Reference no: EM13330032

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Across the developed world couples are postponing parenthood. This review assesses the consequences of delayed family formation from a demographic and medical perspective. One main focus is on the quantitative importance of pregnancy postponement.

Medical and social science databases were searched for publications on relevant subjects such as delayed parenthood, female and male age, fertility, infertility, time to pregnancy, fetal death, outcome of medically assisted reproduction and mental well-being. Attempts to increase the fertility rate among working women bring difficult political dilemmas: how far to alter traditional working practices so that women who are juggling work and child-raising responsibilities are not disadvantaged in their careers compared with men (for example, by legislating for compulsory paternity leave, flexible working and/or limiting total weekly working hours for men as well as women) and above all the question of whether the problem of sub-replacement fertility is so serious that unmarried women should also now be encouraged to have more children. Giving women paid maternity leave can have the unintended negative consequence of dissuading employers from hiring women because they may fear having to pay a pregnant woman wages for a job she isn't doing. This may increase the gender-wage gap, the income disparity between men and women in the labor force. This disincentive can be ameliorated by giving parental leave to both men and women.

Postponement of parenthood is linked to a higher rate of involuntary childlessness and smaller families than desired due to increased infertility and fetal death with higher female and male age. For women, the increased risk of prolonged , infertility, spontaneous abortions, ectopic pregnancies and trisomy 21 starts at around 30 years of age with a more pronounced effects >35 years, whereas the increasing risk of preterm births and stillbirths starts at around 35 years with a more pronounced effect after 40 years. Advanced male age has an important but less pronounced effect on infertility and adverse outcomes. MAR treatment cannot overcome the age-related decline in fecundity.

In general, women have partners who are several years older than themselves and it is important to focus more on the combined effect of higher female and male age on infertility and reproductive outcome. Increasing public awareness of the impact of advanced female and male age on the reproductive outcome is essential for people to make well-informed decisions on when to start family formation.