Selection bias in determining the age dependence of waiting time to pregnancy

Many studies have found decreased fecundability, that is, the ability to conceive in a menstrual cycle, with increasing female age. To evaluate the effect of maternal age on waiting time to pregnancy, the authors reviewed hospital charts of all pregnant women attending prophylactic antenatal care at Odense University Hospital, Denmark, during 1972-1987. Only the first pregnancy of each woman and only planned pregnancies were included (n = 14,754). The fecundability odds ratio (FR) was calculated as the odds of a conception in a menstrual cycle among the older women divided by the odds among women aged 15-24 years. The FR for women aged 25-29 years was 1.12 (95% confidence interval (CI): 1.04, 1.20), for women aged 30-34 years it was 1.15 (95% CI: 1.01, 1.30), and for women above 34 years the FR was 2.44 (95% CI: 1.84, 3.22) after adjustment for confounders. The increased fecundability with age is contrary to previous studies and may be explained by selection bias, as sterile women were not included. In addition, some very fertile young women who became pregnant by accident before efficient birth control methods were available and therefore were excluded from time to pregnancy studies may now use oral contraceptives until they plan a pregnancy later in life and are included.