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Age-related decline in fertility
1Reproductive Endocrinology and Infertility, Albert Einstein College of Medicine, Department of Obstetrics, Gynecology, and Women's Health, 1300 Morris Park Avenue, Mazer 325, Bronx, NY 10461, USA. lubnapal@hotmail.com
Endocrinology and Metabolism Clinics of North America
|October 17, 2003
Summary
Female fertility declines with age due to oocyte quality deterioration and increased aneuploidy. Aggressive management and assisted reproductive technologies (ART) are crucial for older women seeking pregnancy.
Area of Science:
- Reproductive biology
- Gerontology
- Genetics
Background:
- Female fecundity progressively declines with age, primarily due to aging-related detrimental effects on oocytes.
- Declining oocyte quantity and quality, increased meiotic errors, and aneuploidy reduce pregnancy rates and increase wastage in aging women.
- While male aging impacts semen parameters, it has a less significant effect on couple fertility compared to female aging.
Purpose of the Study:
- To review the impact of aging on female fertility and reproductive outcomes.
- To evaluate the effectiveness of current fertility treatments for aging women.
- To propose optimized management strategies for age-related subfecundity.
Main Methods:
- Literature review of age-related fertility decline and assisted reproductive technologies.
- Analysis of oocyte quality, meiotic errors, and aneuploidy in aging females.
- Evaluation of treatment outcomes for ovulation induction and assisted reproductive technology (ART).
Main Results:
- Female gamete aging significantly reduces fertility, leading to lower pregnancy rates and increased miscarriage.
- Ovulation induction success is limited in women over 40; ART is often recommended, especially with coexisting factors.
- Donor oocytes offer an option for women over 44, but pregnancies carry higher obstetric risks.
Conclusions:
- Aggressive management of subfecundity is essential for women over 35.
- Assisted reproductive technologies (ART), potentially combined with preimplantation genetic diagnosis (PGD), offer improved outcomes for aging women.
- Thorough medical evaluation is critical due to increased obstetric and medical complications in older women undergoing fertility treatments.