Six percent of cisgender (i.e. not transgender) women aged 15-44 are considered infertile in the United States, and 12% are unable to carry a pregnancy to term. For those who yearn to create a family despite these circumstances, assisted reproductive technology (ART) is an often-utilised resource. Though faith-based institutions have been referenced as a source of support for involuntarily childless adults, it is unclear how religious doctrine, especially that which prizes 'traditional' gender roles and genetic parenthood, may be a catalyst for distress. More research is needed to understand how the socio-cultural environment affects those who are unable to conceive without assistance. Therefore, the purpose of this research study was to understand the lived experiences of women who have utilised assisted reproduction in a particularly pronatalist, religious cultural context in the United States. From March to September 2017, in-depth interviews were conducted with 10 cisgender women who had utilised ART. Data analysis was conducted in NVivo 10 and consisted of line-by-line analysis, identifying themes, coding categories and developing matrices to uncover relationships between themes and categories. The quest for motherhood was truly a journey for the study participants who experienced rumination and self-blame due to their inability to become pregnant. This was rooted in their socio-cultural context. Thus, the study findings suggest that culture and stigma are linked with women's distress regarding their inability to become pregnant and results in distancing from other women. Genetic parenthood was prized initially, but this desire decreased over time. While past research suggests that infertility strains relationships, our study found that the turmoil of infertility and assisted reproduction actually strengthened couple relationships. Counselling was described as particularly helpful, but it is needed throughout the assisted reproduction process. The inclusion of religion and spirituality, for those who identify as such, in counselling would be beneficial.

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INTRODUCTION AND OBJECTIVES: Studies have shown that there is seasonal variation in semen parameters and birth rates. However, birth outcomes from subjects with semen analysis (SA) data have not been reported. Here we evaluate seasonal variation in semen parameters and resulting birth outcomes among a large cohort of subfertile men.METHODS: We analyzed a cohort of 11,929 subfertile men seen in a single andrology clinic over an 18-year period (1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013) that were linked to the Utah Population Database, a large comprehensive database of medical and demographic data. We obtained age, birth records following the first SA, and first SA results, including total motile count (TMC), total sperm count (TSC), sperm concentration, and progressive motility. Linear regression models assessed the effect of seasons on semen parameters controlling for patient age and year of SA. Average seasonal birth numbers were estimated across the 18-year time span, and the summer season was compared with fall, winter, and spring using Wilcoxon signed rank tests.RESULTS: The meanAESD age at the time of the first SA was 32AE6.5 years. Linear regression demonstrated a consistent U-shaped relationship between TMC, TSC, and sperm concentration and season, with winter yielding the highest values with a decline in the summer and fall. Comparing summer to spring, significantly higher TMC (132AE153 vs. 137AE149 million, p[0.03) and concentration (79AE74 vs. 82AE74 million/mL, p[0.03) was observed in the spring. Mean TSC (238AE248 vs. 249AE247 million, p[0.04) and concentration (79AE74 vs. 83AE76 million/mL, p[0.01) were also observed to be higher in the winter than in the summer. During a mean follow-up of 7.7AE4.7 years following their SA, 61% of men had one or more offspring. Over the 18-year period, summer had the highest births per year (188AE111 births), followed by spring (178AE112, p[0.06), fall (174AE102, p[0.02), and winter (170AE99, p[0.01).CONCLUSIONS: In a single-center study of subfertile men, semen parameters were highest in the spring and winter and lowest in the summer and fall. However, the timing of peak births did not correspond with the distribution of semen parameters.