Association of ethnicity with involuntary childlessness and perceived reasons for infertility: Baseline data from the Study of Women's Health Across the Nation (SWAN)

Objective: To evaluate whether ethnicity is associated with involuntary childlessness and perceived reasons for difficulties in becoming pregnant. Design: Cross-sectional analysis of baseline data from a longitudinal cohort. Setting: Multiethnic, community-based observational study of US women. Patient(s): Women in midlife (3,149), aged 42-52 years. Intervention(s): None. Main Outcome Measure(s): Involuntary childlessness and perceived etiology of infertility. Result(s): One hundred thirty-three subjects (4.2%) were involuntarily childless, defined by a reported history of infertility and nulliparity. Ethnicity was significantly associated with self-reported involuntary childlessness. After controlling for economic and other risk factors, African American (odds ratio [OR] 0.30; 95% confidence interval [CI] 0.15-0.59) and Chinese women (OR 0.36; 95% CI 0.14-0.90) were less likely to suffer from involuntary childlessness compared with non-Hispanic white women. In addition, 302 subjects reported a perceived etiology of infertility. An unexpectedly large proportion of these women (24.5%, 74 of 302) reported etiologies not known to cause infertility (i.e., tipped uterus, ligaments for tubes were stretched), with African American women having been most likely to report these etiologies (OR 2.81; 95% CI 1.26-6.28) as the reason for not becoming pregnant. Conclusion(s): Ethnicity is significantly associated with involuntary childlessness and perceived etiology of infertility. Misattribution of causes of infertility is common and merits further consideration with respect to language or cultural barriers, as well as possible physician misattribution.