Guidelines informing counseling on female age-related fertility decline: a systematic review
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ASSISTED REPRODUCTION TECHNOLOGIES
Guidelines informing counseling on female age-related fertility decline: a systematic review Emma Trawick 1,2 & Jillian Pecoriello 1 & Gwendolyn Quinn 1 & Kara N. Goldman 2 Received: 22 July 2020 / Accepted: 4 October 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose To identify, appraise, and assess clinical practice guidelines informing patient counseling on female age-related fertility decline. Methods Searched electronic database records from January 1, 2006, to September 10, 2018, and professional society websites. The search terms included iterations of “guideline,” “counseling,” “preconception,” “age-related fertility decline,” and “reproductive life planning.” English-language professional organization guidelines addressing patient counseling on age-specific reproductive health topics were included. Assessed the methodological quality of included guidelines using the AGREE II instrument. Guidelines were categorized as high quality or low quality based on AGREE II scores. Extracted age-specific reproductive health recommendations of high-quality guidelines. Results The search identified 2918 records. Nineteen records addressed counseling on age-related fertility decline; only 6 focused only on reproductive aging, with the remaining 13 covering related topics. Eleven met criteria for high quality. All high-quality guidelines had high “rigor of development” scores on AGREE II. Ten high-quality guidelines stated an age at which female fertility declines, ranging from 30 to “late 30s.” One recommended a specific age at which patients should be counseled. Five of eleven high-quality guidelines did not discuss the obstetric and perinatal risks of advanced maternal age. Conclusions Few high-quality guidelines address counseling on female age-related fertility decline, and existing guidance on reproductive aging counseling is inconsistent and incomplete. Greater rigor of development and incorporation of age-specific counseling recommendations into clinical practice guidelines could lead to improved patient anticipatory guidance and more informed reproductive choices. Keywords Systematic review of guidelines . Counseling . Reproductive aging . Fertility
Introduction Women are increasingly delaying childbearing. In the USA, Canada, and the UK, the average age at first birth The findings of this manuscript were presented in an oral presentation at the Annual Meeting of the European Society of Human Reproduction and Embryology in Vienna, Austria, on June 24, 2019. * Kara N. Goldman [email protected] 1
Department of Obstetrics and Gynecology, NYU School of Medicine, 462 First Avenue, NBV 9N1-C, New York, NY 10016, USA
2
Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, 676 North Saint Clair Street, Suite 2300, Chicago, IL 60611, USA
has risen, and much of that rise is attributable to births occurring among those over age 35 [1–5
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