The futile case of the aging ovary: is it mission impossible? A focused review

Despite immense and impressive progress in the field of reproductive medicine, little has been achieved in terms of replenishing aged ovaries and improving their reproductive outcome. Age causes irreversible damage to human eggs in terms of quantity as well as quality. Nature probably designed women to reproduce best in their twenties and thirties. However, due to social, personal, career, educational and financial pressures, women delay pregnancies until their late thirties, by which time the chance of becoming pregnant is compromised by low fecundity rates and an increased risk of miscarriage. Age, unfortunately, is the most detrimental prognostic factor for success of fertility treatment. We have seen an increasing population of older women seeking fertility treatment. The existing evidence does not offer any clear-cut guidelines for the clinical handling of older women seeking fertility treatment. Various strategies have been tried to improve the fertility outcome of such women, but none has met with significant success. This review focuses on what can and what cannot be done in terms of improving fertility rates in older women.