[Therapy of sterility in the premenopause]

Although menopause marks the irreversible loss of female fertility, a substantial loss of the fertility potential is observed many years before menopause. In contrast to spermatogenesis, which remains active until advanced age, female fertility depends on a pool of primordial ovarian follicles and oocytes, which are formed entirely during the prenatal life and whose numbers steadily decline thereafter. The results of inseminations with donor sperm demonstrated that this decline in the number of ovarian follicles becomes clinically relevant decades before menopause. Furthermore, from the results of embryo replacements after in-vitro fertilization of oocytes donated by young women, convincing evidence was provided that the age-related loss of female fertility is caused by ovarian factors, and not by the deterioration of the uterine functions. Although the increasing age of female patients is associated with reduced success rates of all homologous infertility treatments, the individual decision should be based on the measurement of the FSH concentration on the third day of an untreated menstrual cycle, because this value reflects the degree of ovarian function.