Health insurance has become essential in mediating the extremely high costs of childbirth; however, it has been neglected in fertility research. This study examines health insurance coverage as an economic determinant of fertility and includes discussions of the cost of raising children, contraception and childbirth as well as opportunity costs to illustrate that the effect of health insurance may differ by resources, such as income and education. Using data from the 2001 Survey of Income and Program Participation, I analyze the effects of insurance on the probability of pregnancy and birth with Discrete-Time Hazard Models. Results show that health insurance is a powerful indicator of fertility. Married women with insurance coverage, especially private insurance coverage provided by someone else's plan, coverage in own name or public insurance, have increased expected odds of fertility compared to uninsured women.

Male infertility is a significant public health problem. Although male factors are estimated to contribute to 50% of infertility, epidemiologic research on predictors of male infertility is scarce, and few modifiable risk factors have been identified. In particular, not much is known about the risk factors that determine semen quality in healthy males attempting to conceive. This dissertation uses data from Pregnancy Study Online (PRESTO), a preconception cohort of pregnancy planners residing in North America, to examine the role of several anthropometric and lifestyle exposures on semen quality. A subset of male participants provided data on semen volume, sperm concentration, and sperm motility using a novel in-home semen testing device. In the first study, we examined the effects of three anthropometric factors, body mass index (BMI), waist circumference, and weight gained since age 17 years, on semen quality. We found that men in the highest categories of BMI and waist circumference had poorer semen quality, particularly sperm concentration, motility, and total motile sperm count. Results were slightly stronger for waist circumference. Adult weight gain, however, was not appreciably associated with semen quality. Few studies have investigated the effect of marijuana use on semen quality. In the second paper we used PRESTO data to investigate the relationship between current marijuana use and semen parameters. We found that current male marijuana use was not appreciably associated with semen quality. Further control for potential confounders, including BMI, had little influence on the study results. In addition, results were similar among non-smokers of tobacco. The third paper focused on sugar-sweetened beverages (SSB) consumption and semen quality. We found that men who consumed higher quantities of SSB had poorer semen quality, particularly lower sperm concentration, total sperm count, and total motile sperm count. Adjustment for caffeine intake or current BMI had little effect on the results; however, the association between total SSB consumption was stronger among overweight and obese men. In conclusion, we observed that higher BMI and waist circumference were associated with decreased semen quality. In addition, increased sugar-sweetened beverage consumption may increase the risk of being classified as having low semen quality. Given that these exposures are common and modifiable, they may be important targets for public health interventions. / 2024-08-31T00:00:00Z

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