COMMENTARY

Why Ob/Gyns Need to Talk to Patients About Fertility

Allison K. Rodgers, MD

Disclosures

May 24, 2016

Fertility treatment is on the increase.[1] This is partly due to the trend in delayed childbearing, along with better technology and access to care. In 1973, only 2% of women had their first baby between the ages of 35 and 44, while in 2012 that number was up to 13%.[2.]

Ovarian reserve declines with age, particularly after 35.[3] While many women are largely opting to delay childbearing, oocyte preservation technology has improved and was recognized as nonexperimental in 2012 by the American Society for Reproductive Medicine.[4] Many women who present for care are unaware of the age-related decline in ovarian reserve. According to the Centers for Disease Control and Prevention, 1 in 8 couples will have trouble getting pregnant or sustaining a pregnancy.[5] A recent study reviewed biopsies from 15,000 embryos and found that in women age 42 and older, 75%-100% of embryos were aneuploid, compared with women age 26-30, in whom 20%-27% of embryos were aneuploid.[6]

In an effort to better understand the female patient population and their family planning goals, the Fertility Centers of Illinois conducted a national online survey of 1208 nulliparous women across the United States ages 25-45. Our findings:

  • 51% of the women surveyed would like to have children someday.

  • 48% reported that they understood that there was an age-related decline in fertility and increase in aneuploidy and pregnancy loss.

  • 89% of respondents agreed that infertility education should be mentioned at an ob/gyn visit.

  • 52% of women age 35 or older stated that they would have made different life choices if they had known about the age-related decline in fertility.

In the United States, there is a large knowledge gap surrounding fertility and the age-related decline in women ages 25-45. This information is vital to help patients make informed decisions about family planning. Once a female patient enters the collegiate or postcollegiate years, an annual ob/gyn visit provides an opportunity to discuss this topic or provide educational materials. This can be difficult in an already packed visit with discussions of healthy BMI, sexually transmitted diseases, and contraception. However, selective discussions that address family planning and age-related ovarian reserve decline may be helpful. For patients approaching 30 years of age or older, it is important to share the option of fertility preservation and the need to consider their reproductive choices sooner rather than later. Some research has recommended that the ideal time to cryopreserve oocytes is at or before age 36.[7]

Male patients should not be removed from the fertility conversation with their own doctors. Family planning information around timing, the age of a female partner, and fertility preservation are beneficial to address during a check-up with a physician.

Couples who discover fertility issues at a younger age can often achieve pregnancy with fewer procedures and less aggressive treatment options. Women who freeze eggs can preserve their fertility at the age of oocyte cryopreservation with increased success and decreased aneuploidy rates. Our survey confirmed that there is a lack of general knowledge about fertility ability and age, and should be considered during routine health maintenance visits.

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