Abstract
Objective
To provide an overview of delayed child-bearing and to describe the implications for
women and health care providers .
Options
Delayed child-bearing, which has increased greatly in recent decades, is associated
with an increased risk of infertility, pregnancy complications, and adverse pregnancy
outcome . This guideline provides information that will optimize the counselling and
care of Canadian women with respect to their reproductive choices .
Outcomes
Maternal age is the most important determinant of fertility, and obstetric and perinatal
risks increase with maternal age .
Many women are unaware of the success rates or limitations of assisted reproductive
technology and of the increased medical risks of delayed child-bearing, including
multiple births, preterm delivery, stillbirth, and Caesarean section . This guideline
provides a framework to address these issues .
Evidence
Studies published between 2000 and August 2010 were retrieved through searches of
PubMed and the Cochrane Library using appropriate key words (delayed child-bearing,
deferred pregnancy, maternal age, assisted reproductive technology, infertility, and
multiple births) and MeSH terms (maternal age, reproductive behaviour, fertility)
. The Internet was also searched using similar key words, and national and international
medical specialty societies were searched for clinical practice guidelines and position
statements . Data were extracted based on the aims, sample, authors, year, and results
.
Values
The quality of evidence was rated using the criteria described in the Report of the
Canadian Task Force on Preventive Health Care.
Sponsor
The Society of Obstetricians and Gynaecologists of Canada.
Recommendations
- 1.Women who delay child-bearing are at increased risk of infertility . Prospective parents, especially women, should know that their fecundity and fertility begin to decline significantly after 32 years of age . Prospective parents should know that assisted reproductive technologies cannot guarantee a live birth or completely compensate for age-related decline in fertility (II-2A).
- 2.A fertility evaluation should be initiated after 6 months of unprotected intercourse without conception in women 35 to 37 years of age, and earlier in women > 37 years of age (II-2A).
- 3.Prospective parents should be informed that semen quality and male fertility deteriorate with advancing age and that the risk of genetic disorders in offspring increases (II-2A).
- 4.Women ≥ 35 years of age should be offered screening for fetal aneuploidy and undergo a detailed second trimester ultrasound examination to look for significant fetal birth defects (particularly cardiac defects) (II-1A).
- 5.Delayed child-bearing is associated with increased obstetrical and perinatal complications . Care providers need to be aware of these complications and adjust obstetrical management protocols to ensure optimal maternal and perinatal outcomes (II-2A).
- 6.All adults of reproductive age should be aware of the obstetrical and perinatal risks of advanced maternal age so they can make informed decisions about the timing of child-bearing (II-2A).
- 7.Strategies to improve informed decision-making by prospective parents should be designed, implemented, and evaluated . These strategies should provide opportunity for adults to understand the potential medical, social, and economic consequences of child- bearing throughout the reproductive years (III-B).
- 8.Barriers to healthy reproduction, including workplace policies, should be reviewed to optimize the likelihood of healthy pregnancies (III-C).
Key Words
Abbreviations:
ART (assisted reproductive technology), OR (odds ratio), ICSI (intracytoplasmic sperm injection), IUI (intrauterine insemination), LBW (low birth weight), PTD (preterm delivery), SGA (small for gestational age)To read this article in full you will need to make a payment
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Article info
Publication history
No. 271, Reaffirmed November 2017
Footnotes
This document reflects emerging clinical and scientific advances on the date issued, and is subject to change. The information should not be construed as dictating an exclusive course of treatment or procedure to be followed. Local institutions can dictate amendments to these opinions. They should be well-documented if modified at the local level. None of these contents may be reproduced in any form without prior written permission of the publisher.
Women have the right and responsibility to make informed decisions about their care in partnership with their health care providers. In order to facilitate informed choice women should be provided with information and support that is evidence based, culturally appropriate and tailored to their needs. The values, beliefs and individual needs of each woman and her family should be sought and the final decision about the care and treatment options chosen by the woman should be respected.
Identification
Copyright
Copyright © 2017 Published by Elsevier Inc. on behalf of The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada
