Aging and infertility in women

Abstract

BACKGROUNDFemale fertility begins to decline many years prior to the onset of menopause despite continued regular ovulatory cycles. Although there is no strict definition of advanced reproductive age in women, infertility becomes more pronounced after the age of 35. A classic report on the effect of female age on fertility found that the percentage of women not using contraception who remained childless rose steadily according to their age at marriage: 6% at age 20 to 24, 9% at age 25 to 29, 15% at age 30 to 34, 30% at age 35 to 39, and 64% at age 40 to 44 (1). Similarly, a sharp decline in pregnancy rate with advancing female age is noted with donor insemination studies (which control for fertility of the male partner and coital frequency) (2) and with assisted reproductive technologies (ART) including in vitro fertilization (IVF). The risk of spontaneous abortion increases with female age (3). According to the 1999 Assisted Reproductive Technology Success Rates, the percentage of clinical pregnancies (gestational sac as imaged with sonography) that failed to result in a live birth rose according to the woman's age: 14% for patients under age 35, 19% at age 35 to 37, 25% at age 38 to 40, and 40% after age 40 (4).

Ovarian stimulation and in-vitro fertilization outcomes of cancer patients undergoing fertility preservation compared to age matched controls: a 17-year experience

“…Controls were age matched to within 1 year of the cancer patient, as female age is the greatest prognostic indicator of IVF success [28]. Patients were included over 17 years, during which time technology changes and protocols evolve.…”

Insufficiency of melatonin in follicular fluid is a reversible cause for advanced maternal age-related aneuploidy in oocytes

“…Fertility in women starts declining at age 35 years and decreases more rapidly after age 40 years [[1], [2], [3], [4]], with a dramatically increased incidence of infertility, miscarriage, congenital birth defects and fetal aneuploidy [5,6]. Accumulating evidence has indicated that poor oocyte quality is a common and unmanageable problem for women with advanced maternal age, which leads to the unsuccessful reproductive outcome [[7], [8], [9]]. Age-related quality decrease in the ovary reserve occurs as a result of two processes: increased oxidative damage in oocytes caused by excessive reactive oxygen species (ROS) [[10], [11], [12]] and compromised antioxidant defense systems.…”

Prediction models in in vitro fertilization; where are we? A mini review

“…Despite the lack of evidence that IVF is effective in couples without an absolute IVF indication, IVF is often considered as a last resort for all subfertile couples regardless of the etiology of their subfertility [7–12] . Contrary to the perception of many, IVF does not guarantee success; almost 38–49% of couples that start IVF will remain childless, even if they undergo six IVF cycles [13] .…”