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• W2184805803 abstract "A 37-year-old woman who has never been pregnant and her 40-year-old husband have been attempting to conceive a child for the past 3 years. An infertility evaluation has shown no cause for the difficulty. She is ovulating regularly, and a hysterosalpingogram shows that her reproductive tract is anatomically normal. He has a normal sperm count; he has not fathered any children. They are frustrated and want to proceed with in vitro fertilization. What should you advise? T h e C l i nic a l Probl e m Infertility is common — approximately 10% of couples have difficulty conceiving a child. In young, healthy couples, the probability of conception in one reproductive cycle is typically 20 to 25%, and in 1 year it is approximately 90%. 1 An evaluation is commonly recommended after 1 year of unprotected intercourse without conception, the standard clinical definition of infertility. Many infertility specialists are surprised by the number of otherwise highly educated older couples with unrealistic expectations of fertility. The negative effect of a woman’s age on fertility cannot be overemphasized. As women age, fertility declines and the rate of miscarriages increases. In addition, the rate of pregnancy after treatment for infertility drops more rapidly in women who are over the age of 35 years than in younger women. Thus, some clinicians argue that an infertility evaluation should begin after six cycles of unprotected intercourse in women older than 35 years. 2 Several societal factors may contribute to infertility related to aging in women. In the United States, there have been increases over time in the mean maternal age at first birth (25.1 years in 2002 vs. 21.4 years in 1968) and in the mean age of women delivering a child (27.3 years in 2002 vs. 24.9 years in 1968). 3 This trend toward delayed childbearing in part reflects an increasing emphasis on career and educational goals as well as a later mean age at first marriage. 4 In addition, the increased availability of effective methods of birth control makes it more likely that earlier unplanned pregnancies will be avoided." @default.
• W2184805803 created "2016-06-24" @default.
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• W2184805803 date "2007-01-01" @default.
• W2184805803 modified "2023-09-24" @default.
• W2184805803 title "This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the author's clinical recommendations. In Vitro Fertilization" @default.
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