Gynecology 2027

Birth rates in the US and Europe have decreased significantly over the past 25 years. In the US, the average age of first-time mothers has increased from 21 years of age in 1970 to approximately 27 years of age in 2023. In the past quarter century, first-time mothers between 35-39 y/o increased 4-fold, and 6-fold in first-time mothers aged 40-44 y/o. In the US, similar trends have been seen in percent of mothers who remain childless over the past quarter century with over a two-and-a-half-fold rise in women remaining childless between 30-34 years old, a two-fold rise in women aged 35-39 years old, and approximately 80% rise in women aged 40-44 years old. Delayed childbearing and decreased birth rate are theorized to have a significant effect on the global economy, and as a result, many governments have taken notice and instituted policies in an effort to increase fertility rates.

Peak fertility is between 25-30 years of age, correlated with peak oocyte quality. Fertility rates begin to decline slowly and take a steep decline between 35-37 y/o, and a drastic decline after 40 years old. Much data on fecundity is from historical cohort studies, which have limitations of homogeneous populations and do not account for potential changes in coital frequency as couples age. A recent time to pregnancy study revealed that pregnancy rates up to 12 cycles range between 82%-87% in ages 30-35 y/o, 71%-76% in ages 36-39 y/o, and 48%-54% between ages 40-44 y/o. Genetic data reveal increasing oocyte aneuploidy rates with increasing age, with rates approaching 50%-100% between 42-46 y/o. Following IVF, embryo aneuploidy rates reached 80%-90% at 43-45 y/o. Mirroring decreasing fecundity rates with increasing age, miscarriage rates increase with advanced maternal age, with rates reaching 50%-60% between ages of 43-45 y/o.

Studies reveal that knowledge on reproductive aging and availability of fertility preservation are suboptimal amongst reproductive-aged men and women. A survey by ACOG of US OBGYNs revealed that 75% of physicians stated that limited time was a barrier to counseling on reproductive aging and fertility preservation, and 40%-50% stated that limited knowledge was a barrier to counseling.

The first baby born following oocyte cryopreservation was in 1986. In 2013, the experimental label for oocyte cryopreservation was removed by the American Society for Reproductive Medicine (ASRM), however, it was not condoned for elective use. In 2018, ASRM advocated its use for elective reasons and gave the term planned oocyte cryopreservation. Since its experimental use was removed in 2013, oocyte cryopreservation in the US increased approximately 6-fold. Advancements in vitrification, ICSI, increased insurance coverage, and media coverage likely contributed to its increase in usage. Studies have shown that IVF success rates for oocyte cryopreservation are similar to that of fresh oocytes. A meta-analysis of planned oocyte cryopreservation revealed that the average age at which women undergo planned oocyte cryopreservation is approximately 37 y/o, with an average return rate of ~11.0% and live birth rate of ~ 28%. A study following patients 10-15 years after oocyte cryopreservation revealed a higher return rate of 38.1%. Success rates depend on the number of oocytes cryopreserved and the age at which cryopreservation occurred. Complication rates are relatively low, with an overall 0.3% complication rate. Although limited by short-term follow-up, data reveal no increased risk of chromosomal abnormalities, adverse obstetrical outcomes, or congenital anomalies to babies born following oocyte cryopreservation.

In conclusion, there is an increasing number of women delaying childbearing, resulting in a decline in birth rates and increasing rates of infertility. This may have a global and economic impact, and many governments have started to take notice. There is a lack of knowledge regarding reproductive aging and oocyte cryopreservation, and the OB/GYN community is at the forefront of providing this counseling. Oocyte cryopreservation can increase the chances of having a genetically related child, particularly if childbearing is postponed towards the end of their reproductive lifespan.

Dr. Rani Fritz is double board-certified in Obstetrics and Gynecology and Reproductive Endocrinology and Infertility. Dr. Fritz completed his residency in Obstetrics and Gynecology at Columbia University St. Luke’s-Roosevelt Hospital in N.Y., N.Y. Following residency, Dr. Fritz worked for four years as a general Obstetrician and Gynecologist at Brookdale University Hospital and Medical Center in Brooklyn, N.Y. He was then awarded an NIH-sponsored Women’s Reproductive Health Research (WRHR) scholarship at Wayne State University in Detroit, MI, where he focused on placenta-related research. During his time as a WRHR, Dr. Fritz also earned a PhD in Physiology with a concentration in Reproductive Sciences. Dr. Fritz then completed his fellowship in Reproductive Endocrinology and Infertility at Albert Einstein College of Medicine in N.Y. He continues to be active in research and academia, having published over 30 peer-reviewed publications. He has won numerous research awards including the Prize Paper at 2017 ASRM national convention, and President’s Presenter Award at the International Society for Reproductive Investigation in 2014 in Florence, Italy. Her was the invited keynote speaker at the 2024 ACOG District XII meeting, lecturing on reproductive aging. Currently, Dr. Fritz is a practicing REI and the Division Director of REI at Northwell Health South Shore University Hospital and Medical Center in New York.