Age and female fertility

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Female fertility is affected by age and is a major fertility factor for women. A woman's fertility is in generally good quality from the late teens to early thirties, although it declines gradually over time. [1] Around 35, fertility is noted to decline at a more rapid rate. [1] At age 45, a woman starting to try to conceive will have no live birth in 50–80 percent of cases. [2] Menopause, or the cessation of menstrual periods, generally occurs in the 40s and 50s and marks the cessation of fertility, although age-related infertility can occur before then. [3] The relationship between age and female fertility is sometimes referred to as a woman's "biological clock." [4]

Contents

Quantification of effect

Cumulative percentage and average age for women reaching subfertility, sterility, irregular menstruation and menopause Age and female fertility.svg
Cumulative percentage and average age for women reaching subfertility, sterility, irregular menstruation and menopause

In adolescence

The average age of a girl's first period (menarche) is 12 to 13 (12.5 years in the United States, [6] 12.72 in Canada, [7] 12.9 in the UK [8] ) but, in postmenarchal girls, about 80% of the cycles are anovulatory in the first year after menarche, which declines to 50% in the third year, and to 10% by the sixth. [9] Little is known about fertility in young adolescents, as early teenage pregnancies are uncommon in most societies. [10]

In adulthood

A woman's fertility peaks between her late teens to late-20s after which it starts to decline. [1] However, the exact estimates of the chances of a woman to conceive after a certain age are not clear, and are subject to debate. [11]

According to the National Institute for Health and Care Excellence (NICE) over 80 out of every 100 women aged under 40 who have regular unprotected sexual intercourse will get pregnant within 1 year of trying. In the second year the percentage rises to over 90%. [12]

A 2004 study by Henri Leridon, PhD, an epidemiologist with the French Institute of Health and Medical Research, of women trying to get pregnant, without using fertility drugs or in vitro fertilization, had the following results on rates of conception by age:

According to a study done on a sample of 782 healthy European couples ages 19–39, fertility starts declining after age 27 and drops at a somewhat greater rate after age 35. Statistical analysis showed that the women in the 27–29 age group had significantly less chance on average of becoming pregnant than did the 19- to 26-year-olds. Pregnancy rates did not change notably between the 27–29 age group and the 30–34 age group, but dropped significantly for the 35–39 age group. [14]

The age of the male partner had a significant impact on female fertility among the women who had reached their mid-30s, but not among the younger women. However, experts said the new study was too small and there were too many variables which were too difficult to sort out, for a clear conclusion to be drawn. Some experts suggested that the main change in fertility in the older women was the fact that it took them longer to conceive, not necessarily that they were significantly more unlikely to eventually succeed. David Dunson, a biostatistician at the U.S. National Institute of Environmental Health Sciences, said that: "Although we noted a decline in female fertility in the late 20s, what we found was a decrease in the probability of becoming pregnant per menstrual cycle, not in the probability of eventually achieving a pregnancy." [14]

A French study found no difference between the fertility rate of women under 25 and those ages 26–30, after which fertility started to decrease. Estimating the "fertility of a woman" is quite difficult because of the male factor (quality of sperm). This French study looked at 2,193 women who were using artificial insemination because their husbands were azoospermic. The cumulative success rates after 12 cycles of insemination were 73% for women under age 25, 74% in women ages 26–30, 61% for ages 31–35, and 54% in the over 35 age group. [15]

In Hungary, a study by the Központi Statisztikai Hivatal (Central Statistics Office) estimated that 7–12% of Hungarian women younger than 30 were infertile; 13–22% of women age 35 were infertile; and 24–46% of women age 40 were infertile. [16]

The below is a table containing estimates of the percentage of women who, if starting to conceive at a certain age, will fail to obtain a live birth. [2] Note that while for the young ages researchers tend to agree, for older ages there is discrepancy.

Age of woman when she starts to try to conceivePercentage who will have no live birth
according to Vincent (1950)according to Henry (1953), Englandaccording to Henry (1953), Norwayaccording to Pittenger (1973)according to Leridon (1977)according to Trussell-Wilson (1985)according to Menken-Larsen (1986)
204%3.5%3.5%2.2%3%-4%
256%6%5%3.3%6%6%7%
3010%11%8%6.5%10%11%12%
3517%19%13%16%17%16%22%
4037%33%24%40%29%24%46%
4575%58%50%79%50%58%-

Ovarian reserve

"Percentage of ovarian reserve related to increasing age. The curve describes the percentage of ovarian reserve remaining at ages from birth to 55 years, based on the ADC model. 100% is taken to be the maximum ovarian reserve, occurring at 18-22 weeks post-conception. The percentages apply to all women whose ovarian reserve declines in line with a particular model where late and early menopause are associated with high and low peak NGF populations, respectively. It is estimated that for 95% of women by the age of 30 years only 12% of their maximum pre-birth NGF population is present and by the age of 40 years only 3% remains. At birth, women have all their follicles for folliculogenesis, and they steadily decline until menopause." Non-Growing Follicles.png
"Percentage of ovarian reserve related to increasing age. The curve describes the percentage of ovarian reserve remaining at ages from birth to 55 years, based on the ADC model. 100% is taken to be the maximum ovarian reserve, occurring at 18–22 weeks post-conception. The percentages apply to all women whose ovarian reserve declines in line with a particular model where late and early menopause are associated with high and low peak NGF populations, respectively. It is estimated that for 95% of women by the age of 30 years only 12% of their maximum pre-birth NGF population is present and by the age of 40 years only 3% remains. At birth, women have all their follicles for folliculogenesis, and they steadily decline until menopause."

In terms of ovarian reserve, a typical woman has 12% of her reserve at age 30 and has only 3% at age 40. [18] 81% of variation in ovarian reserve is due to age alone, [18] making age the most important factor in female infertility.

The most common methods of checking the status of the ovarian reserve is to perform a blood test on day 3 of the menstrual cycle to measure serum Follicle-Stimulating Hormone (FSH) level, alternatively a blood test to measure the serum Anti-Müllerian Hormone (AMH) level can give similar information. Transvaginal ultrasound can also be used to "count the number of follicles" and this procedure is called Antral Follicle Count.

The American College of Obstetricians and Gynecologists recommends ovarian reserve testing should be performed for women older than 35 years who have not conceived after 6 months of attempting pregnancy and women at higher risk of diminished ovarian reserve, such as those with a history of cancer treated with gonadotoxic therapy, pelvic irradiation, or both; those with medical conditions who were treated with gonadotoxic therapies; or those who had ovarian surgery for endometriomas. [19]

It is important to recognize that a poor result from ovarian reserve testing does not signify an absolute inability to conceive and should not be the sole criterion considered to limit or deny access to infertility treatment. [19]

Historical data

A study of a population of French women from 1670 and 1789 shows that those who married at age 20–24 had 7.0 children on average and 3.7% remained childless. Women who married at age 25–29 years had a mean of 5.7 children and 5.0% remained childless. Women who married at 30–34 years had a mean of 4.0 children and 8.2% remained childless. [20] The average age at last birth in natural fertility populations that have been studied is around 40. [21]

In 1957, a study was done on a large population (American Hutterites) that never used birth control. The investigators measured the relationship between the age of the female partner and fertility. (Infertility rates today are believed to be higher in the general population than for the population in this study from the 1950s.)

This 1957 study found that: [22]

Impact

Family planning

The inverse correlation between age and female fertility in later reproductive life is argued to motivate family planning well before having reached 35 years of age. [23] Mapping of a woman's ovarian reserve, follicular dynamics and associated biomarkers can give an individual prognosis about future chances of pregnancy, facilitating an informed choice of when to have children. [24] Notably, a higher level of anti-Müllerian hormone when tested in women in the general population has been found to have a positive correlation with natural fertility in women aged 30–44 aiming to conceive spontaneously, even after adjusting for age. [25] Thus, AMH measurement is helpful to determine which women may need to conceive at an earlier age, and which women can potentially wait. [26]

Reproductive medicine

It is recommended that women have an infertility evaluation if they are over the age of 40, or if they are over the age of 35 and have not achieved pregnancy after trying for 6 months. [27] In many cases, infertility can be treated with many reproductive technologies, but their success declines with age. The issues of age can be discussed with a qualified fertility specialist such as a reproductive endocrinologist.

In Vitro Fertilization (IVF) is an assisted reproductive technology used to treat infertility and to help families have offspring. While many women in advanced age may opt for IVF treatment in order to have children, patients with higher maternal age (>40 years old) were found to have worse IVF outcomes and a higher miscarriage rate compared to 20–30 year olds. [28] Most IVF centers will attempt IVF using the patient's own eggs until about age 43–45, [22] and clinically reproductive endocrinologists tend to pursue IVF more aggressively in women over 35. [15]

Oocyte cryopreservation (egg freezing) is a procedure done to preserve eggs (oocytes) to have the eggs thawed, fertilized, and transferred to the uterus via an IVF procedure. This gives women the ability to delay pregnancy and avoid many of the infertility problems that arise from germ cell deterioration. Studies have shown that the risk of acquiring congenital abnormalities is not increased in the infants born from frozen and thawed eggs, [29] and IVF from thawed eggs have the same successful implantation rate compared to IVF performed with fresh eggs. [30] While chromosomal abnormalities are avoided with egg freezing, pregnancy at older age increases the risk of gestational diabetes, preeclampsia, preterm labor, and cesarean section regardless of conception method. [31]

A review in 2012 came to the result that therapeutic interventions to halt or reverse the process of reproductive ageing in women is limited, despite recent reports of the potential existence of stem cells which may be used to restore the ovarian reserve. [24]

Complications

Women who become pregnant after age 35 are at increased risk for complications that affect the mother and fetus.

When it comes to the mother, several research studies have shown that pregnant women over 35 years of age are at increased risk for hypertension during pregnancy, eclampsia (hypertension during pregnancy with seizures), and gestational diabetes. [1] [32] Further, women who become pregnant after age 35 are also at risk for delivery complications. These include stillbirth, miscarriage, and complications leading to delivery via caesarean section. [1] [33] [34] [32]

Fetal complications for pregnant women after age 35 are also high. One well-known risk is the increased risk of having a baby with Down syndrome. According to the Academy of Obstetrics and Gynecology, research has shown that risk for Down syndrome increases proportionally to increasing maternal age. [1]

Probability of conceiving a child with Down syndrome according to maternal age by NDSS: [35]

In addition to Down syndrome, pregnant women over 35 are also at increased risk for other birth defects. A study conducted by Gill et al. found an association of advanced maternal age >40 and birth defects such as cardiac issues, esophageal atresia, hypospadias, and craniosynostosis. [36] Lastly, studies have reported that pregnant women over 35 also have increased risk for premature birth and babies with low birth weight. [1] [33]

Ovarian aging

Substantial evidence indicates that the capability to repair DNA double strand breaks by a repair pathway involving BRCA1 (Breast cancer type 1 susceptibility) protein and ATM (ataxia–telangiectasia mutated) serine/threonine kinase weakens with age in oocytes of numerous species including humans. [37] The specific DNA repair pathway affected by age is the homologous recombination DNA repair pathway. In general, women with BRCA1 mutations have lower ovarian reserves and experience earlier menopause. [37]

See also

Related Research Articles

<span class="mw-page-title-main">In vitro fertilisation</span> Assisted reproductive technology procedure

In vitro fertilisation (IVF) is a process of fertilisation where an egg is combined with sperm in vitro. The process involves monitoring and stimulating a woman's ovulatory process, removing an ovum or ova from their ovaries and letting a man's sperm fertilise them in a culture medium in a laboratory. After the fertilised egg (zygote) undergoes embryo culture for 2–6 days, it is transferred by catheter into the uterus, with the intention of establishing a successful pregnancy.

Reproductive technology encompasses all current and anticipated uses of technology in human and animal reproduction, including assisted reproductive technology (ART), contraception and others. It is also termed Assisted Reproductive Technology, where it entails an array of appliances and procedures that enable the realization of safe, improved and healthier reproduction. While this is not true of all people, for an array of married couples, the ability to have children is vital. But through the technology, infertile couples have been provided with options that would allow them to conceive children.

<span class="mw-page-title-main">Infertility</span> Inability to reproduce by natural means

Infertility is the inability of an animal or plant to reproduce by natural means. It is usually not the natural state of a healthy adult, except notably among certain eusocial species. It is the normal state of a human child or other young offspring, because they have not undergone puberty, which is the body's start of reproductive capacity.

<span class="mw-page-title-main">Assisted reproductive technology</span> Methods to achieve pregnancy by artificial or partially artificial means

Assisted reproductive technology (ART) includes medical procedures used primarily to address infertility. This subject involves procedures such as in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), cryopreservation of gametes or embryos, and/or the use of fertility medication. When used to address infertility, ART may also be referred to as fertility treatment. ART mainly belongs to the field of reproductive endocrinology and infertility. Some forms of ART may be used with regard to fertile couples for genetic purpose. ART may also be used in surrogacy arrangements, although not all surrogacy arrangements involve ART. The existence of sterility will not always require ART to be the first option to consider, as there are occasions when its cause is a mild disorder that can be solved with more conventional treatments or with behaviors based on promoting health and reproductive habits.

<span class="mw-page-title-main">Embryo transfer</span> Method of assisted reproduction

Embryo transfer refers to a step in the process of assisted reproduction in which embryos are placed into the uterus of a female with the intent to establish a pregnancy. This technique - which is often used in connection with in vitro fertilization (IVF) - may be used in humans or in other animals, in which situations and goals may vary.

Fertility medications, also known as fertility drugs, are medications which enhance reproductive fertility. For women, fertility medication is used to stimulate follicle development of the ovary. There are very few fertility medication options available for men.

<span class="mw-page-title-main">Anti-Müllerian hormone</span> Mammalian protein found in humans

Anti-Müllerian hormone (AMH), also known as Müllerian-inhibiting hormone (MIH), is a glycoprotein hormone structurally related to inhibin and activin from the transforming growth factor beta superfamily, whose key roles are in growth differentiation and folliculogenesis. In humans, it is encoded by the AMH gene, on chromosome 19p13.3, while its receptor is encoded by the AMHR2 gene on chromosome 12.

Egg donation is the process by which a woman donates eggs to enable another woman to conceive as part of an assisted reproduction treatment or for biomedical research. For assisted reproduction purposes, egg donation typically involves in vitro fertilization technology, with the eggs being fertilized in the laboratory; more rarely, unfertilized eggs may be frozen and stored for later use. Egg donation is a third-party reproduction as part of assisted reproductive technology.

<span class="mw-page-title-main">Ovarian reserve</span>

Ovarian reserve is a term that is used to determine the capacity of the ovary to provide egg cells that are capable of fertilization resulting in a healthy and successful pregnancy. With advanced maternal age, the number of egg cell that can be successfully recruited for a possible pregnancy declines, constituting a major factor in the inverse correlation between age and female fertility.

<span class="mw-page-title-main">Female infertility</span> Diminished or absent ability of a female to achieve conception

Female infertility refers to infertility in women. It affects an estimated 48 million women, with the highest prevalence of infertility affecting women in South Asia, Sub-Saharan Africa, North Africa/Middle East, and Central/Eastern Europe and Central Asia. Infertility is caused by many sources, including nutrition, diseases, and other malformations of the uterus. Infertility affects women from around the world, and the cultural and social stigma surrounding it varies.

Advanced maternal age, in a broad sense, is the instance of a woman being of an older age at a stage of reproduction, although there are various definitions of specific age and stage of reproduction. The variability in definitions is in part explained by the effects of increasing age occurring as a continuum rather than as a threshold effect.

Ovulation induction is the stimulation of ovulation by medication. It is usually used in the sense of stimulation of the development of ovarian follicles to reverse anovulation or oligoovulation.

<span class="mw-page-title-main">Oocyte cryopreservation</span> Procedure to preserve a womans eggs (oocytes)

Oocyte cryopreservation is a procedure to preserve a woman's eggs (oocytes). This technique has been used to postpone pregnancy. When pregnancy is desired, the eggs can be thawed, fertilized, and transferred to the uterus as embryos. Several studies have shown that most infertility problems are due to germ cell deterioration related to aging. The procedure's success rate varies depending on the age of the woman,, as well as depending on health and genetic indicators. In 1986, the first human birth of oocyte oocyte cryopreservation was reported.

Controlled ovarian hyperstimulation is a technique used in assisted reproduction involving the use of fertility medications to induce ovulation by multiple ovarian follicles. These multiple follicles can be taken out by oocyte retrieval for use in in vitro fertilisation (IVF), or be given time to ovulate, resulting in superovulation which is the ovulation of a larger-than-normal number of eggs, generally in the sense of at least two. When ovulated follicles are fertilised in vivo, whether by natural or artificial insemination, there is a very high risk of a multiple pregnancy.

Poor ovarian reserve is a condition of low fertility characterized by 1): low numbers of remaining oocytes in the ovaries or 2) possibly impaired preantral oocyte development or recruitment. Recent research suggests that premature ovarian aging and premature ovarian failure may represent a continuum of premature ovarian senescence. It is usually accompanied by high FSH levels.

Fertility preservation is the effort to help cancer patients retain their fertility, or ability to procreate. Research into how cancer, ageing and other health conditions effect reproductive health and preservation options are growing. Specifically sparked in part by the increase in the survival rate of cancer patients.

Unexplained infertility is infertility that is idiopathic in the sense that its cause remains unknown even after an infertility work-up, usually including semen analysis in the man and assessment of ovulation and fallopian tubes in the woman. It is usually an exercise in excluding all possible causes before making a diagnosis, however the age of the female partner as well as the duration of infertility are often the most scrutinized characteristics of any infertility case.

Natural Cycle In Vitro Fertilization (IVF) is an assisted reproductive technique designed to closely mimic a woman's natural menstrual cycle. In traditional IVF, a woman's ovaries are stimulated with fertility medications to produce multiple eggs, which are then retrieved and fertilized outside the body. A natural cycle IVF, on the other hand, works with the woman's natural hormonal fluctuations and ovulation cycle.

Partner-assisted reproduction, reception of oocytes from partner (ROPA), reciprocal IVF,shared motherhood, partner IVF or co-IVF is a method of family building that is used by couples who both possess female reproductive organs. The method uses in vitro fertilization (IVF), a method that means eggs are removed from the ovaries, fertilized in a laboratory, and then one or more of the resulting embryos are placed in the uterus to hopefully create a pregnancy. Reciprocal IVF differs from standard IVF in that two partners are involved: the eggs are taken from one partner, and the other partner carries the pregnancy. In this way, the process is mechanically identical to IVF with egg donation. Reciprocal IVF offers the highest chance for pregnancy and a lower chance of a multiple births.

Endometriosis and its complications are a major cause of female infertility. Endometriosis is a dysfunction characterized by the migration of endometrial tissue to areas outside of the endometrium of the uterus. The most common places to find stray tissue are on ovaries and fallopian tubes, followed by other organs in the lower abdominal cavity such as the bladder and intestines. Typically, the endometrial tissue adheres to the exteriors of the organs, and then creates attachments of scar tissue called adhesions that can join adjacent organs together. The endometrial tissue and the adhesions can block a fallopian tube and prevent the meeting of ovum and sperm cells, or otherwise interfere with fertilization, implantation and, rarely, the carrying of the fetus to term.

References

  1. 1 2 3 4 5 6 7 "Having a Baby After Age 35: How Aging Affects Fertility and Pregnancy". www.acog.org. Archived from the original on 2024-06-24. Retrieved 2020-10-29.
  2. 1 2 Leridon, Henri (2005). "The biological obstacles to late childbearing and the limits of ART" (PDF). Ined-Inserm, Paris. Archived from the original (PDF) on 2016-04-19. Retrieved 2012-08-26.
  3. ↑ "Menopause: MedlinePlus Medical Encyclopedia". MedlinePlus. Retrieved 2024-07-16.
  4. ↑ Pasqualotto, Fabio Firmbach; Borges Júnior, Edson; Pasqualotto, Eleonora Bedin (May 2008), "The male biological clock is ticking: a review of the literature", Sao Paulo Medical Journal, 126 (3): 197–201, doi: 10.1590/S1516-31802008000300012 , ISSN   1516-3180, PMID   18711662
  5. ↑ te Velde, E. R. (2002). "The variability of female reproductive ageing and also on how the body is built". Human Reproduction Update. 8 (2): 141–154. doi: 10.1093/humupd/8.2.141 . ISSN   1355-4786. PMID   12099629.
  6. ↑ Anderson SE, Dallal GE, Must A (April 2003). "Relative weight and race influence average age at menarche: results from two nationally representative surveys of US girls studied 25 years apart". Pediatrics. 111 (4 Pt 1): 844–50. doi:10.1542/peds.111.4.844. PMID   12671122.
  7. ↑ Al-Sahab B, Ardern CI, Hamadeh MJ, Tamim H (2010). "Age at menarche in Canada: results from the National Longitudinal Survey of Children & Youth". BMC Public Health. 10: 736. doi: 10.1186/1471-2458-10-736 . PMC   3001737 . PMID   21110899.
  8. ↑ Hamilton-Fairley, Diana (2004). "Obstetrics and Gynaecology: Lecture Notes (2nd ed.)" (PDF). Blackwell Publishing. Archived from the original (PDF) on 2018-10-09. Retrieved 2012-08-26.
  9. ↑ Apter D (February 1980). "Serum steroids and pituitary hormones in female puberty: a partly longitudinal study". Clinical Endocrinology. 12 (2): 107–20. doi:10.1111/j.1365-2265.1980.tb02125.x. PMID   6249519. S2CID   19913395.
  10. ↑ Fertility among young adolescents aged 10 to 14 years (PDF), New York: Department of Economic and Social Affairs, Population Division, United Nations, 2020, archived (PDF) from the original on 2024-06-05, retrieved 2024-01-22, Data on fertility among girls under age 15 are deficient, as noted before, in part because childbirth at these ages is uncommon in most societies. In addition, childbearing at these ages, which often occurs within marriage, is likely to be underreported or concealed to avoid shame and stigmatization.
  11. ↑ Barnes, Hannah (2013-09-18). "The 300-year-old fertility statistics still in use today". BBC News. Archived from the original on 2017-12-24. Retrieved 2017-09-04.
  12. ↑ "Fertility problems: assessment and treatment – Guidance and guidelines – NICE". www.nice.org.uk. 20 February 2013. Archived from the original on 3 July 2017. Retrieved 27 July 2017.
  13. ↑ Archived 2012-10-25 at the Wayback Machine Leridon, H. (2004). "Can assisted reproduction technology compensate for the natural decline in fertility with age? A model assessment". Human Reproduction. 19 (7): 1548–1553. doi: 10.1093/humrep/deh304 . PMID   15205397.
  14. 1 2 Hall, Carl T. (2002-04-30). "Study speeds up biological clocks / Fertility rates dip after women hit 27". The San Francisco Chronicle. Archived from the original on 2012-06-17. Retrieved 2007-11-21.
  15. 1 2 Fox M (May 2000). "Age And Infertility: The Biological Clock: Fact Or Fiction?". Jacksonville Medicine. 51 (5). Archived from the original on 2002-08-19. Retrieved 2012-07-29.
  16. ↑ Balázs, Kapitány (February 2010). "A kései gyermekvállalás kockázatai" (PDF). KorFa on-line. Archived from the original (PDF) on 2012-03-13. Retrieved 2012-08-26.
  17. 1 2 Wallace, W. Hamish B.; Thomas W. Kelsey (2010-01-27). Vitzthum, Virginia J. (ed.). "Human Ovarian Reserve from Conception to the Menopause". PLOS ONE. 5 (1): e8772. arXiv: 1106.1382 . Bibcode:2010PLoSO...5.8772W. doi: 10.1371/journal.pone.0008772 . PMC   2811725 . PMID   20111701.
  18. 1 2 Wallace WH, Kelsey TW (2010). "Human Ovarian Reserve from Conception to the Menopause". PLOS ONE. 5 (1): e8772. arXiv: 1106.1382 . Bibcode:2010PLoSO...5.8772W. doi: 10.1371/journal.pone.0008772 . PMC   2811725 . PMID   20111701.
  19. 1 2 Committee on Gynecologic Practice (January 2015). "Committee Opinion No. 618: Ovarian Reserve Testing". Obstetrics and Gynecology. 125 (1): 268–273. doi:10.1097/01.AOG.0000459864.68372.ec. PMID   25560143. S2CID   7906030.
  20. ↑ Leridon, Henri (1 July 2004). "Can assisted reproduction technology compensate for the natural decline in fertility with age? A model assessment". Human Reproduction. 19 (7): 1548–1553. doi: 10.1093/humrep/deh304 . PMID   15205397. Archived from the original on 19 January 2024. Retrieved 16 April 2018– via humrep.oxfordjournals.org.
  21. ↑ Fertility, Biology, and Behavior: An Analysis of the Proximate Determinants (Studies in Population), by John Bongaarts, Robert E. Potter. pp 42 – 43. "The average of these estimates is 40 years, which, as expected, is slightly below the mean age at onset of sterility. The data in Table 2.4 indicate that the mean age at last birth is remarkably invariant. With few exceptions the means fall in the 39–41 year range."
  22. 1 2 Age and Female Infertility, Fertility Tests of Egg Supply Archived 2017-08-27 at the Wayback Machine citing Tietze, Christopher (1957). "Reproductive span and rate of reproduction among Hutterite women". Obstetrical & Gynecological Survey. 12 (5). LWW: 727–728. doi:10.1097/00006254-195710000-00039.
  23. ↑ Infertility, Economics, and Common Sense Archived 2016-03-03 at the Wayback Machine . By Paul E. Visneski. The Journal of Lancaster General Hospital.
  24. 1 2 Nelson, S. M.; Telfer, E. E.; Anderson, R. A. (2012). "The ageing ovary and uterus: New biological insights". Human Reproduction Update. 19 (1): 67–83. doi:10.1093/humupd/dms043. PMC   3508627 . PMID   23103636.
  25. ↑ Broer, S. L.; Broekmans, F. J. M.; Laven, J. S. E.; Fauser, B. C. J. M. (2014). "Anti-Mullerian hormone: ovarian reserve testing and its potential clinical implications". Human Reproduction Update. 20 (5): 688–701. doi: 10.1093/humupd/dmu020 . ISSN   1355-4786. PMID   24821925.
  26. ↑ Broer, S. L.; Broekmans, F. J. M.; Laven, J. S. E.; Fauser, B. C. J. M. (2014). "Anti-Mullerian hormone: ovarian reserve testing and its potential clinical implications". Human Reproduction Update. 20 (5): 688–701. doi: 10.1093/humupd/dmu020 . ISSN   1355-4786. PMID   24821925.
    In turn citing:
  27. ↑ "Evaluating Infertility". www.acog.org. Archived from the original on 2024-06-24. Retrieved 2021-09-20.
  28. ↑ Yan, JunHao; Wu, KeLiang; Tang, Rong; Ding, LingLing; Chen, Zi-Jiang (2012-08-01). "Effect of maternal age on the outcomes of in vitro fertilization and embryo transfer (IVF-ET)". Science China Life Sciences. 55 (8): 694–698. doi: 10.1007/s11427-012-4357-0 . ISSN   1869-1889. PMID   22932885.
  29. ↑ Noyes, N; Porcu, E; Borini, A (January 2009). "Over 900 oocyte cryopreservation babies born with no apparent increase in congenital anomalies". Reproductive BioMedicine Online. 18 (6): 769–776. doi: 10.1016/s1472-6483(10)60025-9 . ISSN   1472-6483. PMID   19490780.
  30. ↑ Argyle, Catrin E.; Harper, Joyce C.; Davies, Melanie C. (2016-03-22). "Oocyte cryopreservation: where are we now?". Human Reproduction Update. 22 (4): 440–449. doi: 10.1093/humupd/dmw007 . ISSN   1355-4786. PMID   27006004.
  31. ↑ Petropanagos, Angel; Cattapan, Alana; Baylis, Françoise; Leader, Arthur (2015-06-16). "Social egg freezing: risk, benefits and other considerations". CMAJ. 187 (9): 666–669. doi:10.1503/cmaj.141605. ISSN   0820-3946. PMC   4467930 . PMID   25869870. Archived from the original on 2024-01-30. Retrieved 2021-09-13.
  32. 1 2 Staff, MayoClinic (July 30, 2020). "Pregnancy after 35: Healthy moms, healthy babies". Mayo Clinic. Archived from the original on 2015-04-11. Retrieved September 12, 2021.
  33. 1 2 Cavazos-Rehg, Patricia (June 2015). "Maternal age and risk of labor and delivery complications". Maternal and Child Health Journal. 19 (6): 1202–11. doi:10.1007/s10995-014-1624-7. PMC   4418963 . PMID   25366100.
  34. ↑ Sauer, Mark (May 2015). "Reproduction at an advanced maternal age and maternal health". Fertility and Sterility. 103 (5): 1136–43. doi: 10.1016/j.fertnstert.2015.03.004 . PMID   25934599.
  35. ↑ "What is Down Syndrome? | National Down Syndrome Society". Archived from the original on 2021-01-16. Retrieved 2022-05-31.
  36. ↑ Gill, Simerpal (July 2012). "Association between Maternal Age and Birth Defects of Unknown Etiology - United States, 1997–2007". Birth Defects Research Part A: Clinical and Molecular Teratology. 94 (12): 1010–18. doi:10.1002/bdra.23049. PMC   4532312 . PMID   22821755.
  37. 1 2 Turan V, Oktay K (January 2020). "BRCA-related ATM-mediated DNA double-strand break repair and ovarian aging". Hum Reprod Update. 26 (1): 43–57. doi:10.1093/humupd/dmz043. PMC   6935693 . PMID   31822904.
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