Recommendations: 1. Women should be informed of age-related infertility in their twenties and thirties, while other reproductive health issues, such as sexual health or contraception, are part of primary women’s health care. Women of childbearing age should be aware that their natural pregnancy and assisted reproductive technology pregnancy success rates (unless donor eggs are used) decrease significantly from the late thirties onward. (II-2A) 2. Because of the decline in fertility after age 35 and the increased time required to conceive, women older than 35 years should visit a fertility clinic after 6 months of trying to conceive. (III-B) 3. Ovarian reserve capacity tests should be performed in women older than 35 or in women with risk factors for reduced ovarian reserve function although they are younger than 35, including mono-ovarianism, history of prior ovarian surgery, poor response to follicle stimulating hormone, prior chemotherapy or radiation therapy, or unexplained infertility. (III-B) 4. Ovarian reserve function tests performed prior to the use of assisted reproductive technology can be used for counseling, but are less predictive of failure to conceive, so women are advised to forgo treatment only if their levels are significantly abnormal. (II-2A) 5. Women over 40 years of age have a lower pregnancy rate with controlled superovulation. If pregnancy does not occur after 1 to 2 cycles of controlled ovulation, in vitro fertilization (IVF) should be considered in women older than 40 years of age. (II-2B) 6. The only effective treatment for ovarian aging is egg donation. Women with reduced ovarian reserve should consider egg donation as an option, as the pregnancy rate with this treatment is much higher than those women who use controlled superovulation or in vitro fertilization with their own oocytes. (II-2B) 7. Women should be informed that the risk of spontaneous miscarriage and chromosomal abnormalities increases with age. Once pregnant, they need to be informed and offered to undergo appropriate prenatal screening. (II-2A) 8. For women older than 40 years of age, their preconception counseling should inform them of the risks associated with pregnancy in older mothers, optimal healthy weight gain and screening for other complications promoting optimal health and weight, screening for complications such as hypertension and diabetes mellitus, etc. (III-B) 9. Older fathers appear to be at increased risk for spontaneous abortion, certain autosomal dominant disorders, autism spectrum disorders, and schizophrenia. Couples whose men are older than 40 years of age should be counseled about these possible risks if they request a pregnancy, even though the risk is small. (II-2C)