In vitro fertilization in the older patient.
In vitro fertilization (IVF) in the older patient presents a significant challenge to the clinician. Older IVF patients have higher cancellation rates, lower oocyte yields, lower pregnancy rates, and higher miscarriage rates, despite significant improvements in IVF success rates in the past decade. Markers of diminished ovarian reserve, including basal follicle-stimulating hormone and estradiol levels, clomiphene citrate challenge test, inhibin B, müllerian-inhibiting substance, ovarian volume, and antral follicle counts, can be useful in counseling patients. Alterations in the stimulation protocol, such as changing the gonadotropin or gonadotropin-releasing hormone (GnRH) agonist dose, use of the agonist flare or microdose flare protocols, or use of a GnRH antagonist have met with varying degrees of success in improving outcomes.
Derman
Seth G
SG
Division of Reproductive Endocrinology, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Medicine and Dentistry of New Jersey Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA. FertilMD@aol.com
Seifer
David B
DB
D000328:Adult; D000367:Age Factors; D003338:Corpus Luteum / Q000187:drug effects / Q000378:metabolism*; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods / Q000592:standards; D005640:Follicle Stimulating Hormone / Q000008:administration & dosage; D013006:Growth Hormone / Q000008:administration & dosage; D006801:Humans; D007247:Infertility, Female / Q000628:therapy*; D008423:Maternal Age; D006080:Ovarian Follicle / Q000187:drug effects / Q000378:metabolism*; D018566:Pregnancy, High-Risk; D014481:United States; D016387:Women's Health
D005640:Follicle Stimulating Hormone; D013006:Growth Hormone