Becoming parents today: the point of view of medical specialists in Canton Ticino

Low birth rate in Canton Ticino: an underestimated issue.
After the survey bearing the same title conducted in Italy and the great interest it stirred, the IBSA Foundation wanted to have a closer look at fertility/infertility in Canton Ticino, the southernmost Swiss canton, and give its contribution to science knowledge and a science culture in its own constituency. Infertility is an extremely complex issue and, if not properly described and analyzed in relation to the affected population, risks to be underestimated. It was therefore decided to poll medical specialists who are the ones dealing with it in their clinical practice.
Since the 1990s the birth rate in Canton Ticino has always been lower than in other Swiss cantons. In 2013 it stood at 8.3 births per 1,000 people, a number which is even lower than the Italian figure for that same year. And yet, a significant percentage (about 41%) of gynaecologists in Canton Ticino believe Switzerland has no low birth rate issue. Polled medical specialists largely attributed the low birth rate to cultural causes such as the postponement of the decision to have a child, while the economic conditions of the younger generations do not appear to be a concern in this geographic area.
The vast majority (90%) of gynaecologists in Canton Ticino recommend patients to begin to seek a solution to their infertility problem soon, within 24 months of failed attempts to conceive. However, when asked about the age at which a woman should begin to worry, only 9.1% of respondents indicated the 25-30 age bracket, while exactly half of interviewees, accounting for the largest percentage of respondents, said they would recommend them to wait up until 30-35 years of age. The remaining 40% indicated an even later age as the age when a woman should begin to worry. In addition, 60% of respondents consider national/local infertility screening programs unnecessary.

In the light of these findings, it is not surprising that 77.3% of patients with infertility/sterility problems seen by gynaecologists in this geography are aged 35 years or more, an age when fertility has already declined and having a child become more challenging. Although they delay their decision, patients are adequately informed about fertility issues and assisted reproduction techniques – say the polled gynaecologists. 40.9% of polled medical specialists – the largest percentage of respondents – believe their patients are well informed and 36.4% think patients know enough. However, when asked to name the causes that patients more frequently associate with infertility problems, the most cited one (40.9%) was non-specific such as ‘anxiety and stress’.
A significant part of the survey focused on the medical specialist approach. Half of the respondents said they see the patients, diagnose the problem and treat them at their surgery initially and only later refer them to an assisted reproduction centre. All polled medical specialists said they suggest assisted reproduction and the largest percentage of those polled (57.1%) said they do this within six months from the moment they first see the patients, so within a short time. The medical specialists were also asked to say how, in their opinion, patients choose the assisted reproduction centre. 36.3% – the largest percentage of those polled – said patients tend to choose a centre that is close to where they live, which may be explained by the trust people have in the network of assisted reproduction centres in Canton Ticino.
Finally, the survey polled the opinion medical specialists have about the current Swiss legislation on assisted reproduction that allows access to ART only for married couples and excludes unmarried couples who live together, singles and same-sex couples. The polled sample of Canton Ticino gynaecologists almost unanimously said access to ART should be ensured also to unmarried couples who live together, 54.5% of them said access should be given also to same-sex couples and 45.5% also to singles.

Becoming parents today 2017: the point of view of medical specialists in Canton Ticino