Which career first?

doi:10.1136/bmj.331.7517.588

BMJ 2005;331:588-589 (17 September), doi:10.1136/bmj.331.7517.588

Editorial

Which career first?

The most secure age for childbearing remains 20-35

The first 150 words of the full text of this article appear below.

Pregnancies in women older than 35 are increasing markedly inWestern countries.¹ Some commentators believe that this demographicshift poses a small or manageable problem as there are compensatorysuccessful fertility treatments. However, it is harder for olderwomen to become and stay pregnant, and outcomes for the motherand child are poorer.^2-5

Age related fertility problems increase after 35 and dramaticallyafter 40. Women have had more opportunity to acquire pelvicinfections or develop endometriosis or premature menopause.Body mass index, which rises with age, independently affectsfertility and treatment adversely. We do not understand reproductivesenescence,^w1 but there are no immediate prospects of treatmentsto reverse it. Paradoxically, the availability of in vitro fertilisation(IVF) may lull women into infertility while they wait for asuitable partner and concentrate on their careers and achievingsecurity and a comfortable living standard. But this expensive,invasive treatment has high failure . . . [Full text of this article]

Susan Bewley, consultant obstetrician, maternal-fetal medicine

Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London SE1 7EH (susan.bewley@gstt.nhs.uk)

Melanie Davies, consultant obstetrician and gynaecologist

Elizabeth Garrett Anderson Hospital, University College Hospital, London WC1E 6DH

Peter Braude, head of department of women's health

Guy's, King's and St Thomas' School of Medicine, King's College London, St Thomas' Hospital, London SE1 7EH

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