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Fecundability decreases with increasing age.
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Evaluation for etiologies of infertility should be offered to women more than 35 years of age who have failed to conceive after 6 months.
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Abnormal tests for ovarian reserve should result in referral to an infertility specialist, as these patients need prompt evaluation and potentially more expedited and aggressive treatment.
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Oocyte donation provides the best chance for successful conception in patients with age-related infertility.
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Pregnancy at an
Age-related Infertility
Section snippets
Key points
Physiology of Reproductive Aging
Women are born with a finite number of oocytes. The peak in oocyte number occurs in utero, with 6 to 7 million oogonia at 16 to 20 weeks of gestation. From this point on, follicle number continues to decrease because of apoptosis of the nondominant follicles. At birth, 1 million to 2 million oocytes remain and only 300,000 to 500,000 are present when puberty begins. Follicle atresia increases at 37 years, when about 25,000 follicles remain. At the onset of menopause, fewer than 1000 follicles
Summary
With the societal shift toward delayed childbearing, it is important for providers to remember that age is still the best marker for reproductive potential. However, patients of advancing age are capable of achieving pregnancy, especially in the era of advanced reproductive technology and donor oocytes. Pregnancy at an advanced maternal age has risks. Patients should be fully counseled and educated regarding options for conception and the implications of advancing age on both maternal and fetal
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Disclosure: The authors have nothing to disclose.