Book Review: Reproductive Ageing

Reproductive Ageing

Edited by Dr Susan Bewley, Professor William Ledger and Dr Dimitrios Nikolaou

Published by Royal College of Obstetricians and Gynaecologists Press

ISBN-10: 1906985138, ISBN-13: 978-1906985134

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The first question I asked when picking up this book was: 'What is the image on the cover?' Closer inspection and the power of Google revealed it is a dried poppy head (somniferum papaver) not, as I first thought, the egg from Alien - the science fiction horror film. What message does this convey?

The book comprises 35 manuscripts from a diverse group of participants in a study group convened by the UK's Royal College of Obstetricians and Gynaecologists (RCOG). The manuscripts are grouped into sections. At the end of each, there are questions from the rest of the participants on the papers within it.

Although I understand why this discussion chapter is included, I am not convinced it works. Often the questions and comments tell you more about the person asking them than they seek to solicit. In these sections, we learn whose children are possibly pursuing their career at the cost of their reproductive capacity. We also learn who collects cuttings from Hello! and OK magazines about celebrities who he suspects of using assisted reproduction with egg donation.

Leaving that to one side, this book is a mine of information on reproductive ageing. It covers the science, societal trends, fertility treatments currently available, in vitro derived gametes and the outcomes on the mothers and children.

In 'Managing expectation and achieving realism: the 'realpolitik' of reproductive ageing and its consequences', Zoe Williams, a journalist on the Guardian newspaper, cites a report from the Institute for Public Policy Research that demonstrates there is a marked difference in the number of children a woman says she wants in her 20s and the number she has by age 45. The report shows that there are 90,000 'missing' babies (1). Some of these women will, of course, choose to have fewer babies than they wanted in their twenties, but one imagines many must be bitterly disappointed.

In Chapter five, 'Trends in fertility: what does the 20th century tell us about the 21st?', Stijn Hoorens, a senior analyst at RAND, reassures us that 'projecting the size and structure of future populations is not as difficult as predicting the weather or traffic'. However, he goes on to say that 'as the mean age of motherhood in Europe has increased by nearly 50 days per year on average. This would imply that by 2050 mothers will be on average around six years older'. So, in Spain, they would be around 37. This is an alarming trend which, if correct, will put increased pressure on assisted reproduction provision.

So what of the image on the cover? For a poppy to successfully reproduce, the seed heads need to be left to mature so that the seeds are ripe and will successfully germinate on their release - the emphasis is not on youth. Of course, poppy seeds have a well-known medicinal use, although not one that necessarily aids conception or ultimately numbs the pain of infertility.

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