Infertility and IVF Treatment in Women After 35 Years
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Together with the demographic fact that the last vestiges of the large baby boomer generation are now aging beyond their reproductive life spans (with use of autologous oocytes), this observation points towards increasing demand for in vitro fertilization (IVF) at advanced female ages, as, indeed, has been observed in the last few years. A shift towards more “older” patients in IVF programs can also be expected from improving pregnancy rates. As a consequence of quick pregnancy success in younger women, the more difficult cases (such as older patients) remain disproportionally in the system, while younger patients are quickly discharged. The success of IVF, of course, declines with older female age. This is believed to be a reflection of declining female fecundity (and increasing miscarriage rates) with advancing age. Declining female fertility has statistically been correlated to the decrease in ovarian follicle numbers. Indeed, when female age-dependent fertility and national age-based IVF outcome curves are compared, they are practically identical. Both suggest a steady decline from early age, which accelerates at 37–38 years of age, when approximately 25,000 follicles are left within ovaries.
Embryo implantation is pivotal for conception but, to date, there is no validated test to examine this function (Cakmak and Taylor, 2011). Finally, male factor infertility is also poorly defined and the reliability of the semen analysis to predict fertility remains low (Wang and Swerdloff, 2014). Despite its heterogeneous pathology, couples with unexplained infertility enter a specific and definite therapeutic strategy (Practice Committee of the American Society for Reproductive Medicine, 2006; NICE, 2013).
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