Determinants of female fecundity and outcome of pregnancy : epidemiological cohort studies to the effects of age, biometry and life style habits

Becoming a mother is no more a matter of destiny only, but increasingly a matter of choice as wel!. Until recently, having children was as natura! as eating, drinking and dying. Children just "happened" during the course of (married) life. However in modem societies life does not just "happen" any more; life is organized around the assumption that men and women should fee! free to choose the goals in their Jives and the ways to achieve such a goal, in other words: to plan their Jives ahead. With the general availability of education, it was possible for women also to achieve a professional goal through a career path. With the availability of contraception, especially since the introduetion of the pill in the sixties, it was possible to design a reproductive "career" as to the question: Do I want children at all; if yes how many and when? In order to abserve changes in societal trends, the disciplines of epidemiology and demography are more suitable than the medica! sciences. A medica! doctor has been educated for the "exception", the individual patient approach and not for the "rule". Demograpbic data show that of those Dutch females who are now fifty years of age or older, about 10% have remairred childless. Of those, now 40 years old, 15% has nat had a child yet. The Netherlands Central Bureau of Stalistics prediets a further increase in childlessness at 40 to about 20-25% for females bom after 1965. Because there are no indications that infertility among females, who are currently 40 years of age, is higher than in previous generations, it seems that voluntary childlessness has risen considerably among women1 Thus an increasing number of women appear to plan a career of non-reproduction. However the women who do plan a reproductive "career" do not only opt for fewer children than in the past, but also that the child should be perfect, in impeccable state. A realm of prenatal screening services are developed to distinguish during early pregnancy between the affected and unaffected fetus; leaving the subsequent decision to carry the pregnancy to term to the individual parents. In other words a desired pregnancy does not necessarily lead to a desireful pregnancy outcome

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