age and female fertility

File:Age and female fertility.svg, sterility, irregular menstruation and menopause{{cite journal|last1=te Velde|first1=E. R.|title=The variability of female reproductive ageing and also on how the body is built.|journal=Human Reproduction Update|volume=8|issue=2|year=2002|pages=141–154|issn=1355-4786|doi=10.1093/humupd/8.2.141|pmid=12099629|doi-access=free}}]]

The average age of a girl's first period (menarche) is 12 to 13 (12.5 years in the United States,{{cite journal |vauthors=Anderson SE, Dallal GE, Must A |title=Relative weight and race influence average age at menarche: results from two nationally representative surveys of US girls studied 25 years apart |journal=Pediatrics |volume=111 |issue=4 Pt 1 |pages=844–50 |date=April 2003 |pmid=12671122 |doi=10.1542/peds.111.4.844}} 12.72 in Canada,{{cite journal|journal=BMC Public Health|year=2010|volume=10|pages=736|doi=10.1186/1471-2458-10-736|title=Age at menarche in Canada: results from the National Longitudinal Survey of Children & Youth |vauthors=Al-Sahab B, Ardern CI, Hamadeh MJ, Tamim H|pmid=21110899|pmc=3001737 |doi-access=free }} 12.9 in the UK{{cite web |url=http://vstudentworld.yolasite.com/resources/final_yr/gynae_obs/Hamilton%20Fairley%20Obstetrics%20and%20Gynaecology%20Lecture%20Notes%202%20Ed.pdf |title=Obstetrics and Gynaecology: Lecture Notes (2nd ed.) |author=Hamilton-Fairley, Diana |publisher=Blackwell Publishing |year=2004 |access-date=2012-08-26 |archive-date=2018-10-09 |archive-url=https://web.archive.org/web/20181009065351/http://vstudentworld.yolasite.com/resources/final_yr/gynae_obs/Hamilton%20Fairley%20Obstetrics%20and%20Gynaecology%20Lecture%20Notes%202%20Ed.pdf |url-status=dead }}) but, in postmenarchal girls, about 80% of the cycles are anovulatory in the first year after menarche, which declines to 50% in the third year, and to 10% by the sixth.{{cite journal |author=Apter D |title=Serum steroids and pituitary hormones in female puberty: a partly longitudinal study |journal=Clinical Endocrinology |volume=12 |issue=2 |pages=107–20 |date=February 1980 |pmid=6249519 |doi=10.1111/j.1365-2265.1980.tb02125.x|s2cid=19913395 }} Little is known about fertility in young adolescents, as early teenage pregnancies are uncommon in most societies.{{Citation |title=Fertility among young adolescents aged 10 to 14 years |date=2020 |url=https://www.un.org/en/development/desa/population/publications/pdf/fertility/Fertility-young-adolescents-2020.pdf |place=New York |publisher=Department of Economic and Social Affairs, Population Division, United Nations |quote=Data on fertility among girls under age 15 are deficient, as noted before, in part because childbirth at these ages is uncommon in most societies. In addition, childbearing at these ages, which often occurs within marriage, is likely to be underreported or concealed to avoid shame and stigmatization. |access-date=2024-01-22 |archive-date=2024-06-05 |archive-url=https://web.archive.org/web/20240605211859/https://www.un.org/en/development/desa/population/publications/pdf/fertility/Fertility-young-adolescents-2020.pdf |url-status=live }}

A woman's fertility peaks between her late teens to late-20s after which it starts to decline. However, the exact estimates of the chances of a woman to conceive after a certain age are not clear, and are subject to debate.{{Cite news|url=https://www.bbc.com/news/magazine-24128176|title=The 300-year-old fertility statistics still in use today|last=Barnes|first=Hannah|date=2013-09-18|work=BBC News|access-date=2017-09-04|language=en-GB|archive-date=2017-12-24|archive-url=https://web.archive.org/web/20171224024610/http://www.bbc.com/news/magazine-24128176|url-status=live}}

According to the National Institute for Health and Care Excellence (NICE) over 80 out of every 100 women aged under 40 who have regular unprotected sexual intercourse will get pregnant within 1 year of trying. In the second year the percentage rises to over 90%.{{cite web|url=https://www.nice.org.uk/guidance/cg156|title=Fertility problems: assessment and treatment – Guidance and guidelines – NICE|website=www.nice.org.uk|date=20 February 2013|access-date=27 July 2017|archive-date=3 July 2017|archive-url=https://web.archive.org/web/20170703172514/https://www.nice.org.uk/guidance/CG156|url-status=live}}

A 2004 study by Henri Leridon, PhD, an epidemiologist with the French Institute of Health and Medical Research, of women trying to get pregnant, without using fertility drugs or in vitro fertilization, had the following results on rates of conception by age:

• At age 30
• 75% will have a conception ending in a live birth within one year
• 91% will have a conception ending in a live birth within four years
• At age 35
• 66% will have a conception ending in a live birth within one year
• 84% will have a conception ending in a live birth within four years
• At age 40
• 44% will have a conception ending in a live birth within one year
• 64% will have a conception ending in a live birth within four years[http://www.ingentaconnect.com/content/oup/humrep/2004/00000019/00000007/art01548] {{Webarchive|url=https://web.archive.org/web/20121025132947/http://www.ingentaconnect.com/content/oup/humrep/2004/00000019/00000007/art01548 |date=2012-10-25 }}[https://web.archive.org/web/20130918061804/http://humrep.oxfordjournals.org/content/19/7/1548]

{{Cite journal |last1=Leridon |first1=H. |year=2004 |title=Can assisted reproduction technology compensate for the natural decline in fertility with age? A model assessment |journal=Human Reproduction |volume=19 |issue=7 |pages=1548–1553 |doi=10.1093/humrep/deh304 |pmid=15205397 |doi-access=free}}

According to a study done on a sample of 782 healthy European couples ages 19–39, fertility starts declining after age 27 and drops at a somewhat greater rate after age 35. Statistical analysis showed that the women in the 27–29 age group had significantly less chance on average of becoming pregnant than did the 19- to 26-year-olds. Pregnancy rates did not change notably between the 27–29 age group and the 30–34 age group, but dropped significantly for the 35–39 age group.{{cite news |url=http://www.sfgate.com/cgi-bin/article.cgi?file=/chronicle/archive/2002/04/30/MN182697.DTL |title=Study speeds up biological clocks / Fertility rates dip after women hit 27 |access-date=2007-11-21 |work=The San Francisco Chronicle |first=Carl T. |last=Hall |date=2002-04-30 |archive-date=2012-06-17 |archive-url=https://web.archive.org/web/20120617073836/http://www.sfgate.com/cgi-bin/article.cgi?file=%2Fchronicle%2Farchive%2F2002%2F04%2F30%2FMN182697.DTL |url-status=live }}

The age of the male partner had a significant impact on female fertility among the women who had reached their mid-30s, but not among the younger women. However, experts said the new study was too small and there were too many variables which were too difficult to sort out, for a clear conclusion to be drawn. Some experts suggested that the main change in fertility in the older women was the fact that it took them longer to conceive, not necessarily that they were significantly more unlikely to eventually succeed. David Dunson, a biostatistician at the U.S. National Institute of Environmental Health Sciences, said that: "Although we noted a decline in female fertility in the late 20s, what we found was a decrease in the probability of becoming pregnant per menstrual cycle, not in the probability of eventually achieving a pregnancy."

A French study found no difference between the fertility rate of women under 25 and those ages 26–30, after which fertility started to decrease. Estimating the "fertility of a woman" is quite difficult because of the male factor (quality of sperm). This French study looked at 2,193 women who were using artificial insemination because their husbands were azoospermic. The cumulative success rates after 12 cycles of insemination were 73% for women under age 25, 74% in women ages 26–30, 61% for ages 31–35, and 54% in the over 35 age group.{{cite journal |author=Fox M |title=Age And Infertility: The Biological Clock: Fact Or Fiction? |journal=Jacksonville Medicine |volume=51 |issue=5 |date=May 2000 |url=http://www.dcmsonline.org/jax-medicine/2000journals/may2000/ageinf.htm |access-date=2012-07-29 |archive-url=https://web.archive.org/web/20020819203900/http://www.dcmsonline.org/jax-medicine/2000journals/may2000/ageinf.htm |archive-date=2002-08-19 |url-status=dead }}

In Hungary, a study by the Központi Statisztikai Hivatal (Central Statistics Office) estimated that 7–12% of Hungarian women younger than 30 were infertile; 13–22% of women age 35 were infertile; and 24–46% of women age 40 were infertile.{{cite web|url=http://www.demografia.hu/letoltes/kiadvanyok/Korfak/KorFa%20online_2010_2.pdf |title=A kései gyermekvállalás kockázatai |publisher=KorFa on-line |date=February 2010 |author=Balázs, Kapitány |access-date=2012-08-26|archive-url=https://web.archive.org/web/20120313053610/http://www.demografia.hu/letoltes/kiadvanyok/Korfak/KorFa%20online_2010_2.pdf|archive-date=2012-03-13}}

The below is a table containing estimates of the percentage of women who, if starting to conceive at a certain age, will fail to obtain a live birth.{{cite web|url=http://www.oeaw.ac.at/vid/download/pce/dec02/pm/PCB05-Leridon.pdf |title=The biological obstacles to late childbearing and the limits of ART |year=2005 |publisher=Ined-Inserm, Paris |archive-url=https://web.archive.org/web/20160419232824/http://www.oeaw.ac.at/vid/download/pce/dec02/pm/PCB05-Leridon.pdf |archive-date=2016-04-19 |url-status=dead |author=Leridon, Henri |access-date=2012-08-26 }} Note that while for the young ages researchers tend to agree, for older ages there is discrepancy.

File:Non-Growing Follicles.png, and they steadily decline until menopause."{{Cite journal

| volume = 5

| issue = 1

| pages = e8772

| last = Wallace

| first = W. Hamish B.

|author2= Thomas W. Kelsey

| title = Human Ovarian Reserve from Conception to the Menopause

| journal = PLOS ONE

| date = 2010-01-27

| doi = 10.1371/journal.pone.0008772

| editor1-last = Vitzthum

| editor1-first = Virginia J.

| pmid = 20111701

| pmc = 2811725

| arxiv = 1106.1382

| bibcode = 2010PLoSO...5.8772W

| doi-access = free

}}]]

In terms of ovarian reserve, a typical woman has 12% of her reserve at age 30 and has only 3% at age 40.{{cite journal |vauthors=Wallace WH, Kelsey TW |title=Human Ovarian Reserve from Conception to the Menopause |journal=PLOS ONE |volume=5 |issue=1 |page=e8772 |year=2010 |pmid=20111701 |pmc=2811725 |doi=10.1371/journal.pone.0008772 |arxiv=1106.1382 |bibcode=2010PLoSO...5.8772W |doi-access=free }} 81% of variation in ovarian reserve is due to age alone, making age the most important factor in female infertility.

The most common methods of checking the status of the ovarian reserve is to perform a blood test on day 3 of the menstrual cycle to measure serum Follicle-Stimulating Hormone (FSH) level, alternatively a blood test to measure the serum Anti-Müllerian Hormone (AMH) level can give similar information. Transvaginal ultrasound can also be used to "count the number of follicles" and this procedure is called Antral Follicle Count.

The American College of Obstetricians and Gynecologists recommends ovarian reserve testing should be performed for women older than 35 years who have not conceived after 6 months of attempting pregnancy and women at higher risk of diminished ovarian reserve, such as those with a history of cancer treated with gonadotoxic therapy, pelvic irradiation, or both; those with medical conditions who were treated with gonadotoxic therapies; or those who had ovarian surgery for endometriomas.{{Cite journal|title = Committee Opinion No. 618: Ovarian Reserve Testing|date = January 2015|journal = Obstetrics and Gynecology|doi = 10.1097/01.AOG.0000459864.68372.ec|pmid = 25560143|volume=125 |pages=268–273|author1 = Committee on Gynecologic Practice|issue = 1|s2cid = 7906030}}

It is important to recognize that a poor result from ovarian reserve testing does not signify an absolute inability to conceive and should not be the sole criterion considered to limit or deny access to infertility treatment.

A study of a population of French women from 1670 and 1789 shows that those who married at age 20–24 had 7.0 children on average and 3.7% remained childless. Women who married at age 25–29 years had a mean of 5.7 children and 5.0% remained childless. Women who married at 30–34 years had a mean of 4.0 children and 8.2% remained childless.{{cite journal|url=https://academic.oup.com/humrep/article/19/7/1548/2356634|title=Can assisted reproduction technology compensate for the natural decline in fertility with age? A model assessment|first=Henri|last=Leridon|date=1 July 2004|journal=Human Reproduction|volume=19|issue=7|pages=1548–1553|via=humrep.oxfordjournals.org|doi=10.1093/humrep/deh304|pmid=15205397|doi-access=free|access-date=16 April 2018|archive-date=19 January 2024|archive-url=https://web.archive.org/web/20240119165257/https://academic.oup.com/humrep/article/19/7/1548/2356634|url-status=live}} The average age at last birth in natural fertility populations that have been studied is around 40.Fertility, Biology, and Behavior: An Analysis of the Proximate Determinants (Studies in Population), by John Bongaarts, Robert E. Potter. pp 42 – 43. "The average of these estimates is 40 years, which, as expected, is slightly below the mean age at onset of sterility. The data in Table 2.4 indicate that the mean age at last birth is remarkably invariant. With few exceptions the means fall in the 39–41 year range."

In 1957, a study was done on a large population (American Hutterites) that never used birth control. The investigators measured the relationship between the age of the female partner and fertility. (Infertility rates today are believed to be higher in the general population than for the population in this study from the 1950s.)

This 1957 study found that:[http://www.advancedfertility.com/age.htm Age and Female Infertility, Fertility Tests of Egg Supply] {{Webarchive|url=https://web.archive.org/web/20170827041041/http://www.advancedfertility.com/age.htm |date=2017-08-27 }} citing {{cite journal |last=Tietze |first=Christopher |date=1957 |title=Reproductive span and rate of reproduction among Hutterite women |journal=Obstetrical & Gynecological Survey |volume=12 |issue=5 |pages=727–728 |doi= 10.1097/00006254-195710000-00039|publisher=LWW}}

• {{lay source |template=cite web |vauthors=Tietze C |title=Reproductive span and rate of reproduction among Hutterite women |type=Abstract |url=http://www.popline.org/node/519488 |archive-url=https://web.archive.org/web/20160107204537/http://www.popline.org/node/519488 |archive-date=2016-01-07 |website=Popline}}

• By age 30, 7% of couples were infertile
• By age 35, 11% of couples were infertile
• By age 40, 33% of couples were infertile
• At age 45, 87% of couples were infertile

The inverse correlation between age and female fertility in later reproductive life is argued to motivate family planning well before having reached 35 years of age.[http://www.jlgh.org/JLGH/media/Journal-LGH-Media-Library/Past%20Issues/Volume%204%20-%20Issue%203/Visneskifall09.pdf Infertility, Economics, and Common Sense] {{Webarchive|url=https://web.archive.org/web/20160303222959/http://www.jlgh.org/JLGH/media/Journal-LGH-Media-Library/Past%20Issues/Volume%204%20-%20Issue%203/Visneskifall09.pdf |date=2016-03-03 }}. By Paul E. Visneski. The Journal of Lancaster General Hospital. Mapping of a woman's ovarian reserve, follicular dynamics and associated biomarkers can give an individual prognosis about future chances of pregnancy, facilitating an informed choice of when to have children.{{Cite journal | last1 = Nelson | first1 = S. M. | last2 = Telfer | first2 = E. E. | last3 = Anderson | first3 = R. A. | doi = 10.1093/humupd/dms043 | title = The ageing ovary and uterus: New biological insights | journal = Human Reproduction Update | volume = 19 | issue = 1 | pages = 67–83 | year = 2012 | pmid = 23103636| pmc =3508627 }} Notably, a higher level of anti-Müllerian hormone when tested in women in the general population has been found to have a positive correlation with natural fertility in women aged 30–44 aiming to conceive spontaneously, even after adjusting for age.{{cite journal|last1=Broer|first1=S. L.|last2=Broekmans|first2=F. J. M.|last3=Laven|first3=J. S. E.|last4=Fauser|first4=B. C. J. M.|title=Anti-Mullerian hormone: ovarian reserve testing and its potential clinical implications|journal=Human Reproduction Update|volume=20|issue=5|year=2014|pages=688–701|issn=1355-4786|doi=10.1093/humupd/dmu020|pmid=24821925|doi-access=free}} Thus, AMH measurement is helpful to determine which women may need to conceive at an earlier age, and which women can potentially wait.{{cite journal|last1=Broer|first1=S. L.|last2=Broekmans|first2=F. J. M.|last3=Laven|first3=J. S. E.|last4=Fauser|first4=B. C. J. M.|title=Anti-Mullerian hormone: ovarian reserve testing and its potential clinical implications|journal=Human Reproduction Update|volume=20|issue=5|year=2014|pages=688–701|issn=1355-4786|doi=10.1093/humupd/dmu020|pmid=24821925|doi-access=free}}
In turn citing:

• {{cite journal |vauthors=Steiner AZ, Herring AH, Kesner JS |title=Antimüllerian hormone as a predictor of natural fecundability in women aged 30-42 years |journal=Obstet Gynecol |volume=117 |issue=4 |pages=798–804 | date=April 2011 |pmid=21422850 |pmc=3825553 |doi=10.1097/AOG.0b013e3182116bc8 |display-authors=etal}}

It is recommended that women have an infertility evaluation if they are over the age of 40, or if they are over the age of 35 and have not achieved pregnancy after trying for 6 months.{{Cite web|title=Evaluating Infertility|url=https://www.acog.org/en/womens-health/faqs/evaluating-infertility|access-date=2021-09-20|website=www.acog.org|language=en|archive-date=2024-06-24|archive-url=https://web.archive.org/web/20240624155654/https://www.acog.org/en/womens-health/faqs/evaluating-infertility|url-status=live}} In many cases, infertility can be treated with many reproductive technologies, but their success declines with age. The issues of age can be discussed with a qualified fertility specialist such as a reproductive endocrinologist.

In Vitro Fertilization (IVF) is an assisted reproductive technology used to treat infertility and to help families have offspring. While many women in advanced age may opt for IVF treatment in order to have children, patients with higher maternal age (>40 years old) were found to have worse IVF outcomes and a higher miscarriage rate compared to 20–30 year olds.{{Cite journal|last1=Yan|first1=JunHao|last2=Wu|first2=KeLiang|last3=Tang|first3=Rong|last4=Ding|first4=LingLing|last5=Chen|first5=Zi-Jiang|date=2012-08-01|title=Effect of maternal age on the outcomes of in vitro fertilization and embryo transfer (IVF-ET)|journal=Science China Life Sciences|language=en|volume=55|issue=8|pages=694–698|doi=10.1007/s11427-012-4357-0|pmid=22932885|issn=1869-1889|doi-access=free}} Most IVF centers will attempt IVF using the patient's own eggs until about age 43–45, and clinically reproductive endocrinologists tend to pursue IVF more aggressively in women over 35.

Oocyte cryopreservation (egg freezing) is a procedure done to preserve eggs (oocytes) to have the eggs thawed, fertilized, and transferred to the uterus via an IVF procedure. This gives women the ability to delay pregnancy and avoid many of the infertility problems that arise from germ cell deterioration. Studies have shown that the risk of acquiring congenital abnormalities is not increased in the infants born from frozen and thawed eggs,{{Cite journal|last1=Noyes|first1=N|last2=Porcu|first2=E|last3=Borini|first3=A|date=January 2009|title=Over 900 oocyte cryopreservation babies born with no apparent increase in congenital anomalies|journal=Reproductive BioMedicine Online|volume=18|issue=6|pages=769–776|doi=10.1016/s1472-6483(10)60025-9|pmid=19490780|issn=1472-6483|doi-access=free}} and IVF from thawed eggs have the same successful implantation rate compared to IVF performed with fresh eggs.{{Cite journal|last1=Argyle|first1=Catrin E.|last2=Harper|first2=Joyce C.|last3=Davies|first3=Melanie C.|date=2016-03-22|title=Oocyte cryopreservation: where are we now?|journal=Human Reproduction Update|volume=22|issue=4|pages=440–449|doi=10.1093/humupd/dmw007|pmid=27006004|issn=1355-4786|doi-access=free}} While chromosomal abnormalities are avoided with egg freezing, pregnancy at older age increases the risk of gestational diabetes, preeclampsia, preterm labor, and cesarean section regardless of conception method.{{Cite journal|last1=Petropanagos|first1=Angel|last2=Cattapan|first2=Alana|last3=Baylis|first3=Françoise|last4=Leader|first4=Arthur|date=2015-06-16|title=Social egg freezing: risk, benefits and other considerations|url=https://www.cmaj.ca/content/187/9/666|journal=CMAJ|language=en|volume=187|issue=9|pages=666–669|doi=10.1503/cmaj.141605|issn=0820-3946|pmc=4467930|pmid=25869870|access-date=2021-09-13|archive-date=2024-01-30|archive-url=https://web.archive.org/web/20240130030225/https://www.cmaj.ca/content/187/9/666|url-status=live}}

A review in 2012 came to the result that therapeutic interventions to halt or reverse the process of reproductive ageing in women is limited, despite recent reports of the potential existence of stem cells which may be used to restore the ovarian reserve.

Women who become pregnant after age 35 are at increased risk for complications that affect the mother and fetus.

When it comes to the mother, several research studies have shown that pregnant women over 35 years of age are at increased risk for hypertension during pregnancy, eclampsia (hypertension during pregnancy with seizures), and gestational diabetes.{{Cite web|last=Staff|first=MayoClinic|date=July 30, 2020|title=Pregnancy after 35: Healthy moms, healthy babies|url=https://www.mayoclinic.org/healthy-lifestyle/getting-pregnant/in-depth/pregnancy/art-20045756|url-status=live|access-date=September 12, 2021|website=Mayo Clinic|archive-url=https://web.archive.org/web/20150411003404/http://www.mayoclinic.org:80/healthy-lifestyle/getting-pregnant/in-depth/pregnancy/art-20045756 |archive-date=2015-04-11 }} Further, women who become pregnant after age 35 are also at risk for delivery complications. These include stillbirth, miscarriage, and complications leading to delivery via caesarean section.{{Cite journal|last=Cavazos-Rehg|first=Patricia|date=June 2015|title=Maternal age and risk of labor and delivery complications|journal=Maternal and Child Health Journal|volume=19|issue=6|pages=1202–11|doi=10.1007/s10995-014-1624-7|pmid=25366100|pmc=4418963}}{{Cite journal|last=Sauer|first=Mark|date=May 2015|title=Reproduction at an advanced maternal age and maternal health|journal=Fertility and Sterility|volume=103|issue=5|pages=1136–43|doi=10.1016/j.fertnstert.2015.03.004|pmid=25934599|doi-access=free}}

Fetal complications for pregnant women after age 35 are also high. One well-known risk is the increased risk of having a baby with Down syndrome. According to the Academy of Obstetrics and Gynecology, research has shown that risk for Down syndrome increases proportionally to increasing maternal age.

Probability of conceiving a child with Down syndrome according to maternal age by NDSS:{{cite web | url=https://www.ndss.org/about-down-syndrome/down-syndrome/ | title=What is Down Syndrome? | National Down Syndrome Society | access-date=2022-05-31 | archive-date=2021-01-16 | archive-url=https://web.archive.org/web/20210116153808/https://www.ndss.org/about-down-syndrome/down-syndrome/ | url-status=live }}

• At age 20, 1 in 2000
• At age 24, 1 in 1300
• At age 25, 1 in 1200
• At age 29, 1 in 950
• At age 30, 1 in 900
• At age 34, 1 in 450
• At age 35, 1 in 350
• At age 39, 1 in 150
• At age 40, 1 in 100
• At age 44, 1 in 40
• At age 45, 1 in 30
• At age 49, 1 in 10

In addition to Down syndrome, pregnant women over 35 are also at increased risk for other birth defects. A study conducted by Gill et al. found an association of advanced maternal age >40 and birth defects such as cardiac issues, esophageal atresia, hypospadias, and craniosynostosis.{{Cite journal|last=Gill|first=Simerpal|date=July 2012|title=Association between Maternal Age and Birth Defects of Unknown Etiology - United States, 1997–2007|journal=Birth Defects Research Part A: Clinical and Molecular Teratology|volume=94|issue=12|pages=1010–18|doi=10.1002/bdra.23049|pmid=22821755|pmc=4532312}} Lastly, studies have reported that pregnant women over 35 also have increased risk for premature birth and babies with low birth weight.

Substantial evidence indicates that the capability to repair DNA double strand breaks by a repair pathway involving BRCA1 (Breast cancer type 1 susceptibility) protein and ATM (ataxia–telangiectasia mutated) serine/threonine kinase weakens with age in oocytes of numerous species including humans.{{cite journal |vauthors=Turan V, Oktay K |title=BRCA-related ATM-mediated DNA double-strand break repair and ovarian aging |journal=Hum Reprod Update |volume=26 |issue=1 |pages=43–57 |date=January 2020 |pmid=31822904 |pmc=6935693 |doi=10.1093/humupd/dmz043 }} The specific DNA repair pathway affected by age is the homologous recombination DNA repair pathway. In general, women with BRCA1 mutations have lower ovarian reserves and experience earlier menopause.

• Paternal age effect
• Advanced maternal age
• Pregnancy over age 50

{{reflist|30em}}

• http://www.reproductivefacts.org/uploadedFiles/ASRM_Content/Resources/Patient_Resources/Fact_Sheets_and_Info_Booklets/agefertility.pdf, by American Society for Reproductive Medicine

Category:Fertility