Rethinking Oocyte Yield in Advanced Maternal Age: Toward Age- and Biology-Calibrated Counseling Targets in IVF

Area of Science:

• Reproductive Endocrinology
• In Vitro Fertilization (IVF)

Background:

• The concept of an "optimal" oocyte number for IVF success is based on studies of younger populations.
• Current dosing strategies for IVF medications often rely on anti-Müllerian hormone (AMH) and weight, which may not be suitable for all age groups.

Purpose of the Study:

• To evaluate if the established "optimal" oocyte number is applicable to women of advanced reproductive age undergoing IVF.
• To explore the age-dependent relationship between oocyte yield and cumulative live birth rate (CLBR).

Main Methods:

• Synthesis of mechanistic biology, randomized trials (RCTs), meta-analyses, and real-world registry data.
• Analysis of studies across diverse geographic regions and populations.
• Review of existing dosing algorithms and their limitations for older women.

Main Results:

• The relationship between oocyte yield and CLBR is significantly influenced by age.
• Older women generally require higher oocyte numbers to reach a comparable CLBR plateau compared to younger women.
• Existing RCT data predominantly features younger, homogeneous populations, underrepresenting older women and diverse ancestries.

Conclusions:

• Age-specific oocyte targets are warranted for women of advanced reproductive age undergoing IVF.
• Refining individualized dosing algorithms with age- and population-specific targets may improve clinical decision-making and outcomes.
• Further research is needed on sparse RCT data in women over 38 and ancestry-specific factors.