Aging and reproductive potential in women

Reproductive potential in women declines with age. Age-related changes in the ovary account for most of this loss of reproductive function. Oocytes, all of which are present at birth, decline in number and quality with age. The endocrine function of the ovary also declines with age, and the ovary becomes unable to sustain its normal function in the neuroendocrine axis. The neuroendocrine axis may be further affected by primary changes occurring in the hypothalamus and pituitary during aging, although this has not been established in humans. Aging also affects the function of the uterus as the endometrium loses its ability to support implantation and growth of an embryo. Diminished uterine function during aging may be due to changes in the uterine vasculature or to changes in the hormone-dependent development of the endometrium. Finally, aging increases a woman's risk of developing medical, gynecologic or obstetric conditions that may impair her fertility. Knowledge of these affects of aging on a woman's reproductive function is essential to advise and treat the growing number of women seeking pregnancy at advanced reproductive age.