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Management of infertility and pregnancy in women of advanced age

Ruth C Fretts, MD, MPH
Section Editor
Louise Wilkins-Haug, MD, PhD
Deputy Editor
Kristen Eckler, MD, FACOG


All women of reproductive age should receive preconception counseling since many pregnancies are unplanned and thus may occur under less than optimal conditions (eg, poorly controlled diabetes, exposure to teratogens). (See "The preconception office visit".)

Women who delay childbearing are at increased risk of infertility and certain pregnancy complications. Providing information to all patients of child-bearing age about the obstetrical risks of advanced maternal age can help them make informed decisions about the timing of child-bearing.

Women should know that the probability of achieving a pregnancy begins to decline significantly at about age 32 and that coexisting medical disease and pregnancy complications become more common with advancing age. These complications include ectopic pregnancy, spontaneous abortion, fetal chromosomal abnormalities, some congenital anomalies, placenta previa, gestational diabetes, preeclampsia, and cesarean delivery. Such complications may, in turn, result in preterm birth. There is also an increased risk of perinatal mortality. (See "Effect of advanced age on fertility and pregnancy in women".)

These risks should be balanced against career and other personal issues that might favor delaying pregnancy. There are, however, a few advantages to delayed childbearing. As an example, older couples tend to be more emotionally mature and financially stable than when they were younger.


Many experts suggest initiating a fertility evaluation after six months of unprotected intercourse without conception in women 35 to 40 years of age, and immediate evaluation in women over 40 years of age [1,2]. Evaluation is also initiated sooner than six months if the female partner has a history of oligomenorrhea/amenorrhea, pelvic infection, pelvic surgery, chemotherapy, radiation therapy, or endometriosis. (See "Evaluation of female infertility".)


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Literature review current through: Sep 2016. | This topic last updated: Oct 25, 2016.
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