University of Agricultural Sciences, College of Community Science, Dharwad, Karnataka, IndiaIndia
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Delayed parenthood has become an increasingly common phenomenon worldwide. Although postponement of childbearing may be influenced by education, career development, financial stability, relationship circumstances, and personal readiness, reproductive health conditions may also contribute substantially to difficulties in achieving parenthood. Among these conditions, Polycystic Ovary Syndrome (PCOS) and endometriosis are important causes of impaired fertility among women of reproductive age. The present review examines the relationship between delayed parenthood and these two reproductive health conditions, with particular emphasis on infertility, reproductive dysfunction, delayed diagnosis, and fertility outcomes. Evidence reviewed in the seminar literature indicates that women with PCOS experience higher rates of infertility, ovulatory dysfunction, menstrual irregularities, and fertility-treatment use. Delayed diagnosis of PCOS was also associated with delayed childbearing. Similarly, women with endometriosis demonstrated higher rates of infertility, pelvic pain, and reduced likelihood of achieving a first live birth. Increasing severity of endometriosis was associated with poorer pregnancy and live-birth outcomes. Evidence regarding interventions in PCOS suggests that lifestyle modification can improve ovulation, menstrual regularity, metabolic health, and conception outcomes. The combination of lifestyle modification with pharmacological treatments such as metformin or letrozole may further improve reproductive outcomes in appropriate patients. Current evidence supports the importance of early recognition, fertility counselling, timely diagnosis, individualized management, and reproductive-health education for women at risk of fertility difficulties. Addressing PCOS and endometriosis early may help reduce avoidable delays in conception and support individuals in achieving their reproductive goals.
Keywords: Delayed parenthood; delayed childbearing; PCOS; endometriosis; infertility; fertility; reproductive health; ovulatory dysfunction; fertility outcomes; early intervention; Delayedparenthood; delayedchildbearing; reproductivehealth; ovulatorydysfunction; fertilityoutcomes; earlyintervention
Delayedparenthoodhasbecomeincreasinglycommon overrecentdecades.Individualsmaypostponechildbearingbecauseofhighereducation,careerdevelopment, financial considerations, relationship circumstances,andthedesiretoachievepersonalandprofessionalstabilitybeforestartingafamily.Yourseminarliteratureidentifiesdelayedparenthoodasanimportant demographic and public-health issue because postponementofchildbearingmaycoincidewithdecliningfertilityandincreasingreproductive-healthchallenges[1].Fertilityawarenessisanimportantcomponent of reproductive decision-making. However, individualsmayhavelimitedknowledgeregardingagerelated fertility decline, pregnancy risks, and the effectiveness and limitations of assisted reproductive technologies.Theawarenessstudiesincludedinthe seminardemonstratedmoderatefertilityawareness, whileknowledgegapsremainedregardingreproductiveagingandpregnancy-relatedrisks[2].
Delayedparenthoodshouldnot,however,beconsideredonlyinrelationtosocialorpersonaldecisions. Underlyingreproductivehealthconditionsmayalso affect the ability to conceive and may contribute to prolongedattemptstoachievepregnancy.Theseminaridentifiesseveralhealthconditionsthatcanaffect fertility,includingPCOS,endometriosis,thyroiddisorders,obesity,diabetes,hormonaldisorders,andpelvic inflammatorydisease.PCOSandendometriosiswere selectedasthemajorfocusbecauseoftheirdirecteffectsonfemalereproductivefunction.
PCOS is an endocrine and metabolic reproductive disorder associated with menstrual irregularities, hyperandrogenism, andovulatorydysfunction. The international evidence-based guideline emphasizes assessment of reproductive goals and appropriate managementofinfertilityinwomenwithPCOS,with lifestyleoptimizationandovulationinductionforming importantcomponentsofcare[3]. Endometriosisis a chronic gynecological condition associated with painandinfertility.Itseffectsonfertilitymayinvolve inflammation, adhesions, altered pelvic anatomy, and other mechanisms. Reviews of endometriosis have demonstrated substantial reproductive and psychosocialeffectsandemphasizetheimportance of individualized fertility-oriented management. Therefore,understandingPCOSandendometriosisin the context of delayed parenthood is important for reproductive-healthprofessionals.Earlyrecognition andappropriatemanagementmayprovideopportunitiestoaddressfertilityrisksbeforeprolongeddelays inconceptionoccur.
Delayedparenthoodisacomplexphenomenoninvolvingsocial,economic,personal,andbiologicalfactors. Theseminarevidenceindicatesthatmostparticipants inthereviewedawarenessstudiesdesiredchildrenin thefuture,butfinancialstability,careerdevelopment, work–lifebalance,childcare,andpersonalreadinessinfluenceddecisionsregardingthetimingofparenthood [4].Therelationshipbetweendelayedparenthoodand reproductivehealthbecomesparticularlyimportant whenchildbearingispostponeduntilalaterreproductiveage. Fertilitydoesnotremainconstantthroughoutthereproductivelifespan,andage-relatedchanges mayinfluencetheprobabilityofnaturalconception andreproductiveoutcomes.Theseminar’sawareness studiesfoundthatparticipantshadmoderateknowledgeoffertilitydeclinebutretainedimportantmisconceptionsandknowledgegaps[5].
At the same time, reproductive disorders may independentlyreducefertility. Awomanwhopostpones pregnancyforpersonalreasonsmaysubsequentlyencounterdifficulty conceiving because ofan underlyingconditionsuchasPCOSorendometriosis.Consequently,delayedparenthoodandreproductivehealth conditionsmayinteract,creatingamorecomplexpathwaytoinfertility.
PCOSisoneofthemostcommonendocrineandreproductivedisordersaffectingwomenofreproductive age.Itischaracterizedbyacombinationofreproductive,hormonal,andmetabolicabnormalities.TheseminardescribesPCOSinrelationtoirregularmenstrual cycles,anovulation,hormonalimbalance,obesity,insulinresistance,andimpairedfertility[6]. Ovulatory dysfunctionisparticularlyimportantinrelationtodelayedparenthoodbecauseirregularorabsentovulationcanreducethelikelihoodofspontaneousconception. The2023internationalguidelinerecommends thatfertilitygoalsbeincorporatedintoPCOScareand identifiesletrozoleasthepreferredfirst-linepharmacologicalovulation-inductiontreatmentforanovulatory infertilitywhentherearenootherinfertilityfactors.
Theevidenceincludedintheseminardemonstrates astrongassociationbetweenPCOSandinfertility.In thestudypresentedbyJohametal.(2025),infertility wasreportedamong72%ofwomenwithPCOScomparedwith16%ofwomenwithoutPCOS.Womenwith PCOSwerealsomorelikelytousefertility-hormone treatmentandseekfertilityassistance.Thereported adjustedoddsratioforinfertilityassociatedwithPCOS was14.9(95%CI:10.9–20.3)[7]. ThesefindingsindicatethatPCOScansubstantiallyaffectreproductive outcomes.Ovulatorydysfunctionmaymakeconceptionmoredifficultandmayincreasethelikelihoodof fertility-treatmentuse.Thus,PCOScanbecomeanimportantreproductive-healthfactorwhenparenthood ispostponed.
ThelongitudinalAustraliancohortstudyincludedin theseminarfoundthatwomenwithPCOSexperienced higherratesofinfertility,IVFtreatment,andfertilityhormonetreatmentcomparedwithwomenwithout PCOS.WomenwithPCOSwerealsomorelikelytohave theirfirstchildbirthatanolderage[8].ThestudyfurtheridentifiedPCOSandinfertilityassignificantpredictorsofdelayedchildbearing. Importantly,latediagnosisofPCOSwasindependentlyassociatedwith delayedchildbearing, withthefullyadjustedmodel showinganoddsratioofapproximately2.05.
Thesefindingssuggestthatthetimingofdiagnosismay beclinicallyrelevant.Delayedrecognitionofreproductivesymptomscanpostponeappropriatetreatment andfertilityplanning,potentiallyincreasingtheperiod between reproductiveintentionand successful conception.
Theseminar’sIndianstudybyRenaeetal.(2021)providesadditionalevidenceregardingthereproductive burdenassociatedwithPCOS.WomenwithPCOSexperiencedgreaterdifficultiesbecomingpregnantand weremorelikelytoseekmedicalconsultationforinfertility.Difficultybecomingpregnantwasthestrongest factorassociatedwithpreviousPCOSdiagnosisinthe study[9].
PCOScanalsocoexistwithmetabolicandpsychologicalconcerns.Thestudyreportedhigherlevelsofobesity,depression,hypertension,andhighcholesterol amongwomenwithPCOScomparedwithwomenwithoutPCOS.Therefore, PCOSmanagementshouldextendbeyondovulationaloneandaddressthebroader reproductive,metabolic,andpsychologicalhealthof theindividual.
Endometriosis is a chronic gynecological disorder characterized by the presence of endometrial-like tissue outside the uterine cavity. It commonly affects the ovaries and pelvic structures and can be associated with inflammation, adhesions, pelvic pain,dysmenorrhea,andinfertility[10].Therelationship between endometriosis and infertility is well established,althoughthemechanismsarecomplex. Current reviews describe possible contributions frompelvicinflammation, adhesions, alteredpelvic anatomy,tubaldysfunction,andotherreproductive mechanisms.
TheFinnishpopulation-basedcohortpresentedinthe seminarprovidesstrongevidenceofpoorerreproductiveoutcomesamongwomenwithendometriosis.Infertility was diagnosed in 17.2% of women with endometriosiscomparedwith3.2%ofwomenwithout endometriosis[11]. Thestudyalsofoundasubstantial difference in first live birth. A first live birth occurredin40.2%ofwomenwithendometriosiscomparedwith66.3%ofwomenwithoutendometriosis. Theincidence-rateratioforfirstlivebirthwas0.51(95% CI: 0.49–0.52). These findings demonstrate that endometriosisisassociatedwithreducedreproductive successandmaycontributetodelaysinachievingparenthood.
Endometriosis is not solely a fertility disorder; pain is an important component of the condition. The study by Charles et al. included in the seminar reportedsubstantiallyhigherratesofdysmenorrhea, dyspareunia,andchronicpelvicpainamongwomen withendometriosis.Infertilitywasalsomorecommon intheendometriosisgroup[12].Painandreproductive difficulties may affect quality of life and family planning. Aqualitativesystematicreviewfoundthat endometriosis-associated infertility can influence family-planning decisions and cause substantial emotional distress for women and their partners, supporting the need for fertility counselling and psychosocialcare.
Theseverityofendometriosismayalsoinfluencereproductiveoutcomes.Intheseminarstudy,pregnancy andlive-birthoutcomesdeclinedasdiseaseseverity increased.Pregnancyoutcomesdecreasedfrom85% inminimaldiseaseto35%inseveredisease,whilelivebirthoutcomesdecreasedfrom80%to30%.Thesame studyreportedlowerpregnancyandimplantationoutcomesamongwomenwithendometriosis.Overall,increasingdiseaseseveritywasassociatedwithgreater reproductivedifficulties[13].
However,currentevidencealsoemphasizesthatdisease stage alone does not necessarily predict fertility. Recentreviewssuggestthattherelationshipbetweenanatomicalseverityandfertilityiscomplex,and treatmentdecisionsshouldconsiderthewholepatient ratherthanrelyingsolelyonstaging.
Thereducedfirst-live-birthratereportedintheFinnish cohortisparticularlyrelevanttodelayedparenthood. Womenwithendometriosishadapproximately49% lower incidence of first live birth compared with womenwithoutendometriosis.Thelowercumulative first-live-birthratepersistedacrossreproductiveages [14].Thissuggeststhatendometriosismayinfluence the achievement of parenthood even when women are actively attempting conception. Consequently, earlyrecognitionofsymptomsandfertility-oriented counsellingmaybeparticularlyvaluableforwomen whowishtopostponeorplanfuturepregnancy.
PCOSandendometriosisaredifferentconditions,but bothcancontributetoinfertilityanddelayedparenthood.
Bothconditionsdemonstratewhydelayedparenthood shouldbeconsideredinthecontextofreproductive health. PCOS primarily affects fertility through ovulatory and endocrine-metabolic disturbances, whereas endometriosis may affect fertility through multipleinflammatory,anatomical,andreproductive mechanisms.
Lifestylemodificationisanimportantcomponentof PCOSmanagement.Theinterventionstudyincluded intheseminarincorporateddietarymodification,physicalactivity,weightmanagement,behaviouralcounselling,andsleepmanagement.Followingthelifestyle intervention, ovulation increased from 38% to 72%, menstrualregularityincreasedfrom42%to76%,and conceptionincreasedfrom29%to58%.Theneedfor fertilitytreatmentdecreasedfrom48%to26%,while averagetimetoconceptiondecreasedfrom14.2to8.1 months. Metabolicoutcomesalsoimproved,includingBMI,insulinresistance,waistcircumference,and physicalactivityadherence. TheinternationalPCOS guideline similarly recommends healthy eating and regularphysicalactivityaspartofPCOScareandpreconceptionoptimization.
Theseminaralsoreviewedevidenceregardingcombined lifestyle modification and metformin. The interventionincorporateddietarymodification, physicalactivity,behaviouralcounselling,andmetformin toimproveinsulinsensitivity.Followingintervention, menstrualregularityandovulationincreased,insulin resistancedecreased, andconceptionoutcomesimproved. Delayedconceptiondecreasedfrom62%to 34%,whileaveragetimetoconceptiondecreasedfrom 15.4to8.7months.
However,metforminshouldbeusedaccordingtoindividualclinicalcircumstances.TheinternationalguidelinerecognizesmetforminasanoptioninPCOSbut notesthatitsroleandefficacyforovulationinduction differfromthoseofletrozole.
Letrozole is an important fertility treatment for anovulatory infertility associated with PCOS. The seminar’sinterventionstudycombinedlifestylemodificationwithletrozoleandreportedimprovementsin ovulation,clinicalpregnancy,andlive-birthoutcomes. Thestudyreportedanincreaseinovulationfrom35% to 62%, clinical pregnancy from 18% to 28%, and live birth from 15% to 27.5%. Delayed conception decreased from 62% to 34%, while average time to conceptiondecreasedfrom15.2to8.4months. The 2023internationalPCOSguidelineidentifiesletrozole asthepreferredfirst-linepharmacologicaltreatment foranovulatoryinfertilityinwomenwithPCOSwhen therearenootherinfertilityfactors.
Managementofendometriosis-associatedinfertilityrequiresindividualizedassessment.Treatmentdecisions shouldconsiderage,durationofinfertility,symptoms, diseaselocationandseverity,ovarianreserve,tubal function,previoustreatment,andreproductivegoals. Historically,surgicaltreatmentwasfrequentlyusedin the management of endometriosis-associated infertility. However,contemporaryevidenceemphasizes thatsurgery,particularlyovariansurgery,mayaffect ovarianreserveandshouldthereforebecarefullyconsidered. Assistedreproductivetechnologieshavean increasinglyimportantroleinfertilitymanagementfor selectedwomenwithendometriosis.
Arecentreviewemphasizesthatfertilitypreservation
Primarynature Endocrineandmetabolicreproductivedisorder Chronicinflammatorygynecologicaldisorder Majorfertilitymecha- Ovulatorydysfunction nism Menstrualfeatures Irregularorabsentmenstruation Majorassociatedfea- Hyperandrogenism,obesity,insulinresistance Pelvicpain,adhesions,inflammation tures Fertility conse- Difficultyconceivingduetoimpairedovulation Reducedfertilityandreproductivesuccess quence Diagnosis Maybedelayedoroverlooked Importantfertilityin- Lifestyleoptimizationandovulationinduction Individualizedfertilitymanagementand,where tervention Reproductive- Restore/optimizeovulationandmetabolichealth Preservefertilityandmanagesymptoms/disease healthpriority
andreproductivecounsellingshouldbeconsideredas partoflong-termmanagementbecauseendometriosis isachronicconditionthatmayaffectreproductivepotential.Therefore,managementshouldnotfocusonly onsymptomcontrol.Forwomenwhowishtobecome parents, reproductive goals should be incorporated intotreatmentplanning.
Early diagnosis is important for both PCOS and endometriosis.InPCOS,delayeddiagnosishasbeenassociatedwithdelayedchildbearingintheseminarevidence. Inendometriosis,diagnosticdelaysarealso recognized as an important clinical problem, partly becausesymptomsmaybeattributedtonormalmenstruationortreatedsymptomaticallywithoutdefinitive diagnosis.
Fertilityawarenessshouldthereforeincludeeducation about: • normalreproductiveaging; • menstrualirregularities; • symptomssuggestiveofPCOS; • symptomssuggestiveofendometriosis; • factorsassociatedwithinfertility; • whenfertilityassessmentshouldbeconsidered; and • availablefertility-treatmentoptions.
Theseminar’sawarenessstudiesdemonstratethatalthoughmanyindividualshavereasonableawareness offertilitydecline,importantknowledgegapsremain. Educationshouldnotbeusedtopressureindividuals intoearlierparenthood. Rather, itshouldenableinformedreproductivedecision-makingandhelpindividualsunderstandwhenprofessionalassessmentmay bebeneficial.
Multifactorialimpairmentoffertility
Dysmenorrheaandmenstrualpain
Oftenassociatedwithdiagnosticdelay
appropriate,ART
appropriately
Theliteraturereviewedindicatesseveralimportantareasrequiringfurtherresearch.First,morelongitudinal researchisneededtounderstandtheinteractionbetweendelayedparenthood,PCOS,endometriosis,age, andfertilityoutcomesoverthereproductivelifespan. Second,thereisaneedformoreresearchfromIndia andotherlow-andmiddle-incomesettings,particularly regarding delayed diagnosis, access to fertility services,fertilityawareness,andreproductive-health education.
Third,furtherresearchisrequiredtodeterminehow earlyidentificationofPCOSandendometriosiscaninfluencelong-termreproductiveoutcomes.Fourth,interventionstudiesshouldevaluatenotonlyconception andlivebirthbutalsoqualityoflife,psychologicalwellbeing,treatmentburden,cost,andlong-termreproductivehealth. Finally,fertility-awarenessinterventions shouldbeevaluatedtodeterminewhetherimproved knowledgeactuallyresultsinearlierdiagnosis,appropriatehealthcare-seeking,andbetterreproductiveoutcomes.
Nurses and other reproductive-health professionals haveanimportantroleinaddressinghealthconditions associatedwithdelayedparenthood.
Nursescaneducatewomenaboutmenstrualhealth, fertility, age-relatedfertilitychanges, PCOS,andendometriosis.
Menstrualirregularities,severedysmenorrhea,chronic pelvicpain,infertilityconcerns,andsymptomssuggestiveofPCOSshouldberecognizedandappropriately referredforassessment.
ForwomenwithPCOS,nursescansupporthealthyeating,physicalactivity,weightmanagement,sleep,and treatmentadherence.
Womenwithreproductivehealthconditionsshouldreceiveinformationregardingfertilityexpectations,treatmentoptions,andwhenspecialistconsultationmay beappropriate.
PCOSandendometriosismayaffectbodyimage,emotionalwell-being,relationships,andfamilyplanning. Nursescanprovidesupportivecommunicationandfacilitatereferralwhenpsychologicalorcouple-based supportisneeded.
Long-termfollow-upisimportantbecausebothPCOS andendometriosiscanrequireongoingmanagement. Reproductivegoalsshouldbereassessedaswomen’s circumstanceschange.
Delayedparenthoodisamultifactorialreproductivehealthissueinfluencedbysocial,economic,personal, and biological factors. While career development, financial stability, education, relationships, and personalreadinessinfluencethetimingofparenthood, reproductivehealthconditionscancreateadditional barrierstoachievingpregnancy.
PCOSandendometriosisareparticularlyimportantbecausebotharestronglyassociatedwithinfertilityand poorerreproductiveoutcomes.Theevidencereviewed intheseminardemonstratesthatwomenwithPCOS experiencehigherratesofinfertility,fertility-treatment use,anddelayedchildbearing,whiledelayeddiagnosismayfurtherincreasethelikelihoodofpostponing childbirth.Endometriosisissimilarlyassociatedwith infertility,chronicpelvicpain,reducedfirst-live-birth rates,andpoorerreproductiveoutcomes,particularly withincreasingdiseaseseverity.
Early recognition and appropriate management may help reduce the reproductive consequences of these conditions. In PCOS, lifestyle modification can improve metabolic and reproductive health, whilepharmacologicaltreatmentssuchasletrozole mayimproveovulationandpregnancyoutcomesin womenwithanovulatoryinfertility.Forendometriosis, individualized fertility-oriented management and carefulconsiderationoffertility-preservingstrategies areimportant.
Overall,reproductive-healtheducation,earlydiagnosis, timely referral, fertility counselling, and individualizedmanagementshouldformanimportantpart ofcareforwomenwithPCOSandendometriosis.Addressingtheseconditionsearlymayhelpwomenmake informedreproductivedecisionsandimprovetheiropportunitiestoachievedesiredparenthood.
Yogita Simpiger, Shweta Biradar and Vinuta Mukthamath (2026). Delayed Parenthood: The Role of Polycystic Ovary Syndrome and Endometriosis in Fertility and Reproductive Outcomes – A Review. Public Health Open Journal. 11(1):795–79x. 10.17140/PHOJ-11-795