Shalender Bhasin1, Candace Kerr2, Kutluk Oktay3, Catherine Racowsky4. 1. Research Program in Men's Health: Aging and Metabolism, Boston Claude D. Pepper Older Americans Independence Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. 2. Program Director, Aging Physiology Branch, Division of Aging Biology, National Institute on Aging, Bethesda MD. 3. Laboratory of Molecular Reproduction and Fertility Preservation, Department of Obstetrics and Gynecology, Yale University, New Haven, CT. 4. Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Abstract
CONTEXT: Powerful demographic transitions towards aging of human populations, older age at first childbirth, and lower birth-rates will profoundly influence the health, vitality, and economies of human societies, and deserve greater attention in health policy and research. EVIDENCE ACQUISITION: Information on birth-rates, fertility rates, and outcomes of assisted reproductive technologies were obtained from databases of government agencies (census data, Centers for Disease Control). EVIDENCE SYNTHESIS: Fecundity declines with advancing age, especially in women >35 and in men >50. Advanced parental age adversely affects pregnancy outcomes for the mother and the offspring, and increases the offspring's risk of chromosomal disorders, neurodegenerative diseases and birth defects. Because of increased life expectancy, today, men and women can expect to spend a major portion of their life during a period of reproductive senescence; diseases associated with reproductive senescence will influence the health and wellbeing of middle-aged and older adults. Inversion of the population age pyramid would affect healthcare costs, retirement age, generational distribution of wealth, and the vitality of human societies.Several actions can be taken to mitigate the societal consequences of these trends. An educational campaign to inform young people about the trade-offs associated with postponement of childbirth will enable them to make informed choices. Some repositioning of research agenda and healthcare policy is needed to address the public health threat posed by reproductive aging. CONCLUSION: The societal consequences of low fertility rates and delayed parenthood on nation's health, vitality, and economic growth should be considered in crafting research, health and economic policy.
CONTEXT: Powerful demographic transitions towards aging of human populations, older age at first childbirth, and lower birth-rates will profoundly influence the health, vitality, and economies of human societies, and deserve greater attention in health policy and research. EVIDENCE ACQUISITION: Information on birth-rates, fertility rates, and outcomes of assisted reproductive technologies were obtained from databases of government agencies (census data, Centers for Disease Control). EVIDENCE SYNTHESIS: Fecundity declines with advancing age, especially in women >35 and in men >50. Advanced parental age adversely affects pregnancy outcomes for the mother and the offspring, and increases the offspring's risk of chromosomal disorders, neurodegenerative diseases and birth defects. Because of increased life expectancy, today, men and women can expect to spend a major portion of their life during a period of reproductive senescence; diseases associated with reproductive senescence will influence the health and wellbeing of middle-aged and older adults. Inversion of the population age pyramid would affect healthcare costs, retirement age, generational distribution of wealth, and the vitality of human societies.Several actions can be taken to mitigate the societal consequences of these trends. An educational campaign to inform young people about the trade-offs associated with postponement of childbirth will enable them to make informed choices. Some repositioning of research agenda and healthcare policy is needed to address the public health threat posed by reproductive aging. CONCLUSION: The societal consequences of low fertility rates and delayed parenthood on nation's health, vitality, and economic growth should be considered in crafting research, health and economic policy.