Thesis (M.D.)--Aberdeen University, 2009. / Title from web page (viewed on Dec. 8, 2009). Includes bibliographical references.

In chapter one, the existing literature on ovarian ageing and fertility is reviewed. In it I (a) discuss the natural history and the potential causes of ovarian ageing (b) assess available tests of ovarian ageing and their limitations (c) discus the trends in the age of first childbirth, its causes and health service consequences. In chapter two, I explore women’s awareness of issues associated with delayed childbearing, including their social and medical implications and the limitations of available treatment. In chapter three, I surveyed IVF clinics throughout the United Kingdom, to determine (1) proportion of women aged 40 or more in each clinic (2) attitudes of clinicians towards older women and (3) clinicians’ views on an upper age limit for IVF. In chapter four, I investigated trends in the age at which women present to general infertility clinics (a step prior to IVF) in Grampian region. Women were grouped according to their age at first presentation to the infertility clinic (&lt;30, 30-34, 35-39 and ≥40 years). I tested the hypothesis that women of advanced reproductive age have a different diagnostic profile than younger women (&lt;30 years). In particular older women are more likely to be diagnosed with unexplained sub-fertility, probably due to ovarian ageing. This hypothesis was tested based on routinely collected data from a single secondary care centre. In chapter five, a systematic review of currently available dynamic tests of ovarian reserve assesses their power to predict fertility outcomes. In chapter six, I calculated the costs of achieving a live birth in different age groups (< 30, 30-34, 35-39 and ≥40 years) following IVF. In chapter seven, I summarize the results of the studies reported in this thesis and consider how they have improved our understanding of various aspects of delayed childbearing.