Is early initiation of infertility treatment justified in women over the age of 35 years?

Abstract

Research Question: Natural fecundity and IVF-ICSI success rate both decrease with age. For this reason, in women older than 35, it is generally recommended to initiate the infertility work-up earlier. However, this assumption may expose couples to over-diagnosis and over-treatment. Design: To shed light on this issue, we developed a theoretical model aimed at assessing the effects of starting the infertility work-up after 6 rather than 12 months of pregnancy seeking The assumptions of the model were: 1) infertile women are straightly treated with IVF-ICSI for up to three cycles; 2) IVF-ICSI success rate at first cycle linearly declines with age (3% per year), 3) the drop-out rate after the 1 st and 2 nd cycle is 18% and 25%, respectively, 4) the relative reduction of the success rate at 2 nd and 3 rd cycle is 16% and 26%, respectively. Results: On these bases, the anticipation moderately improved the cumulative chances of live birth of a full IVF-ICSI program. This improvement depended on age. Specifically, it increased from 2.0% at age 35 to 3.0% at age 43. Conversely, the incremental success rate per single IVF cycle was mainly stable, varying only from 1.4% at age 35 to 1.3% at age 43. Conclusions: In women older than 35, anticipation of the infertility work-up is associated with only a modest increase in the rate of success of IVF-ICSI. In most scenarios, this advantage may compare unfavorably with the chances of natural conception during the 6 months period.

Surgery versus IVF for the treatment of infertility associated to ovarian and deep endometriosis (SVIDOE: Surgery Versus IVF for Deep and Ovarian Endometriosis). Clinical protocol for a multicenter randomized controlled trial

“…Age and ovarian reserve are crucial for IVF success but the impact of a one-year delay is modest. For instance, in a recent theoretical model, we highlighted that even in women older than 35 years, a 6-months delay in the access to IVF is unremarkable [ 22 ]. The rate of success of IVF linearly declines after age 35, with an absolute loss of 2–4% per year [ 22 ].…”

“…For instance, in a recent theoretical model, we highlighted that even in women older than 35 years, a 6-months delay in the access to IVF is unremarkable [ 22 ]. The rate of success of IVF linearly declines after age 35, with an absolute loss of 2–4% per year [ 22 ]. This loss seems unremarkable if balanced with the expected benefit of surgery of 30%.…”

A machine learning‐based risk scoring system for infertility considering different age groups

“…Age plays an important role in pregnancy success in influencing pregnancy success rates, as noted in one study, both natural fecundity and the rate of success of ART decrease at a similar rate after the age of 35 years and end at about the age of 45 years. 3 On the basis of clinical experience and previous findings, we divided the patients into two groups, that is, less than 35 years old and greater than or equal to 35 years old. The above processes were carried out in the two groups, respectively, and the corresponding risk scoring systems for different age groups were constructed to further improve the accuracy of diagnosis.…”

“…For those people, assisted reproductive techniques (ART) present them a chance to achieve the parenthood goal. However, with a number of factors to consider, such as age, 3 hormone level, 4 and ovarian function, 5 it is of great difficulty for clinicians to adopt optimal treatment measures, and around 30% of patients does not achieve parenthood or end up having less children than they would like to 6 . In view of the complexity of infertility diagnosis, we consider applying artificial intelligence (AI) methods to establish a risk scoring system based on the key features of patients with infertility, so as to assist clinicians to preliminarily judge the severity of patients' condition.…”

Oocyte Cryopreservation during COVID-19 pandemic - Economic implications

“…The questions this raises are whether in emergency situations, oocyte cryopreservation serves the public interest and Am J Biomed Sci & Res whether elective oocyte cryopreservation should be covered by public healthcare (or considered mandatory in insurance coverage) and be state funded. Since oocyte cryopreservation is a complex and costly process [13][14][15][16][17], this issue is becoming more pressing in the face of an imminent economic crisis, for both private and public health services.…”