In vitro fertilisation (IVF) is a widely available and reasonably successful means of treating most causes of infertility. Success rates have gradually improved over the past three decades but are strongly influenced by female age. Yet, across Europe, more women are choosing to defer pregnancy. In the UK, the number of first time mothers under the age of 25 years has halved in two decades, while there has been a three-fold increase in women delivering at the age of 35 years or more. Postponement of pregnancy has led to an increase in the incidence of ‘unexplained infertility’ due to age-related decline in oocyte quality and ovarian reserve. IVF is not an efficient treatment for older women and can only yield livebirth rates (per cycle started) of 10.6% at 40 years and 3.2% above 42 years. Clearly, the
major reason for the decline in birth rate in the UK is social. Couples are having fewer children for financial reasons, to gain education, to establish a career and to enjoy the many opportunities open to young adults without children.
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