An update on the age of subfertile couples in Walcheren: age at registration mirrors increasing age at first birth

Herman K. Snick1, Johannes L.H. Evers2 and John A. Collins3

Department of Obstetrics and Gynaecology, Ziekenhuis Walcheren, Vlissingen, The Netherlands

Email: collinsj{at}auracom.com

Dear Sir,

We refer to a report which describes the well-established trend in Western countries that the age of women at first birth is increasing (ESHRE Capri Workshop Group, 2001Go). In the USA, the mean age at first birth increased from 21.4 to 24.9 years from 1970 to 2000 (Matthews and Hamilton, 2002Go). In Europe, in around 2001, the mean age at first birth was <24 years in eastern European countries and ≥28 years in most western European countries (Hohn et al., 2002Go). The delay in starting a family is important because increasing age is not favourable to fecundability (Collins and Rowe, 1989Go; Stovall et al., 1991Go; van Noord-Zaadstra et al., 1991Go; Wichmann et al., 1994Go; Dunson et al., 2004Go). While later initiation of childbearing would be expected to cause a corresponding delay in the recognition of infertility and registration for its treatment, a trend to older age at registration in infertility clinics has not been widely reported. In one report, among 1001 women receiving donor insemination treatment, mean age increased from ~24 years to 32 years in the interval from 1982 to 1997 (Botchan et al., 2001Go).

Infrequent reporting of increased age among infertile couples may reflect referral patterns that vary over time and come from regions with uncertain demographic characteristics; therefore, age trends may escape notice or be considered unreliable. The peninsula of Walcheren in The Netherlands is a geographically isolated but demographically and socio-economically representative area of one industrialized Western country. Of the Walcheren population, 9.9% exhibit subfertility complaints at least once during their lifetime and virtually all couples go to a single centre for their first infertility consultation (Snick et al., 1997Go). When we reported in 1997 on the likelihood of live birth among untreated couples in Walcheren, the data showed a trend toward increasing age of both partners during the years of intake, but this point was not included in the reported results.

There recently has been an opportunity to collect data on age at intake for and duration of infertility from the same clinic. In 2002 and 2003, there were 70 and 79 new couples, respectively, compared with 66–112 couples per annum from 1985 to 1993. The means and SDs for male age were 31.2 (SD 5.3) years and 33.0 (5.6) years in 1985–1993 and 2002–2003, respectively. For female age, the means (SD) were 29.1 (SD 4.5) and 31.2 (SD 5.3) years in 1985–1993 and 2002–2003, respectively. Figure 1 plots the mean female age by year from the 1997 report, the 2002–2003 data and age at first birth in The Netherlands (CBS, StatlineGo). In the Walcheren population, the mean age at first birth equals the age in The Netherlands. The delay in first medical care attendance for infertility was nearly unchanged, the duration of infertility at intake was 20.7 (13.9) months in 1985–1993 and 22.9 (SD 16.8) months in 2002–2003.



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Figure 1. Mother's age at first birth in The Netherlands, 1960–2002 and mean female partner's age at registration at the gynaecology clinic, Walcheren, 1985–1993 and 2002–2003 (95% confidence interval).

 
These data suggest that the average age of infertile female partners is ~2 years more than the average age at first birth in the population. Variability among countries in maternal age at first birth may explain some of the variability in mean age among infertile couples. Because differences in maternal age at first birth among countries (as in the European example) are greater than differences over time within countries (as in the USA example), maternal age at first birth should be considered as an ecological co-variate when prevalence of infertility is compared among countries.

Notes

1 Present address: 78 bd. Tixador, 66140 Canet en Roussillon, France Back

2 Present address: Department of Obstetrics and Gynaecology, GROW Research Institute, Academisch Ziekenhuis Maastricht, University of Maastricht, Maastricht, The Netherlands Back

3 Present address: Department of Obstetrics and Gynecology, McMaster University, Hamilton and Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, Canada Back

References

Botchan A, Hauser R, Gamzu R, Yogev L, Paz G and Yavetz H (2001) Results of 6139 artificial insemination cycles with donor spermatozoa. Hum Reprod 16, 2298–2304.[Abstract/Free Full Text]

Collins JA and Rowe TC (1989) Age of the female partner is a prognostic factor in prolonged unexplained infertility: a multicentre study. Fertil Steril 52, 15–20.[ISI][Medline]

CBS, StatLine (http://statline.cbs.nl/StatWeb/).

Dunson DB, Baird DD and Colombo B (2004) Increased infertility with age in men and women. Obstet Gynecol 103, 51–56.[Abstract/Free Full Text]

ESHRE Capri Workshop Group (2001) Social determinants of human reproduction. Hum Reprod 16, 1518–1526.[Abstract/Free Full Text]

Hohn C, Confesson A and Sardon JP (2002) Recent Demographic Developments in Europe 2002. Council of Europe Publishing, Strasbourg.

Matthews TJ and Hamilton BE (2002) Mean age of mother, 1970–2000. Natl Vital Stat Rep 51, 1–13.[Medline]

Snick HKA, Snick TS, Evers JLH and Collins JA (1997) The spontaneous pregnancy prognosis in untreated subfertile couples: the Walcheren primary care study. Hum Reprod 12, 1582–1588.[Abstract]

Stovall DW, Toma SK, Hammond MG and Talbert LM (1991) The effect of age on female fecundity. Obstet Gynecol 77, 33–36.[Abstract]

van Noord-Zaadstra BM, Looman CW, Alsbach H, Habbema JDF, te Velde ER and Karbaat J (1991) Delaying childbearing: effect of age on fecundity and outcome of pregnancy. Br Med J 302, 1361–1365.[ISI][Medline]

Wichmann L, Isola J and Tuohimaa P (1994) Prognostic variables in predicting pregnancy. A prospective follow up study of 907 couples with an infertility problem. Hum Reprod 9, 1102–1108.[Abstract]





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