title: The "graying" of infertility services: an impending revolution nobody is ready for.
abstract: BACKGROUND
  As demand for infertility services by older women continues to grow, because achievable in vitro fertilization (IVF) outcomes are widely underestimated, most fertility centers do not offer maximal treatment options with use of autologous oocytes. Limited data suggest that clinical IVF outcomes in excess of what the American Society for Reproductive Medicine (ASRM) considers "futile" can, likely, be achieved up to at least age 45 years.
  
  
  METHODS
  In an attempt to point out an evolving demographic trend in IVF, we here report our center's IVF data for 2010-2012 and national U.S. data for 1997-2010. Though our center's data are representative of only one IVF center's patients, they, likely, are unique since they probably represent the most adversely selected IVF patient population ever reported and, thus, are predictive of future demographic trends. In addition we performed a systematic review of the literature on the subject based on PubMed, Medline and Google Scholar searches till year-end 2013. The literature search was performed using key words and phrases relevant to fertility treatments in older women.
  
  
  RESULTS
  As demonstrated by our center's patient demographics and national U.S. data, IVF centers are destined to treat increasingly adversely selected patients. Despite our center's already extremely adversely selected patient population, age-specific IVF cycle outcomes in women above age 40 years, nevertheless, exceeded criteria for "futility" by the ASRM and widely quoted outcome expectations in the literature for patient ages. Age 43 discriminates between better and poorer clinical pregnancy and live birth rates.
  
  
  CONCLUSIONS
  "Graying" of the infertility populations in the developed world, a problem with potentially far-reaching medical and societal consequences, has so far been only insufficiently addressed in the literature. As women's postmenopausal life spans already exceed postmenarcheal life spans at the start of the 20th century, the "graying" of infertility services can be expected to further accelerate, no longer as in recent decades bringing only women in their 40s into maternity wards but also women in their 50s and 60s. Medicine and society better get ready for this revolution.
authors.affiliation: Center for Human Reproduction, New York, NY 10021, USA. ngleicher@thechr.com.
authors.forename: Norbert
authors.initials: N
authors.lastname: Gleicher
authors.forename: Vitaly A
authors.initials: VA
authors.lastname: Kushnir
authors.forename: Andrea
authors.initials: A
authors.lastname: Weghofer
authors.forename: David H
authors.initials: DH
authors.lastname: Barad
mesh_terms: D000328:Adult; D000375:Aging; D001723:Birth Rate; D005260:Female; D005307:Fertilization in Vitro / Q000639:trends; D006301:Health Services Needs and Demand; D006801:Humans; D007247:Infertility, Female / Q000628:therapy*; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D009865:Oocytes; D010062:Ovulation Induction; D010342:Patient Acceptance of Health Care; D011247:Pregnancy; D011255:Pregnancy Maintenance; D012922:Social Change; D014019:Tissue Donors; D014481:United States / Q000453:epidemiology