DÄ internationalArchive37/2015The Cause Is Reproductive Behavior
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The harvesting of unfertilized oocytes for cryopreservation is, in the widest sense, a continuation of the introduction of hormonal contraception 50 years ago. Back then, women wanted to make their own decision about the timing of their pregnancies. “Social freezing” is similar. The difference is the factor that is time. In the past, the desire for a child was shifted within the fertile interval, to the age of 35. Owing to social changes, some women nowadays regard this age as too young for motherhood. They seek oocyte retrieval at the age of 35 before the genetic risks that may affect the child planned for later are too high.

The social reasons for an older age at first pregnancy need to be accepted. In Germany, 23% of primiparous women are older than 35; in Spain, 33%; and in Italy, 31%. In Bulgaria and Romania, with 12% of primiparous women in either country older than 35, the situation resembles that in Germany in the past (in 1965 in the US and Germany, the rate was about 5%). If educational opportunities for women improve in these two countries over the next few years, the average age of primiparous women will rise.

This trend has consequences for obstetric medicine; the delivery mode may serve as an example. In Bulgaria and Romania, the rate of Cesarean sections is half that in the other three EU countries mentioned—at 30% each. This is primarily determined by a higher need for safety during the delivery with increasing age. This is associated with a higher educational status, which also prompts a more conscious reflection of birth risks. Examples include the higher risk of pelvic floor damage with prolapse (15%[1]) and subsequent incontinence (30%[2]) at an older age. These kinds of urogenital problems can be life shortening—a recent Swiss study found that such problems may shorten women’s lives by up to 20 years (3). The rates of Cesarean section will rise further in women older than 40, as a result of “social freezing.”

In conclusion, the requirement for “social freezing” is the logical continuation in reproductive behavior as determined by social factors.

DOI: 10.3238/arztebl.2015.0612a

Prof. Dr. med. Dipl. Psych. J. M. Wenderlein

Universität Ulm

wenderlein@gmx.de

Conflict of interest statement

The author declares that no conflict of interest exists.

1.
Gyhagen M, Bullarbo M, Nielsen TF, Milsom I: The prevalence of urinary incontinence 20 years after childbirth: a national cohort study in singleton primipara after vaginal or caesarean delivery. BJOG 2013; 120: 152–60 CrossRef MEDLINE
2.
Svare JA, Hansen BB, Lose G: Risk factors for urinary incontinence 1 year after the first vaginal delivery in a cohort of primiparous Danish women. Int Urogynecol J 2014; 25: 47–51 CrossRef MEDLINE
3.
John G, Gerstel E, Jung M, et al.: Urinary incontinence as a marker of higher mortality in home care patients. BJU Int 2014 13; 113–9 CrossRef MEDLINE
4.
von Wolff M, Germeyer A, Nawroth F: Fertility preservation for non-medical reasons—controversial, but increasingly common. Dtsch Arztebl Int 2015; 112: 27–32 VOLLTEXT
1.Gyhagen M, Bullarbo M, Nielsen TF, Milsom I: The prevalence of urinary incontinence 20 years after childbirth: a national cohort study in singleton primipara after vaginal or caesarean delivery. BJOG 2013; 120: 152–60 CrossRef MEDLINE
2.Svare JA, Hansen BB, Lose G: Risk factors for urinary incontinence 1 year after the first vaginal delivery in a cohort of primiparous Danish women. Int Urogynecol J 2014; 25: 47–51 CrossRef MEDLINE
3.John G, Gerstel E, Jung M, et al.: Urinary incontinence as a marker of higher mortality in home care patients. BJU Int 2014 13; 113–9 CrossRef MEDLINE
4.von Wolff M, Germeyer A, Nawroth F: Fertility preservation for non-medical reasons—controversial, but increasingly common. Dtsch Arztebl Int 2015; 112: 27–32 VOLLTEXT

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