Age-related Infertility

https://doi.org/10.1016/j.ogc.2014.09.005Get rights and content

Section snippets

Key points

  • Fecundability decreases with increasing age.

  • Evaluation for etiologies of infertility should be offered to women more than 35 years of age who have failed to conceive after 6 months.

  • 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.

  • Oocyte donation provides the best chance for successful conception in patients with age-related infertility.

  • Pregnancy at an

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

First page preview

First page preview
Click to open first page preview

References (62)

  • R.P. Buyalos et al.

    Basal estradiol and follicle-stimulating hormone predict fecundity in women of advanced reproductive age undergoing ovulation induction therapy

    Fertil Steril

    (1997)
  • G.E. Hofmann et al.

    Inhibin-B: the physiologic basis of the clomiphene citrate challenge test for ovarian reserve screening

    Fertil Steril

    (1998)
  • D.J. Hendriks et al.

    The clomiphene citrate challenge test for the prediction of poor ovarian response and nonpregnancy in patients undergoing in vitro fertilization: a systematic review

    Fertil Steril

    (2006)
  • A. de Vet et al.

    Antimullerian hormone serum levels: a putative marker for ovarian aging

    Fertil Steril

    (2002)
  • D.M. Wunder et al.

    Anti-Mullerian hormone and inhibin B as predictors of pregnancy after treatment by in vitro fertilization/intracytoplasmic sperm injection

    Fertil Steril

    (2008)
  • G.J. Scheffer et al.

    Antral follicle counts by transvaginal ultrasonography are related to age in women with proven natural fertility

    Fertil Steril

    (1999)
  • M.G. Hull et al.

    The age related decline in female fecundity: a quantitative controlled study of implanting capacity and survival of individual embryos after in vitro fertilization

    Fertil Steril

    (1996)
  • R.T. Scott et al.

    Comprehensive chromosomal screening is highly predictive of the reproductive potential of human embryos: a prospective, blinded, nonselection study

    Fertil Steril

    (2012)
  • C.C. Chang et al.

    Prospective controlled study to evaluate laboratory and clinical outcomes of oocyte vitrification obtained in in vitro fertilization patients aged 30 to 39 years

    Fertil Steril

    (2013)
  • G.M. Lockwood

    Social egg freezing: the prospect of reproductive ‘immortality’ or a dangerous delusion?

    Reprod Biomed Online

    (2011)
  • U.M. Reddy et al.

    Maternal age and the risk of stillbirth throughout pregnancy in the United States

    Am J Obstet Gynecol

    (2006)
  • US Bureau of the Census. Percent of people 25 years and over who have completed high school or college, by race,...
  • T.J. Mathews et al.

    Mean age of mother, 1970-2000

    Natl Vital Stat Rep

    (2002)
  • S.J. Ventura et al.

    Revised birth and fertility rates for the United States, 2000 and 2001

    Natl Vital Stat Rep

    (2003)
  • J.A. Martin et al.

    Births: final data from 2000

    Natl Vital Stat Rep

    (2002)
  • J. Menken et al.

    Age and infertility

    Science

    (1986)
  • Practice Committee of the American Society for Reproductive Medicine

    Definitions of infertility and recurrent pregnancy loss: a committee opinion

    Fertil Steril

    (2013)
  • B.M. van Noord-Zaadstra et al.

    Delaying childbearing: effect of age on fecundity and outcome of pregnancy

    Br Med J

    (1991)
  • T.G. Baker

    A quantitative and cytological study of germ cells in human ovaries

    Proc R Soc Lond B Biol Sci

    (1963)
  • E. Block

    Quantitative and morphologic investigations of the follicular system in women; variations at different ages

    Acta Anat (Basel)

    (1952)
  • A. Stein

    A woman’s age, childbearing, and childrearing

    Am J Epidemiol

    (1985)
  • Cited by (132)

    • Unveiling uterine aging: Much more to learn

      2023, Ageing Research Reviews
    • Why and when choosing child-free life in Sweden? Reasons, influencing factors and personal and societal factors: Individual interviews during 2020–2021

      2023, Sexual and Reproductive Healthcare
      Citation Excerpt :

      The analysis showed that the length of the decision-making process in years varied greatly among the informants. As the informants’ ages ranged from 26 to 53 years (median 35 years), they may have gone on to have children later, although science has shown that fertility declines drastically after the age of 35 years [36–38]. Half of the informants lived in single-person households, in line with how the general population lived in Sweden at the time of the study [39].

    View all citing articles on Scopus

    Disclosure: The authors have nothing to disclose.

    View full text