In-vitro Fertilization in Women of Advanced Reproductive Age

Journal für Reproduktionsmedizin und Endokrinologie - Journal of Reproductive Medicine and Endocrinology 2005; 2 (1): 5-12

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Keywords: Alter,  Gynäkologie,  IVF,  Präimplantationsdiagnostik

Postponement of family planning can be seen as a consequence of increased life expectancy and extended education in industrialized countries. The increasing number of prospective parents undergoing in-vitro fertilization (IVF) due to advanced reproductive age, however, reflects the discrepancy between socio-cultural development and physical limits. Assisted reproduction is, therefore, challenged to create and adapt treatment regimens for women of advanced reproductive age to bridge between this wish for late parenthood and the age-related decline in fecundity. Consequently, the knowledge concerning age-related changes of reproductive functions gains in importance. While follicular depletion and impaired oocyte quality, frequently also called ‘diminished ovarian reserve’, are generally acknowledged as the underlying mechanisms for the decline in maternal fecundity, the way to correctly assess the status of ovarian reserve has remained controversial. Besides increasing attempts to achieve conception, deferring pregnancy and delivery into older age also implies medical risks and ethical considerations. The use of IVF in older women, therefore, raises the issue of the utilization of preimplantation genetic diagnosis (PGD) in the assessment of embryonic aneuploidies, as well as in attempts to optimize pregnancy rates with IVF. Moreover, expected future concepts in assisted reproduction are warranted to allow for the establishment of viable singleton pregnancies in women of advanced reproductive age.