title: Management of infertility in women over 40.
abstract: Women's fertility potential is declining with age because of multiples intrinsic and extrinsic factors such as life style, oxidative stress and/or endocrine disruptors and is affecting the ability of these women to conceive naturally. This declining fertility potential and the late age of motherhood is increasing significantly the number of patients consulting infertility specialists. Different strategies of investigation and management are proposed to patients over 40 in order to overcome their infertility and improve the live birth rate in these patients. Intra Uterine Insemination (IUI) in women over 40 is associated with a low rate of ongoing pregnancy and IUI should not therefore be offered always as the first line of treatment. When the predictive factors are positive IVF/ICSI seem to be good alternatives until 43 years of age. Customized ovarian stimulation and flexible laboratory methods such as in vitro maturation (IVM), preimplantation genetic diagnosis (PGD), embryo vitrification and transfer after thawing in subsequent natural or artificial cycles can improve the success rate of ART in patients over 40. Meanwhile, oocyte and embryos donation remain good options for patient over 40 with a bad prognosis and can lead to successful ongoing pregnancies until 45 years of age. Ovarian tissue cryopreservation, oocyte vitrification at the germinal vesicle (GV) stage or metaphase II stage present a breakthrough for fertility preservation but the ideal age for starting fertility preservation is still debated as well as the minimum number of oocytes to be vitrified in order to optimize the chances of pregnancy when needed at an older age. This manuscript reports the results of our own experience from patients older than 40 in the light of the published data and discusses the different therapeutic alternatives which can be proposed to patients over 40 consulting ART centres.
authors.affiliation: Reproductive Medicine and Medical Cytogenetics Department, Regional University Hospital and School of Medicine, Picardie University Jules Verne, CGO, 124 rue Camille Desmoulins, 80054 Amiens, France. Electronic address: Cabry.Rosalie@chu-Amiens.fr.
authors.forename: Rosalie
authors.initials: R
authors.lastname: Cabry
authors.affiliation: Reproductive Medicine and Medical Cytogenetics Department, Regional University Hospital and School of Medicine, Picardie University Jules Verne, CGO, 124 rue Camille Desmoulins, 80054 Amiens, France. Electronic address: Merviel.Philippe@chu-Amiens.fr.
authors.forename: Philippe
authors.initials: P
authors.lastname: Merviel
authors.affiliation: Eylau/Unilabs Laboratory, Reproductive Biology Unit, 55 Rue Saint Didier, 75016 Paris, France. Electronic address: hazout.andre@hotmail.com.
authors.forename: Andre
authors.initials: A
authors.lastname: Hazout
authors.affiliation: Eylau/Unilabs Laboratory, Reproductive Biology Unit, 55 Rue Saint Didier, 75016 Paris, France. Electronic address: Stephanie.belloc75@gmail.com.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Belloc
authors.affiliation: Eylau/Unilabs Laboratory, Reproductive Biology Unit, 55 Rue Saint Didier, 75016 Paris, France. Electronic address: Alain.Dalleac@Unilabs.com.
authors.forename: Alain
authors.initials: A
authors.lastname: Dalleac
authors.affiliation: Reproductive Medicine and Medical Cytogenetics Department, Regional University Hospital and School of Medicine, Picardie University Jules Verne, CGO, 124 rue Camille Desmoulins, 80054 Amiens, France. Electronic address: Copin.Henri@chu-Amiens.fr.
authors.forename: Henri
authors.initials: H
authors.lastname: Copin
authors.affiliation: Reproductive Medicine and Medical Cytogenetics Department, Regional University Hospital and School of Medicine, Picardie University Jules Verne, CGO, 124 rue Camille Desmoulins, 80054 Amiens, France. Electronic address: Benkhalifamoncef78@gmail.com.
authors.forename: Moncef
authors.initials: M
authors.lastname: Benkhalifa
mesh_terms: D000375:Aging; D015925:Cryopreservation; D004624:Embryo Transfer; D005260:Female; D005298:Fertility; D005307:Fertilization in Vitro; D006801:Humans; D007247:Infertility, Female; D008423:Maternal Age; D018587:Oocyte Donation; D009865:Oocytes; D010053:Ovary; D011247:Pregnancy
keywords: Assisted reproductive technology; Female over 40; Fertility potential