Introduction

1. ■ Reproductive ageing in women is caused by declining number and quality of oocytes. There is little immediate prospect of reversing the underlying biological phenomena and determinants of reproductive ageing. Male reproductive ageing also occurs and is associated with adverse effects, though to a lesser degree.

2. ■ There is a steady continuing rise in age at childbirth. Women may face personal, social or economic constraints to earlier childbearing and these may also vary cross-culturally.

3. ■ Sexually transmitted infections are rising in older women.

4. ■ Early ovarian ageing affects around 10% of women in the general population. There is no evidence to support the use of screening for early ovarian ageing or ovarian response tests.

5. ■ Infertility is a time of great emotional and social stress for women and couples. Reproductive outcome in fertility treatment depends mainly on the woman's age. Assisted reproductive technologies, including in vitro fertilisation (IVF) with the woman's own fresh oocytes, cannot compensate for the effect of reproductive ageing. The purported benefits of oocyte banking either by cryopreservation or by vitrification for postponing pregnancy to a later age are unproven.

6. ■ Delay in childbirth is associated with worsening reproductive outcomes: more infertility and medical co-morbidity, and an increase in maternal and fetal morbidity and mortality. Women who start their family in their 20s or complete it by age 35 years face significantly reduced risks.

7. ■ Multiple pregnancies are associated with poorer fetal and maternal outcomes.

8. ■ The 2004 National Institute for Health and Clinical Excellence (NICE) clinical guideline on fertility1 has not been fully implemented.