Fertility after the age of 40

There is approximately a 50% decrease in the fertility rate of unselected women attempting pregnancy at age 40 or older compared with younger women and a two to three fold increased rate of spontaneous abortion. Approximately 45% of older women achieve a term outcome, however. Proper counseling of the older patient should include a realistic view of the following risks: a 30% to 50% reduced pregnancy potential, effect of pregnancy on other maternal illnesses, an increased risk of pre-eclampsia, hypertension, and diabetes, and an increased risk of chromosomal abnormalities, abortion, and stillbirth. Knowing these risks, additional testing for ovarian reserve may help to identify women with favorable indices in whom IVF, other forms of assisted reproduction, or surgery to restore fertility are most appropriate. Women with decreased ovarian reserve could be offered oocyte donation as an alternative to surgical correction for infertility, because pregnancy rates are excellent when donor oocytes are transferred to the uteri of women older than the age of 40. In short, age alone should no longer be a deterrent in the treatment of infertility.