Abstract
The introduction of in vitro fertilization (IVF) in 1978 – an accomplishment awarded
with the 2010 Nobel Prize in Physiology or Medicine – has revolutionized the lives
of millions of couples previously unable to conceive. Though initially applied primarily
to young women with blocked Fallopian tubes, over the past three decades IVF has been
increasingly used to combat age-related infertility. It has become clear that the
decline in fertility with increasing female age is largely due to a rapid decrease
in oocyte (egg) quantity and quality, with a higher proportion of oocytes displaying
genetic abnormalities. Despite significant improvements in medical stimulation and
laboratory culturing of embryos, IVF success once women reach the age of 45 is exceedingly
rare. It has been well established through elegant clinical studies that, unlike the
ovary, the reproductive capacity of the uterus does not diminish with age, even into
the late 40s and 50s. With the use of oocytes from younger donors, women who are menopausal
can attain very high rates of conception. The increased obstetrical risks in this
population, which has a higher risk of underlying medical co-morbidities, must be
considered prior to attempts at assisted conception, often in consultation with a
multidisciplinary team of physicians. Finally, attempts to reverse the age-related
decline in oocyte quality through micro-manipulation of the nucleus and cytoplasm
have yielded disappointing results and are fraught with ethical concerns.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to MaturitasAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Reproductive span and rate of reproduction among Hutterite women.Fertil Steril. 1957; 8: 89-97
- Factors affecting normal expectancy of conception.J Am Med Assoc. 1956; 161: 855-860
- Quantitative morphological investigations of the follicular system in women; variations at different ages.Acta Anat. 1952; 14: 108-123
- Accelerated disappearance of ovarian follicles in mid-life: implications for forecasting menopause.Hum Reprod. 1992; 7: 1342-1346
- A mathematical model of follicle dynamics in the human ovary.Hum Reprod (Oxford, England). 1995; 10: 770-775
- To err (meiotically) is human: the genesis of human aneuploidy.Nat Rev. 2001; 2: 280-291
- Female fecundity as a function of age: results of artificial insemination in 2193 nulliparous women with azoospermic husbands. Federation CECOS.N Engl J Med. 1982; 306: 404-406
- Aging and infertility in women.Fertil Steril. 2006; 86: S248-S252
- Clomiphene citrate and intrauterine insemination: analysis of more than 4100 cycles.Fertil Steril. 2008; 90: 2281-2286
- Fertility treatment when the prognosis is very poor or futile.Fertil Steril. 2009; 92: 1194-1197
- Ovulation induction combined with intrauterine insemination in women 40 years of age and older: is it worthwhile?.Hum Reprod (Oxford, England). 1996; 11: 1109-1112
Centers for Disease Control and Prevention. National summary report: Assisted Reproductive Technology (ART) report. Centers for Disease Control and Prevention; 2009.
- Elevated day 3 serum follicle stimulating hormone and/or estradiol may predict fetal aneuploidy.Fertil Steril. 1999; 71: 715-718
- Outcome of in vitro fertilization in women 45 years and older who use autologous oocytes.Fertil Steril. 2007; 87: 74-76
- Outcome of Assisted Reproductive Technology in women over the age of 41.Fertil Steril. 2000; 74: 471-475
- One thousand initiated cycles of in vitro fertilization in women > or =40 years of age.Fertil Steril. 1998; 70: 1030-1034
- Intracytoplasmic sperm injection, results in women older than 39, according to age and the number of embryos replaced in selective or non-selective transfers.Hum Reprod (Oxford, England). 1998; 13: 884-889
- Four hour 24 chromosome aneuploidy screening using high throughput PCR SNP allele ratio analyses.Fertil Steril. 2009; 92: S49-S50
- Accurate single cell 24 chromosome aneuploidy screening using whole genome amplification and single nucleotide polymorphism microarrays.Fertil Steril. 2010; 94: 2017-2021
- Female age in ART: when to stop?.Gynecol Obstet Investig. 2004; 58: 225-234
- Nonsurgical ovum transfer as a treatment in infertile women. Preliminary experience.J Am Med Assoc. 1984; 251: 1171-1173
- A preliminary report on oocyte donation extending reproductive potential to women over 40.N Engl J Med. 1990; 323: 1157-1160
- Pregnancy after age 50: application of oocyte donation to women after natural menopause.Lancet. 1993; 341: 321-323
Centers for Disease Control and Prevention. 2007 Assisted Reproductive Technology report. Atlanta: Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Reproductive Health, American Society for Reproductive Medicine, Society for Assisted Reproductive Technology; 2007.
- Spontaneous abortion among pregnancies conceived using Assisted Reproductive Technology in the United States.Obstet Gynecol. 2003; 101: 959-967
- Poor oocyte quality rather than implantation failure as a cause of age-related decline in female fertility.Lancet. 1991; 337: 1375-1377
- Age-related decline in female fertility is not due to diminished capacity of the uterus to sustain embryo implantation.Fertil Steril. 1994; 61: 97-101
- Obstetric and prenatal outcome in menopausal women: a 12-year clinical study.Reprod Biomed Online. 2003; 6: 257-261
Cunningham FG, Leveno KJ, Bloom SL, Hauth JC, Rouse DJ, Spong CY. Maternal Physiology In: Cunningham FG, Leveno KJ, Bloom SL, Hauth JC, Rouse DJ, Spong CY (eds). Williams Obstetrics: 23rd Edition New York: McGraw-Hill 2009.
- Oocyte and embryo donation 2006: reviewing two decades of innovation and controversy.Reprod Biomed Online. 2006; 12: 153-162
- Maternal and perinatal risks for women over 44 – a review.Maturitas. 2009; 64: 109-113
- Pregnancies in post-menopausal women. Oocyte donation to women of advanced reproductive age: ‘how old is too old?’.Hum Reprod (Oxford, England). 1994; 9: 571-572
- Preservation of fertility in patients with cancer.N Engl J Med. 2009; 360: 902-911
Cohen J, Scott, R, Alikani, M, Schimmel, T, Munne S, Levron J, et al. Ooplasmic transfer in mature human oocytes.Mol Hum Reprod 1998;4(March (3)):269–80.
- maternal age strategies to improve pregnancy outcome.Ann NY Acad Sci. 2001; 943: 26-33
- Adult phenotype in the mouse can be affected by epigenetic events in the early embryo.Development (Cambridge, England). 1993; 119: 933-942
- Gametes from embryonic stem cells: a cup half empty or half full?.Science (New York, NY). 2007; 316: 409-410
- In vitro-differentiated embryonic stem cells give rise to male gametes that can generate offspring mice.Dev Cell. 2006; 11: 125-132
- Induced pluripotent stem cells: fundamentals and applications of the reprogramming process and its ramifications on regenerative medicine.Stem Cell Rev. 2011;
- Turning straw into gold: directing cell fate for regenerative medicine.Nat Rev. 2011; 12: 243-252
- Seven roads traveled well and seven to be traveled more.Fertil Steril. 2011; 95: 853-856
Article info
Publication history
Published online: July 22, 2011
Accepted:
July 8,
2011
Received:
July 6,
2011
Identification
Copyright
© 2011 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
