What is the best treatment option for infertile women aged 40 and over?

Armstrong, Sarah; Akande, Valentine

doi:10.1007/s10815-013-9980-6

Cited by 27 publications

(13 citation statements)

References 37 publications

(41 reference statements)

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“… 41 Although assisted reproduction (AR) can increase many couples’ means of conceiving, the outcome of AR is also adversely affected by advancing maternal age. 42,43 Older prospective mothers display a reduced number of retrieved oocytes after ovarian stimulation for IVF. 44 In this way, although it is still unknown whether mTOR stimulators can overcome age-related decreases in oocyte quality, an approach to recruitment of more primordial follicles is here proposed: It may be helpful for women suffering aging-related infertility to obtain more mature oocytes for IVF treatment.…”

Section: Discussionmentioning

confidence: 99%

New strategy for in vitro activation of primordial follicles with mTOR and PI3K stimulators

Sun

et al. 2015

Cell Cycle

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It had been known for decades that primordial follicles in mammalian ovaries are assembled with definite numbers and represent the ovarian reserve throughout the reproductive life. Intra-oocyte PI3K/mTOR pathways have been indicated to play a central role on the activation of primordial follicles. Genetic modified mouse models with chronic activation of PI3K/mTOR signals in primordial oocytes showed premature activation of all primordial follicles and eventually their exhaustion. On the other hand, this may suggest that, unlike chronic activation of PI3K/mTOR, its acute activation in infertility would activate primordial follicles, permitting fertility during the treatment. Previously, PI3K stimulators were reported as a temporary measure to accelerate primordial follicle activation and follicular development in both mouse and human, and were applied in the treatment of infertility in premature ovarian failure (POF) patients. To address whether mTOR stimulators could play similar role in the process, we transiently treated neonatal and aged mouse ovaries with mTOR stimulators-phosphatidic acid (PA) and propranolol. Our results demonstrated the stimulators increased activation of primordial follicles and the production of progeny. Human ovarian cortex cubes were also treated with mTOR or/and PI3K stimulators in vitro. When they were used separately, both of them showed similar promotive effects on primordial follicles. Surprisingly, after joint-treatment with the 2 kinds of stimulators together, synergistic effects on follicular development were observed. Based on increased efficiency of follicular activation in humans, here we propose in vitro transient treatment with mTOR and PI3K stimulators as an optimized protocol for the application in different clinical conditions with limited follicle reserve.

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Section: Discussionmentioning

confidence: 99%

New strategy for in vitro activation of primordial follicles with mTOR and PI3K stimulators

Sun

et al. 2015

Cell Cycle

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“…29,80 Therefore, IUI stimulated with clomiphene or FSH may waste a critical time period and thus may reduce patient's chance for success in subsequent IVF cycles. 81 The duration of IUI attempts is also a significant factor. An initial IUI treatment for 6 months results in considerable cost saving with no delay in achieving pregnancy or jeopardizing the chance of pregnancy in couples with unexplained subfertility.…”

Section: When Should In Vitro Fertilization Be Considered?mentioning

confidence: 99%

Indications of Intrauterine Insemination for Male and Non–Male Factor Infertility

Kim

Park

2014

Semin Reprod Med

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Intrauterine insemination (IUI) is a widely used fertility treatment for couples with male and/or non-male factor infertility and is a relatively simple and inexpensive procedure. When used for unexplained infertility, IUI combined with ovarian stimulation increases the pregnancy rates, but evidence does not support this to be true when applied for male factor infertility. Recently, the revised World Health Organization laboratory manual for semen criteria provided a new insight for practical guidelines. Further randomized, controlled studies are necessary to develop standardized IUI strategies. The authors reviewed, via literature search, on the indications, prognostic factors, ovarian stimulation protocols, and methods that have been employed for IUI treatment.

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“…Ideally, clinicians should determine the most appropriate treatments for individuals; however, there are many factors that influence treatment success. Female patients’ age is the most decisive factor in treatment success . Except for the age, we must identify significant risk factors to tailor treatments to patients’ needs, and we also aimed to investigate the effect of age‐related fertility decline by stratifying female patients in ART and non‐ART treatment.…”

Section: Introductionmentioning

confidence: 99%

The efficacy of non‐assisted reproductive technology treatment might be limited in infertile patients with advanced endometriosis in their 30s

Isono

Wada‐Hiraike

Akino

et al. 2018

J of Obstet and Gynaecol

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Aim: To determine the efficacious treatment for infertile couples, we assessed the impact of infertility factors including endometriosis on assisted reproductive technology (ART) and non-ART treatment, and the effect of age in infertility treatment outcomes was also investigated. Methods: The medical records of 1864 females, infertile patients from January 2000 to December 2015 at our hospital, were retrospectively reviewed under the approval of the Institutional Review Board. We extracted 10 representative factors and calculated the cumulative live birth rate (CLBR) in these patients. Multivariate analysis of ART and non-ART treatment was performed to assess the impact of infertility factors, and the age-related decline in cumulative live birth rate was calculated by creating eight agestratified subgroups. Results: In total, 21.9% and 49.4% of the patients conceived after being treated with non-ART and ART, respectively. Multivariate analysis revealed that age > 35, advanced endometriosis defined by the revised American Society for Reproductive Medicine classification system stages III to IV, and the past history or current presence of uterine fibroid had significantly negative impact on the outcome of non-ART. Age stratification revealed that advanced endometriosis adversely affected the outcome of non-ART, especially for patients in their 30s. Assisted reproductive technology treatment for patients with advanced endometriosis was shown to be efficacious because the negative impact had been diminished. Conclusion: Considering that non-ART treatment had limited role in patients with advanced endometriosis, prompt initiation of ART in these patients aged as young as 30 years can be recommended to achieve conception.

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What is the best treatment option for infertile women aged 40 and over?

Cited by 27 publications

References 37 publications

New strategy for in vitro activation of primordial follicles with mTOR and PI3K stimulators

New strategy for in vitro activation of primordial follicles with mTOR and PI3K stimulators

Indications of Intrauterine Insemination for Male and Non–Male Factor Infertility

The efficacy of non‐assisted reproductive technology treatment might be limited in infertile patients with advanced endometriosis in their 30s

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