Middle-aged pregnancy and the need to return to traditional concepts of family planning
The continuing and rapidly rising rates of conceptions in women aged
35-39 and >40 reported in last weeks BMJ (1) are worrying and
unexplained. Women have been liberated from a past era of unfettered
fertility but may unwittingly have moved on to one of excess contraception
and loss of desired fertility. An annual 90,000 “baby gap” between desired
and achieved children has recently been reported (2), which is well in
excess of the small number of babies born with assisted reproduction. Our
patients tell us that they receive mixed messages from the media, they do
not receive appropriate advice from their doctors, and nor do they
appreciate fully the facts about fertility despite information in the
public domain. For example, a recent Sunday Times article claimed that a
Hollywood actress’s twin pregnancy at 47 meant that women of 38 could
relax about their fertility for another 8 years (3), even though it is
statistically likely that this was IVF ovum donation. Whilst late
childbearing may not necessarily be a matter of choice, it has inevitable
adverse impacts. Our earlier editorial drew attention to the serious
medical implications of this upward population trend and the well-known,
if uncomfortable, hazards of later reproduction (4). Neither age nor
pregnancy are diseases of themselves, but the combination can and does
lead to dis-ease; age-related involuntary childlessness, infertility,
recurrent miscarriage, fetal anomaly and pregnancy complications.
Although improved general health is associated with a fall and rise in the
ages of menarche and death respectively, the age of menopause (and prior
decade loss of fertility) remains absolutely unchanged. It relates to the
inevitable biological loss of oocytes from prenatal life onwards. This
loss of ovarian function is likely to remain stubbornly resistant to
medical intervention. Doctors have to advise women (and men) of the well
known age-related risks of reproduction and the shortage of effective
treatments. The standard advice remains that childbearing is securest
between 20 and 35. Doctors must both heed this important medical
information for themselves and pass it on to their patients who attend for
advice about reproductive health (whether contraception, termination,
infection or smears). GPs, genito-urinary and family planning doctors will
need to correctly advise women on fertility issues and other means of
having children, e.g. by adoption, as the aging trend looks set to
continue.
References
(1) Conceptions in England and Wales are falling in women under 18 but
rising overall. BMJ 2006;332:506
(2) “Britain suffers 90,000 baby gap each year”. Press release for: Dixon
M, Margo J. Population politics. Institute for Public Policy Research. 19
Feb 2006
(3) Older mums; Celebrity sex clinic; Loving it Sunday Times Style 29 Jan
2006:5
(4) Which career first? Bewley S, Davies M, Braude P. BMJ.2005; 331: 588-
589
Rapid Response:
Middle-aged pregnancy and the need to return to traditional concepts of family planning
The continuing and rapidly rising rates of conceptions in women aged
35-39 and >40 reported in last weeks BMJ (1) are worrying and
unexplained. Women have been liberated from a past era of unfettered
fertility but may unwittingly have moved on to one of excess contraception
and loss of desired fertility. An annual 90,000 “baby gap” between desired
and achieved children has recently been reported (2), which is well in
excess of the small number of babies born with assisted reproduction. Our
patients tell us that they receive mixed messages from the media, they do
not receive appropriate advice from their doctors, and nor do they
appreciate fully the facts about fertility despite information in the
public domain. For example, a recent Sunday Times article claimed that a
Hollywood actress’s twin pregnancy at 47 meant that women of 38 could
relax about their fertility for another 8 years (3), even though it is
statistically likely that this was IVF ovum donation. Whilst late
childbearing may not necessarily be a matter of choice, it has inevitable
adverse impacts. Our earlier editorial drew attention to the serious
medical implications of this upward population trend and the well-known,
if uncomfortable, hazards of later reproduction (4). Neither age nor
pregnancy are diseases of themselves, but the combination can and does
lead to dis-ease; age-related involuntary childlessness, infertility,
recurrent miscarriage, fetal anomaly and pregnancy complications.
Although improved general health is associated with a fall and rise in the
ages of menarche and death respectively, the age of menopause (and prior
decade loss of fertility) remains absolutely unchanged. It relates to the
inevitable biological loss of oocytes from prenatal life onwards. This
loss of ovarian function is likely to remain stubbornly resistant to
medical intervention. Doctors have to advise women (and men) of the well
known age-related risks of reproduction and the shortage of effective
treatments. The standard advice remains that childbearing is securest
between 20 and 35. Doctors must both heed this important medical
information for themselves and pass it on to their patients who attend for
advice about reproductive health (whether contraception, termination,
infection or smears). GPs, genito-urinary and family planning doctors will
need to correctly advise women on fertility issues and other means of
having children, e.g. by adoption, as the aging trend looks set to
continue.
References
(1) Conceptions in England and Wales are falling in women under 18 but
rising overall. BMJ 2006;332:506
(2) “Britain suffers 90,000 baby gap each year”. Press release for: Dixon
M, Margo J. Population politics. Institute for Public Policy Research. 19
Feb 2006
(3) Older mums; Celebrity sex clinic; Loving it Sunday Times Style 29 Jan
2006:5
(4) Which career first? Bewley S, Davies M, Braude P. BMJ.2005; 331: 588-
589
Competing interests:
None declared
Competing interests: No competing interests