means a situation where a community or national fertility rate shows a substantial decline compared to industrialized countries of Europe, The USA, and Latin America in the contemporary world.

Understanding Fertility Attitudes and Outcomes Among Survivors of Adolescent and Young Adult Cancers in a Low-Resource Setting: A Registry-Based Computer-Assisted Telephone Interview Survey.

Purpose: To establish the extent of self-reported reproductive failure associated with cancer treatment, and attitudes toward fertility among adolescent and young adult (AYA) cancer survivors in Uganda. Methods: A registry-based computer-assisted telephone interview survey was conducted in Uganda. The survey population were survivors of childhood, adolescent and early adulthood cancers diagnosed between 2007 and 2018. The survey explored fertility outcomes, experiences of oncofertility and fertility attitudes of AYA cancer survivors. Results: Thirty-four (female = 14 and male = 20) interviews were completed. Survivors were 18-35 years of age. The median age at cancer diagnosis was 23.5 for females and 17.5 for males. Kaposi's sarcoma contributed to 44% of primary cancer diagnoses. All the survivors had received chemotherapy alone or in combination with other modalities and 79% of survivors had not received satisfactory information about future fertility before cancer treatment. Twenty one percent of males and 46% females met the criteria for infertility and 60% of these had met this criterion after their cancer diagnosis. Eighty two percent wanted to raise a biologically related child. Forty seven percent would be dissatisfied with their lives if they were unable to have a child or additional children. Conclusion: AYA cancer survivors in this low-resource setting reported reproductive failure, despite a strong fertility desire. Information and counseling provided on therapy-related problems before cancer treatment was insufficient and reinforces the need to build capacity for oncofertility resources within the region.

Reducing blood loss during laparoscopic myomectomy using a tourniquet loop around the lower uterine segment

To present a simple and effective hemostatic technique using a tourniquet loop during laparoscopic myomectomy. Pericervical tourniquet has been proven to be a safe and effective measure to reduce blood loss during open myomectomy. However, the use of a tourniquet in laparoscopic myomectomy has been rarely reported probably because the application is difficult and troublesome. In our technique, a prefabricated tourniquet loop, adapted from a Foley catheter, is applied around the lower segment of the uterus. It is easy to apply a tourniquet loop around the lower uterine segment during laparoscopic myomectomy. There is no need to make a window in the broad ligament to apply a pericervical tourniquet or triple tourniquets. Meanwhile, complete blockage of blood supply from the uterine artery and utero-ovarian anastomoses may ensure better hemostasis. A tertiary hospital. The patient was a 34-year-old woman with uterine leiomyoma and a desire for future fertility. She had been suffering from urinary frequency and chronic bladder pressure for the past 6 months. Magnetic resonance imaging confirmed 2 intramural masses measuring 96 mm × 91 mm and 25 mm × 13 mm at the anterior uterine wall. Institutional review board and ethics committee approval was obtained. Laparoscopic myomectomy was performed with the application of a tourniquet loop around the lower segment of the uterus (step-by-step video demonstration): homemade tourniquet loop formation using a 14-Fr latex Foley catheter; trocar placement with 2 umbilical ports (10 mm and 5 mm) and a 5-mm port at the lower-left quadrant of the abdomen; application of a tourniquet loop around the lower uterine segment; tumor enucleation and myometrial closure; removal of the tourniquet loop and a check for bleeding; contained specimen extraction via the merged umbilical incision; and inspection of the abdominal cavity and closure of the merged umbilical incision. Feasibility of using a tourniquet loop as an effective hemostatic technique in laparoscopic myomectomy. The surgery lasted for approximately 90 minutes, and the tourniquet time was approximately half an hour. The estimated blood loss was only 20 mL. Her hemoglobin value on day 1 after the surgery was 131 g/L, the same as the preoperative level. Pathology confirmed the diagnosis of leiomyoma. The patient was discharged 2 days after the surgery with no complications. During follow-up, the patient reported that there was no discomfort and that her menses were normal. Her fallopian tubes were patent in the hysterosalpingogram. Her ovarian function, which was assessed by serum follicle-stimulating hormone concentration (5.34 mIU/mL) on day 3 of her menstrual cycle and antimüllerian hormone level (2.01ng/mL), was in the normal range. She was suggested to conceive 1 year after the procedure. Application of a tourniquet loop around the lower uterine segment is a simple and effective hemostatic technique during laparoscopic myomectomy. Randomized prospective studies are needed to determine the hemostatic effect of the laparoscopic use of a tourniquet loop and its impact on fertility and ovarian function.

Uterine Smooth Muscle Tumor of Uncertain Malignant Potential – An Unusual Case Report

The term smooth uterine muscle of uncertain malignant potential (STUMP) indicates a group of uterine smooth muscle tumors (SMTs) that cannot be diagnosed unequivocally as benign or malignant. Diagnosis, surgical management, and follow-up of this neoplasm remain controversial, especially in pre-menopausal women with fertility desire, due to the non aggressive behaviour and prolonged survival rate when compared to leiomyosarcomas. Studies of STUMP are limited in population and rarity results in few analysis of its fertility outcomes and oncologic prognosis. STUMP has a lower tumor growth rate and recurrence is often delayed by years after initial event compared to high grade leiomyosarcomas which have an aggressive clinical course and behavior thus making it very important to differentiate stump from leiomyosarcomas .Recurrencerate ranges from 8.7% to 11%.

Does female off-farm employment affect fertility desire? Evidence from rural China

PurposeOff-farm employment is an important factor associated with fertility transition in many developing countries. The purpose of this paper is to investigate the impact of female off-farm employment on their fertility desire in rural China.Design/methodology/approachBased on the data from the China Labor-force Dynamics Survey, the authors adopt an instrumental variable approach to address the endogeneity issue. Desired number of children and desire for a second child are used to measure fertility desire.FindingsThe results show that off-farm employment participation significantly reduces women's desired number of children and the likelihood of their desire for a second child. Moreover, off-farm employment reduces women's fertility desire mainly through pathways including the weakening of son preference and a decrease in job autonomy, rather than the changes in leisure hours. Further evidence suggests that social health insurance plays an important role in moderating the adverse relationship between off-farm employment and the desire for a second child. The fertility-reducing effects are more pronounced among younger women, among those participating in off-farm wage employment and among families with only wives' participation in the off-farm labor market.Originality/valueThis paper contributes to the existing research by investigating the causal impact of off-farm employment on fertility desire in a rural developing context and the possible underlying mechanisms responsible for this relationship. This study provides important insights on this topic in developing countries and may have important implications for theory and practice.