Time to clarify effect of socioeconomic class on subfertility

Editor—Why is socioeconomic status never considered in the epidemiology of subfertility, although some of the known causes such as obesity and smoking are strongly related to it?¹

The emphasis on the effect of age on fertility perpetuates the myth that subfertility is a disease of affluence, experienced mostly by women who have high powered jobs or who are having such a good time that they delay motherhood. In effect, they bring the subfertility on themselves, an idea popular since the Victorian era.

Most subfertility is found in women—and men—who cannot afford expensive treatments. People who smoke and are obese are more likely to be comparatively poor and hence fall into this category. People who seek treatment that must be paid for are unlikely to be representative of the population at large. In developed countries direct evidence on socioeconomic status and infertility is never collected.