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Purpose: To understand how often couples return to ART centres for a second child. Methods: Retrospective monocentric cohort study including women who had a first live birth with IVF. The primary objective was to assess the rate of those returning for a second child within five years of the previous pregnancy. The secondary aim was to disentangle the determinants of this rate. Results: A total of 374 patients were included, of whom 188 returned (50%, 95% CI 45–55%). Among those who did not return (n = 186), four (2%) referred to another ART Center and 24 were unreachable. Of the 158 contacted subjects that did not refer for ART, 53 (34%, 95% CI 27–41%) conceived naturally, 57 (36%, 95% CI 29–44%) abandoned their intent of parenthood, and 48 (30%, 95% CI 24–38%) unsuccessfully attempted natural conception. These 48 women (13%) who expressed interest in a second child but did not undergo ART were compared to those seeking a second pregnancy through ART. Baseline characteristics were similar except for an older age (Median 36, IQR: 34–38 vs 34, IQR: 32–36, p = 0.001). Additionally, in terms of IVF cycle characteristics, women who did not return were more likely to achieve their first pregnancy with a fresh transfer rather than a frozen transfer (75% vs 59%, p = 0.05). They also had a higher number of retrieved oocytes (Median 10, IQR: 7–13 vs 9, IQR: 5–12) and less frequently cryopreserved embryos (27% vs 52%, p = 0.003). Conclusion: The proportion of couples who have conceived with ART and who are interested in having a second child is high. Our results underline the importance of paying more attention to the number of intended children, as this information could influence clinical management. [ABSTRACT FROM AUTHOR]

The universal two-child policy in China did not lead to a significant increase in fertility, which results in many public debates. In this study, we examine to what extent a couple's desires for more children are associated with their behavior for having a second child, and whether there is a gender power imbalance in the realization process. Using the China Family Panel Studies data in 2014 and 2018, the findings suggest that the overall rate of having a second child is low after the policy relaxation. Compared to wives, husbands have greater power in the second-child realization, and this phenomenon is only salient in rural areas. Education, as an indicator of resources and a tool of empowerment, played a limited role in reversing the husband's dominance in fertility outcomes in rural areas. This study sheds light on domestic power relations and fertility realization in an era right after the policy relaxation in China and calls for policies to target the issues of how to raise fertility levels without sacrificing women's interests. [ABSTRACT FROM AUTHOR]

Background: The determinants of the intention to stop childbearing tend to differ over time and contexts. This allows the issue of families' childbearing intentions to continually remain on the research agenda. As societal context and temporal variability will matter for second childbearing intentions, this study aimed at uncovering the reasons behind the intentions to stop childbearing from one-child mothers' perspective., Method: A qualitative descriptive study in Isfahan City, Iran, was used to scrutinize reasons behind the unwillingness to have a second pregnancy. A purposeful sampling with maximum variation was used to select one-child mothers. Until reaching saturation, 48 semistructured interviews were conducted. A thematic analysis was used to analyse the qualitative data., Results: Five themes and 19 subthemes emerged from the data analysis as structural attributes (economic, social and political conditions), parental attributes (parental (dis)agreements, childrearing troubles, having impatience and being at the inappropriate age for childbearing), husband attributes (having the intention to stop parenting, financially and emotionally nonsupportive and being busy by working), maternal attributes (health-related problems, adverse experience during former pregnancy, being employed, self-compassion, the fear of parity progression and being pessimistic) and child attributes (having a naughty child and having the physical or mental distress of the first child)., Conclusion: Overall, findings highlight the multifaceted nature of factors influencing second childbearing intentions. Structural reasons at macro level, intrafamily relationship, mothers' self-related factors and challenges of raising the first child all play distinct roles in discouraging mothers from a second child intention. Understanding these key reasons can help policymakers, researchers and individuals alike to comprehend the complexities involved in family planning and fertility decisions., (© 2024 John Wiley & Sons Ltd.)