Trawick Emma, Pecoriello Jillian, Quinn Gwendolyn, Goldman Kara N
Department of Obstetrics and Gynecology, NYU School of Medicine, 462 First Avenue, NBV 9N1-C, New York, NY, 10016, USA.
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.
J Assist Reprod Genet. 2021 Jan;38(1):41-53. doi: 10.1007/s10815-020-01967-4. Epub 2020 Nov 14.
To identify, appraise, and assess clinical practice guidelines informing patient counseling on female age-related fertility decline.
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.
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.
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.
识别、评估和评价有关针对女性年龄相关生育力下降进行患者咨询的临床实践指南。
检索2006年1月1日至2018年9月10日的电子数据库记录以及专业协会网站。检索词包括“指南”“咨询”“孕前”“年龄相关生育力下降”和“生殖生活规划”的不同表述。纳入了针对特定年龄生殖健康主题的患者咨询的英文专业组织指南。使用AGREE II工具评估纳入指南的方法学质量。根据AGREE II评分将指南分为高质量或低质量。提取高质量指南中特定年龄的生殖健康建议。
检索共识别出2918条记录。19条记录涉及年龄相关生育力下降的咨询；仅6条仅关注生殖衰老，其余13条涵盖相关主题。11条符合高质量标准。所有高质量指南在AGREE II上的“制定严谨性”得分都很高。10条高质量指南指出了女性生育力下降开始的年龄，范围从30岁到“接近40岁”。一条推荐了应向患者提供咨询的具体年龄。11条高质量指南中有5条未讨论高龄产妇的产科和围产期风险。
很少有高质量指南涉及针对女性年龄相关生育力下降的咨询，而且现有的生殖衰老咨询指南不一致且不完整。提高制定的严谨性并将特定年龄的咨询建议纳入临床实践指南，可能会改善患者的预期指导，并使生殖选择更加明智。
