Improvements in IVF in women of advanced age

Abstract

Women above age 40 years in the US now represent the most rapidly growing age group having children. Patients undergoing in vitro fertilization (IVF) are rapidly aging in parallel. Especially where egg donations are legal, donation cycles, therefore, multiply more rapidly than autologous IVF cycles. The donor oocytes, however, are hardly ever a preferred patient choice. Since with use of own eggs, live birth rates decline with advancing age but remain stable (and higher) with donor eggs, older patients always face the difficult and very personal choice between poorer chances with own and better chances with donor oocytes. Physician contribution to this decision should in our opinion be restricted to accurate outcome information for both options. Achievable pregnancy and live birth rates in older women are, however, frequently underestimated, thereby mistakenly biasing fertility providers, private insurance companies and even regulatory government agencies. Restriction on access to IVF for older women is then often the consequence. In this review, we summarize the limited published data on best treatments of ‘older’ ovaries, while also addressing treatment approaches that should be avoided in older women. This focused review, therefore, to a degree is subjective. Research addressing aging ovaries in IVF has been disappointingly sparse, and has in our opinion too heavily concentrated on methods of embryo selection (ES), which, especially in older women, not only fail to improve IVF outcomes, but actually, negatively affect live birth chances. We conclude that, aside from breakthroughs in gamete creation, only pharmacological interventions into early (small growing follicle stages) follicle maturation will offer new potential to positively impact oocyte and embryo quality and, therefore, IVF outcomes. Research, therefore, should be accordingly redirected.

The efficacy of non‐assisted reproductive technology treatment might be limited in infertile patients with advanced endometriosis in their 30s

“…Delayed marriage and childbearing have become global phenomena because of concerns regarding lifestyle in developed countries, and advanced age is the most detrimental factor affecting the establishment of conception . Numerous studies have indicated that fertility rates begin to gradually decline at the age of 30, with greater declines by age 35 and substantial declines by age 40 . Providing effective treatment over a short‐time period is a major challenge for all gynecologists engaging in infertility treatment.…”

Dehydroepiandrosterone as a potential agent to slow down ovarian aging

“…Aging is the most important factor in reproductive health; fertility and the live birth rate of individuals who undergo in vitro fertilization (IVF) cycles are reduced with aging, especially in those older than 35 years of age . One study in which oocyte donation/recipient cycles were investigated indicated that oocyte quality, rather than the uterine environment, plays a crucial role in IVF outcomes among aged infertile women .…”

Anti-müllerian hormone as an fertility indicator in women of late reproductive age

“…Неудивительно, что на данный момент сохраняется тенденция обращения женщин позднего репродуктивного возраста по поводу лечения бесплодия, учитывая, что реализация репродуктивной функции с возрастом имеет ряд сложностей. Основные причины снижения эффективности программ вспомогательных репродуктивных технологий (ВРТ) в данной группе пациенток условно можно разделить на «ооцит-независимые» и «ооцит-зависимые» [3].…”

“…К «ооцит-независимым» факторам относятся отягощенный гинекологический или соматический анамнез. Имплантация эмбриона, децидуальная трансформация и плацентация напрямую зависят от состояния эндометрия [3]. Доказана роль гипоксических процессов в эндометрии женщин старшего репродуктивного возраста, в связи с чем наблюдается тенденция к компенсаторной плацентарной гипертрофии [4].…”

“…Во время менструального цикла уровень АМГ в сыворотке меняется незначительно, соответственно его измерение возможно в любой день цикла. АМГ выполняет ключевую роль в процессе перехода покоящихся примордиальных фолликулов в фазу активного роста [3]. АМГ используется в качестве маркера резерва яичников с 2002 г., однако во многих странах сохраняется тактика возрастного ограничения лечения бесплодия за счет средств государства [1].…”