Over the past several decades, demographic and socioeconomic trends have resulted in an increase in the absolute number of women seeking pregnancy in their late 30’s and early to mid-40’s. In addition, a significant number of women in this age group are seeking evaluation and treatment for infertility. Although there is a very well demonstrated decline in female fertility as a function of age, this phenomenon has typically has been under-recognized not only by the general population, but also by many health care providers. This is probably related to the fact that in previous decades women generally had completed childbearing by the late 30’s and in fact many of the pregnancies that occurred in the later reproductive years were unplanned. An increased awareness of the effects of aging on fertility for patients and health care providers is critical to the prevention of age-related infertility.
Age and Infertility. The Biological Clock, fact or fiction?
With recent dramatic advances in infertility treatment, age related infertility remains as one of our most difficult challenges. Reproductive specialists have known for years that the pregnancy rate is inversely related to the female partner's age. Early explanations for this trend included decreased coital frequency, diminished desire for childbearing, decreased overall time to try for a pregnancy, and diminished ovarian reserve with advancing age.1,2 Today, we would add increased spontaneous abortion, oocyte depletion, and oocyte aging to the list.3 Coupling this issue of age with our current societal trend of increased numbers of women who delay childbearing for educational and career goals, we now have a dramatic increase in age related infertility. For those providing primary care to women, it is now much more important to carefully counsel patients regarding family planning issues, especially with regards to advancing age and diminished pregnancy rates. Patients who are in their early to mid thirties or beyond who are considering pregnancy or have been trying for any length of time without success warrant an early referral for evaluation.