From the Guidelines
Infertility rates among younger women, including those in their mid-20s, are increasing beyond what can be explained by delayed childbearing alone, with factors such as rising rates of conditions like polycystic ovary syndrome (PCOS), endometriosis, and male factor infertility contributing to this trend. While advanced maternal age remains a significant factor in overall infertility trends, research indicates concerning increases in infertility among younger age groups 1. Several factors may be contributing to this trend, including environmental factors such as endocrine-disrupting chemicals, increasing obesity rates, and sexually transmitted infections, which also play important roles 1. Additionally, declining sperm counts and quality over recent decades contribute significantly to fertility challenges even among younger couples. For those concerned about fertility, early assessment is recommended, particularly if attempting conception for 6-12 months without success. Basic fertility testing typically includes hormonal evaluations (AMH, FSH, estradiol), ultrasound assessment of ovarian reserve, and semen analysis. Lifestyle modifications like maintaining healthy weight, limiting alcohol, avoiding smoking, reducing environmental toxin exposure, and managing chronic conditions can help preserve fertility potential regardless of age.
Some key points to consider:
- Infertility can have a profound impact on a person's physical and psychosocial quality of life, making early assessment and intervention crucial 1.
- Preconception counseling is essential for women of reproductive age, especially those with chronic diseases like inflammatory bowel disease (IBD), to improve pregnancy outcomes and address concerns about infertility and medication use during pregnancy 1.
- Success rates for in vitro fertilization in women with IBD who have undergone ileal pouch-anal anastomosis (IPAA) are comparable to those in women without IBD or with IBD but no history of IPAA, highlighting the importance of timely referral to a fertility specialist.
Overall, the increasing rates of infertility among younger women, including those in their mid-20s, are a concerning trend that requires attention and action to address the underlying factors contributing to this issue.
From the Research
Epidemiology of Infertility
- Infertility is a significant issue, affecting approximately 8-12% of reproductive-aged couples worldwide 2.
- The prevalence of infertility is estimated to be around 15% of couples of reproductive age 3.
Age and Infertility
- Female fecundity declines with age, and this factor should guide decision-making in infertility treatment 4.
- The fertility decline in females starts around 25-30 years of age, and the median age at last birth is 40-41 years in most studied populations experiencing natural fertility 2.
- Immediate IVF may be considered as a first-line treatment strategy in women older than 38 to 40 years 4.
Infertility Rates in Younger Women
- There is no direct evidence in the provided studies to suggest that infertility rates are increasing in younger women, such as those in their mid-20s.
- However, lifestyle and environmental factors, such as smoking and obesity, can adversely affect fertility, and these factors may be contributing to increasing infertility rates in younger women 4.
Causes of Infertility
- The most common causes of infertility are ovulatory dysfunction, male factor infertility, and tubal disease 4.
- Approximately 85% of infertile couples have an identifiable cause, while 15% have "unexplained infertility" 4.
- Male infertility may be due to testicular and post-testicular deficiencies, and semen decline has been observed over the years 2.