title: Improvements in IVF in women of advanced age.
abstract: Women above age 40 years in the US now represent the most rapidly growing age group having children. Patients undergoing in vitro fertilization (IVF) are rapidly aging in parallel. Especially where egg donations are legal, donation cycles, therefore, multiply more rapidly than autologous IVF cycles. The donor oocytes, however, are hardly ever a preferred patient choice. Since with use of own eggs, live birth rates decline with advancing age but remain stable (and higher) with donor eggs, older patients always face the difficult and very personal choice between poorer chances with own and better chances with donor oocytes. Physician contribution to this decision should in our opinion be restricted to accurate outcome information for both options. Achievable pregnancy and live birth rates in older women are, however, frequently underestimated, thereby mistakenly biasing fertility providers, private insurance companies and even regulatory government agencies. Restriction on access to IVF for older women is then often the consequence. In this review, we summarize the limited published data on best treatments of 'older' ovaries, while also addressing treatment approaches that should be avoided in older women. This focused review, therefore, to a degree is subjective. Research addressing aging ovaries in IVF has been disappointingly sparse, and has in our opinion too heavily concentrated on methods of embryo selection (ES), which, especially in older women, not only fail to improve IVF outcomes, but actually, negatively affect live birth chances. We conclude that, aside from breakthroughs in gamete creation, only pharmacological interventions into early (small growing follicle stages) follicle maturation will offer new potential to positively impact oocyte and embryo quality and, therefore, IVF outcomes. Research, therefore, should be accordingly redirected.
authors.affiliation: The Center for Human ReproductionNew York, New York, USA The Foundation for Reproductive MedicineNew York, New York, USA The Brivanlou Stem Cell Biology and Molecular Embryology LaboratoryThe Rockefeller University, New York, New York, USA ngleicher@rockefeller.edu.
authors.forename: Norbert
authors.initials: N
authors.lastname: Gleicher
authors.affiliation: The Center for Human ReproductionNew York, New York, USA Department of Obstetrics and GynecologyWake Forest University, Winston Salem, North Carolina, USA.
authors.forename: Vitaly A
authors.initials: VA
authors.lastname: Kushnir
authors.affiliation: The Center for Human ReproductionNew York, New York, USA Department of Molecular and Integrative PhysiologyThe University of Kansas Medical Center, Kansas City, Kansas, USA.
authors.forename: David F
authors.initials: DF
authors.lastname: Albertini
authors.affiliation: The Center for Human ReproductionNew York, New York, USA The Foundation for Reproductive MedicineNew York, New York, USA.
authors.forename: David H
authors.initials: DH
authors.lastname: Barad
mesh_terms: D005260:Female; D005298:Fertility; D005307:Fertilization in Vitro; D006801:Humans; D050498:Live Birth; D008423:Maternal Age; D011247:Pregnancy; D011256:Pregnancy Outcome
keywords: advanced female age; clinical pregnancy rate; embryo selection; in vitro fertilization; live birth rate; premature ovarian aging