The backdrop to the research is one of the defining demographic shifts of our era: the systematic postponement of parenthood. Infertility is medically defined as the failure to conceive or maintain a pregnancy after twelve months or more of regular unprotected intercourse, and its global lifetime prevalence is estimated at 17.5 percent, according to a 2022 systematic review and meta-analysis. Because the biological capacity to reproduce declines with age—steeply for women and, to a lesser extent, for men—every year of delay raises the share of couples who eventually confront fertility problems. In Australia, where the study was set, an estimated 16 percent of heterosexual couples report difficulties conceiving. The timing of first births has transformed accordingly: in 1991, roughly a quarter of Australian women had their first child at age 30 or older; by 2020, more than half did. Meanwhile the two-child ideal has barely budged over two decades, even as completed family size has slid steadily downward—a widening gap between intended and achieved fertility that postponed and thwarted conception helps to explain.

Demographers have long known that fertility preferences are not fixed traits. Economic insecurity, career changes, new partnerships, separations and health shocks have all been shown to nudge childbearing desires and expectations up or down. Yet the uncertainty generated by infertility itself—a condition that is at once chronic, often persisting for months or years, and unplanned, arriving without warning—has remained largely uncharted territory. Earlier cross-sectional studies offered tantalising clues: among American women, those who identified as infertile reported lower fertility intentions but higher desires and a larger ideal family size, and infertile women attending gynaecology clinics in China expressed bigger ideal families alongside shakier confidence in achieving them. Because such single-moment snapshots cannot establish which came first, the altered preferences or the infertility, the causal story stayed murky. The new study is among the first to follow men as well as women through the transition into infertility and watch, statistically, what happens to their plans.

To do so, Lazzari turned to the Household, Income and Labour Dynamics in Australia (HILDA) Survey, a nationally representative panel launched in 2001 with more than 13,000 participants and wave-on-wave response rates above 90 percent. The analysis hinges on two waves separated by four years: 2015, designated Time 1, and 2019, designated Time 2. Respondents aged 18 to 45 for women and 18 to 50 for men answered two questions on 11-point scales: “How do you feel about having a child (more children) in the future?”, capturing desire, and “How likely are you to have a child (more children) in the future?”, capturing expectation, with the expectation scale running from very likely at zero to very unlikely at ten. Crucially, HILDA poses these questions to everyone of reproductive age, not merely to those who conceive easily—an inclusive design that sidesteps the routine exclusion of infertile respondents from fertility research, under the mistaken assumption that they lack fertility preferences. Infertility status was derived from a single question: “Based on medical advice, do you know of any physical or health reason that would make it difficult for you (and/or your partner) to have children?”

The methodological architecture is deliberately conservative. The cross-sectional sample numbered 6,520 respondents after the exclusion of cases with missing values, while the longitudinal core comprised 3,702 people who were fertile at baseline and traced to follow-up four years later; those already reporting infertility in 2015 were removed so that the analysis isolates the transition into the condition. Between the waves, 11.3 percent of women and 5.5 percent of men made that transition. Because infertility is not randomly assigned—people with strong fertility desires are more likely to forgo contraception and attempt conception, and therefore more likely to encounter infertility—Lazzari employed the regressor variable method, an ordinary least squares technique that predicts preferences at Time 2 while statistically holding constant each person’s baseline preference at Time 1. The models further adjusted for events unfolding between waves, including the birth of a child, changes in relationship status and shifts in financial satisfaction, together with age, education, parity, migration and Indigenous status, and area of residence. A supplementary analysis of 777 heterosexual co-resident couples incorporated partners’ own preferences, ages and education, since childbearing decisions are typically negotiated between two people rather than made by one.

The snapshot results echoed earlier work with new precision. Among infertile men, 42 percent registered a desire score of zero and 45 percent an expectation score of zero, compared with 27 and 25 percent of their fertile counterparts; just under 40 percent of infertile women expressed the lowest possible expectation of having a child, against 23 percent of fertile women. Yet once age, parity, partnership status, education and finances were taken into account, a paradox surfaced: infertility was actually associated with higher fertility desires among women, and with lower expectations among both sexes. The expectation gap was no artefact of infertile respondents simply being older or more often parents—it persisted, statistically significant, after all observable differences were accounted for, in line with the study’s cross-sectional hypotheses.

The longitudinal analysis delivered the headline finding. Net of all controls, transitioning into infertility between 2015 and 2019 predicted a significant downward revision of fertility expectations for both men and women, confirming the hypothesis that expectations bend under the weight of the condition. Desires, by contrast, did not move significantly in either direction. Simple descriptive comparisons told the same story: by 2019, both groups had tempered their outlooks, but the downward adjustment in expectations was markedly larger among those who had experienced infertility, and for women the difference between infertile and never-infertile respondents was statistically significant in formal tests. A companion model restricted to co-resident couples, which additionally modelled each partner’s own wishes and relationship satisfaction, reproduced the pattern almost exactly: infertility reshaped expectations within couples, but left desires standing.

Two of the study’s predictions failed in illuminating ways. Lazzari had hypothesised that people of lower socioeconomic status, facing greater barriers to assisted reproductive technology, would revise their expectations downward more sharply, and that women, who the literature says bear the greater emotional toll, would show stronger effects than men. Neither held: education and financial satisfaction left the infertility–expectation link essentially unchanged, and interaction models revealed no gender-specific effects. The author points to Australia’s policy environment as a partial explanation: the national insurer Medicare subsidises assisted reproduction without restrictions on age, parity or the number of subsidised treatments, and general practitioners serve as gatekeepers to fertility clinics—circumstances that may blunt socioeconomic gradients, even though disparities in access persist and women remain about three times more likely than men to consult a doctor about fertility concerns. An alternative reading is that men who are aware of their infertility already constitute a self-selected, highly engaged group, compressing observable gender differences.

The dissociation between expectations and desires slots neatly into modern theories of fertility decision-making. In the traits–desires–intentions framework, desires represent an idealised vision of childbearing, relatively insulated from situational constraints, whereas intentions and expectations rationally incorporate perceived barriers and perceived behavioural control, as the Theory of Planned Behaviour also maintains. Cognitive models and the Theory of Conjunctural Action add that decisions are shaped as much by emotional associations and mental schemas as by explicit calculation. The Narrative Framework goes furthest: heightened uncertainty may darken expectations without extinguishing the imagined future self as a parent. Infertility is uniquely ambiguous on this score, since a medical diagnosis implies reduced odds of conception rather than impossibility—natural conceptions after unsuccessful assisted reproduction are far from rare—and because it destabilises identity, leaving people suspended between a parenthood they cannot assume and a childlessness they will not embrace, a state sociologists have described as a “spoiled identity.” Desires, in this reading, encode a deep psychological commitment to parenthood that survives even biological setbacks.

The implications cut two ways. For survey researchers the message is unambiguous: failing to measure infertility risks misreading the declining expectations of affected respondents as irrationality or unstable reproductive planning rather than a rational response to uncertainty. People may continue actively pursuing a child even as their stated expectations fall, deviating from what expectation-based forecasts alone would predict—an insight with consequences for projections of population fertility as parenthood is delayed further. The study also carries caveats: infertility was self-assessed and conditional on having received medical advice, likely undercounting disadvantaged and remote populations who consult doctors less often; two measurement points cannot capture self-perceptions that fluctuate over time; and HILDA records no information on assisted reproduction treatment, whose failures can darken expectations independently of the underlying condition. Still, the central lesson stands. Fertility expectations, the paper concludes, are more likely to be adjusted downward in the face of infertility, while desires tend to remain mostly unaffected—a quiet testament to how tenaciously the imagined future survives an uncertain present.

Infertility remains a complex and often deeply personal issue affecting millions worldwide, yet the uncertainty surrounding its onset, duration, and resolution continues to challenge both medical professionals and those directly impacted. Lazzari’s study meticulously unpacks this uncertainty, highlighting how it shapes fertility preferences in ways that transcend mere biological determinism. Instead, individuals engage in a process of reimagining parenthood that integrates emotional resilience, temporal flexibility, and evolving definitions of family.

At the biological level, infertility can manifest in myriad forms—from physiological barriers like ovulatory dysfunction and azoospermia to idiopathic cases where no clear cause is identifiable. These medical uncertainties complicate prognoses and treatment efficacy, which, in turn, exacerbate psychological stress. Lazzari’s analysis underscores the feedback loop between medical ambiguity and shifting fertility preferences, illustrating that the unpredictability of infertility outcomes acts as a catalyst for reevaluating life plans and reproductive timelines.

One of the hallmark findings of Lazzari’s work is that fertility preferences are no longer static endpoints but dynamic constructs. Fertility intentions, she argues, evolve in tandem with ongoing experiences of infertility, medical consultations, and social interactions. This fluidity reflects a broader cultural acknowledgment that parenthood must be adaptable to personal and demographic realities—a recognition gaining momentum in scholarship and public discourse alike.

Importantly, Lazzari situates her research within a broader sociological framework, highlighting how gender norms, economic pressures, and cultural values interact with infertility uncertainty to influence reproductive decision-making. Women, men, and couples navigate these intersecting forces differently, and these variations are critical in understanding the full spectrum of responses to infertility. For example, some may delay attempts at conception or pursue alternative family-building routes such as adoption or assisted reproductive technologies (ART).

Assisted reproductive technologies have undeniably shifted the fertility landscape by expanding options to circumvent or mitigate infertility challenges. However, Lazzari draws attention to the limitations of ART—not only in terms of accessibility and cost but also concerning success rates that inherently contain elements of uncertainty. The emotional toll of repeated treatments, coupled with medical unpredictability, often necessitates ongoing reevaluation of parenthood goals, illustrating the cyclical nature of fertility preference adjustment.

Within this context, the psychological dimensions of infertility receive significant emphasis in Lazzari’s article. Infertility is frequently accompanied by grief, anxiety, and identity renegotiation, which can profoundly impact decision-making. The uncertainty compounds these emotional experiences, driving individuals to develop coping mechanisms and alternative narratives about what parenthood means to them beyond biological reproduction. Mental health support and counseling emerge as essential components of a holistic approach to fertility care.

Lazzari’s work also explores temporal adaptations to infertility uncertainty. Time—a critical yet intangible element—becomes a malleable construct as individuals adjust timelines for childbearing or reconsider life trajectories. This temporal reconfiguration is influenced by age-related fertility decline, societal expectations, and the hopes and setbacks experienced during attempts to conceive. The concept of “fertility windows” is reframed not as rigid categorical markers but as fluid timeframes subject to continual revision.

Moreover, the article highlights the emergence of “contingent parenthood” strategies, wherein people prepare for various family formation scenarios depending on how infertility evolves. These strategies recognize the unpredictability of outcomes and promote psychological preparedness for alternative pathways, whether that involves pursuing ART, embracing childfree living, or exploring kinship networks that extend beyond conventional parenting roles. This trend reflects a broader societal shift towards valuing diversity in family structures.

Methodologically, Lazzari’s research employs a multi-disciplinary approach combining demographic data analysis, qualitative interviews, and psychological assessments. This triangulation allows for a comprehensive understanding of how infertility uncertainty permeates lived experiences and decision-making processes. The robust data set underscores the heterogeneity of fertility preference trajectories, rejecting one-size-fits-all models in favor of individualized, context-sensitive perspectives.

One of the notable aspects of this study is its longitudinal dimension, tracking changes in fertility preferences over extended periods. Such longitudinal insight reveals that fertility goals are not only impacted by medical developments but also by evolving personal circumstances, economic conditions, and shifting cultural messages. This dynamic nature challenges policymakers and healthcare providers to rethink reproductive counseling and support services to be more flexible and responsive.

The implications of Lazzari’s findings extend beyond individual decision-making to inform public health strategies and reproductive justice frameworks. Recognizing infertility uncertainty as a significant factor in fertility preference adjustment calls for enhanced access to comprehensive fertility education, equitable ART provision, and mental health resources. Additionally, policy interventions must address socio-economic disparities that exacerbate infertility-related stress and constrain reproductive autonomy.

Lazzari’s article also prompts a reevaluation of how research on fertility and family planning is positioned within academic and clinical domains. The integration of uncertainty not as a peripheral concern but as a central analytic lens offers new avenues for investigating reproductive behavior, demographic trends, and social policy. Future research inspired by this work might explore intersections with emerging technologies, cultural shifts, and global fertility patterns.

Furthermore, the notion of “reimagining parenthood” articulated in the article resonates deeply with contemporaneous movements advocating for more inclusive and flexible definitions of family. By foregrounding the lived realities of infertility uncertainty, Lazzari contributes to a broader discourse that challenges normative assumptions and embraces multiplicity in reproductive aspirations and outcomes.

In conclusion, E. Lazzari’s research provides an invaluable contribution to the understanding of fertility preferences amidst the pervasive uncertainty of infertility. Through nuanced analysis and interdisciplinary synthesis, the article sheds light on the evolving nature of parenthood conceptualization, offering critical insights for individuals, clinicians, and policymakers navigating this complex terrain. As fertility science and social attitudes continue to evolve, such scholarship paves the way for more empathetic, adaptive, and equitable reproductive futures.

Subject of Research: Fertility preferences and parenthood conceptualization in the context of infertility uncertainty.

Article Title: Fertility preferences adjusted: reimagining parenthood in response to the uncertainty of infertility.

Article References:
Lazzari, E. Fertility preferences adjusted: reimagining parenthood in response to the uncertainty of infertility.
Genus 81, 12 (2025). https://doi.org/10.1186/s41118-025-00248-1

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