Delayed childbearing and reproductive ageing: a narrative review

BACKGROUND: Delayed childbearing is increasingly common worldwide, with more women conceiving at age ≥35 years. This demographic shift intersects with age-related fertility decline, affecting natural conception, assisted reproductive technology (ART) outcomes and perinatal health. METHODS: We conducted a narrative review based on structured searches of PubMed, Embase and Web of Science (2015-2025), supplemented by landmark earlier studies. We included peer-reviewed original research, systematic reviews, meta-analyses and clinical guidelines. Findings were synthesised narratively. RESULTS: mutations. Donor oocytes partially offset embryonic decline, but uterine ageing persists, especially after 45 years. Social oocyte freezing offers age-dependent efficacy, with optimal cost-effectiveness when performed in the early 30s. CONCLUSIONS: The health challenges of delayed childbearing may stem from a fundamental mismatch between enabling societal structures and immutable biological timelines. Clinical practice should adopt proactive, age-stratified care that includes preconception education, timely ART, risk-adapted obstetric management and advocacy for supportive social policies.