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Guidelines informing counseling on female age-related fertility decline: a systematic review

  • Assisted Reproduction Technologies
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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.

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Acknowledgments

Dorice Vieira, MLS, MA, MPH, assisted with the search strategy and implementation. She is the systematic review librarian of NYU School of Medicine.

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  1. Department of Obstetrics and Gynecology, NYU School of Medicine, 462 First Avenue, NBV 9N1-C, New York, NY, 10016, USA

    Emma Trawick, Jillian Pecoriello & Gwendolyn Quinn

  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

    Emma Trawick & Kara N. Goldman

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Appendix

Appendix

Fig. 2
figure 2

Flowchart, modeled off the PRISMA 2009 Flow Diagram [24], shows the search, screen, and selection of included guidelines for 2020 search

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Table 5 Results of AGREE II guideline appraisals for guidelines identified in 2020 systematic search
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Trawick, E., Pecoriello, J., Quinn, G. et al. Guidelines informing counseling on female age-related fertility decline: a systematic review. J Assist Reprod Genet 38, 41–53 (2021). https://doi.org/10.1007/s10815-020-01967-4

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