Perimenopausal Conception

Abstract

Fertility, defined as the ability to achieve a pregnancy, declines gradually over the woman's lifespan. Although this decline seems to begin from the age of 30 years, it is more obvious between 35 and 40 and increases dramatically thereafter. The age of 41 is considered to be the point when fertility stops and sterility starts. The actual menopause occurs approximately 10 years after the substantial loss of conception potential. Thus, the biological rather than the chronological age of the woman can predict more accurately her fertility potential. This decline in female reproductive potential correlates with ovarian factors, although a slight contribution from the uterus itself and from the neuroendocrine axis cannot be excluded. The ovarian reserve decreases with advancing age, while a parallel decrease in the quality of the oocytes is present, as indicated by the increased incidence of oocyte aneuploidy. The endocrine function of the ovary also declines with age, the later becoming unable to sustain its normal function in the neuroendocrine axis. Additionally, the role of the various endometrial factors remains controversial. On the other hand, exposure to toxic factors and the increased prevalence of infertility-related diseases like endometriosis and PID, may also contribute. Spontaneous conception rates are minimal in perimenopausal women, mainly due to a qualitative and quantitative loss of female gametes. In the rare case of spontaneous conception achievement, complications are more likely. The application of classic ovulation induction and IVF may serve some selected cases, where the woman's ovarian biological age does not correspond to her chronological one. However, the implantation, clinical pregnancy, and live birth rates in women of advanced age undergoing IVF treatment, show very poor results. On the other hand, preimplantation genetic diagnosis is an accurate diagnostic tool for exclusion of genetically deficient embryos prior to embryo transfer. Oocyte donation seems to be the most reliable option of the perimenopausal woman, since the cumulative birth rates after four treatment cycles is approximately 80%. Cryopreservation of ovarian tissue may be an alternative in nulliparas women <40 years of age who want to have children in the future or women with the same desire who, unfortunately, have had pelvic radiotherapy, chemotherapy, oophorectomy, or premature menopause. This technique has given encouraging results in animals, but has not achieved pregnancies in humans. In the future, the use of drugs to block oocyte depletion as well as recent techniques, such as cytoplasmic or germinal vesicle transfer, will be more widely tested and may offer an option to the perimenopausal woman who wishes to conceive.

Riesgo Obstétrico Y Perinatal en Embarazadas Mayores De 35 Años

“…La reserva ovárica disminuye con la edad (13), acompañado de una menor calidad de los ovocitos, lo que determina mayor incidencia de aneuploidía (13). De hecho, 2/3 de los abortos de mujeres embarazadas en edades tardías presentan anormalidades cromosómicas (2).…”

“…De hecho, 2/3 de los abortos de mujeres embarazadas en edades tardías presentan anormalidades cromosómicas (2). Por esta razón, las tasas de embarazo espontáneo en la perimenopausia son menores (13).…”

Chemotherapy-Induced Damage to Ovary: Mechanisms and Clinical Impact

“…However, the presence or absence of menstruation is an inaccurate assessment of ovarian function. It is worth mentioning that the loss of conception potential occurs about 10 years before menopause/ovarian failure in healthy women [34]. Meanwhile, women might have regular menstrual cycles for several years after chemotherapy, but may have lower likelihood of pregnancy during this period due to a significant reduction in ovarian reserve.…”

Ceramide and mitochondrial function in aging oocytes: joggling a new hypothesis and old players

“…Mitochondrial dysfunction has been implicated in both general body aging (Ames et al 1995, Sastre et al 2002 and aging of female reproductive tissues (Janny & Menezo 1996, Jansen & de Boer 1998, Kirkwood 1998, Ruman et al 2003, Tarlatzis & Zepiridis 2003, Ottolenghi et al 2004, Gougeon 2005. Our most recent observations demonstrate that, both function and morphology of mitochondria are impaired in oocytes from older mice (GI Perez & LL Kujjo 2011, unpublished observation).…”

“…Our most recent observations demonstrate that, both function and morphology of mitochondria are impaired in oocytes from older mice (GI Perez & LL Kujjo 2011, unpublished observation). And hence, considering the importance of mitochondrial function in the oocyte, it is not surprising that oocyte quality decreases with aging (Ruman et al 2003, Tarlatzis & Zepiridis 2003, Ottolenghi et al 2004, Gougeon 2005). This in turn may translate into a fall in the success rates of IVF cases, partially due to increases in oocyte mitochondrial defects.…”