Fertility preserving options for women of advancing age
- Karine Chung, MD, MSCE
Karine Chung, MD, MSCE
- Associate Professor of Obstetrics and Gynecology
- Division of Reproductive Endocrinology and Infertility
- USC Keck School of Medicine
- Richard Paulson, MD
Richard Paulson, MD
- Professor and Vice-Chair, Department of Obstetrics & Gynecology
- Chief, Division of Reproductive Endocrinology and Infertility
- University of Southern California
- Keck School of Medicine
Population-based birth statistics demonstrate a consistent increase in the proportion of women choosing to delay childbearing until later in their reproductive years . This trend has largely been attributed to the increase in women pursuing postgraduate educational degrees and higher levels of professional achievement, activities whose demands for time and energy compete with those of starting a family .
Because the ability to conceive is strongly influenced by a woman's age, many women who delay childbearing may face infertility by the time they are ready to become pregnant. The prevalence of infertility increases significantly after age 35 year, and by age 45 years, as many as 99 percent of women are infertile . (See "Effects of advanced maternal age on pregnancy".)
As the trend to delay childbearing continues, and as awareness of the age-related decline in fertility increases, interest in the emerging technologies of fertility preservation has grown. Although these procedures are commonly considered for women undergoing sterilizing treatments (eg, chemotherapy, radiation therapy, ovarian resection), elective use of fertility preservation techniques among women of advancing reproductive age remains controversial [4-8].
Fertility preservation options that may be applied to women of advancing reproductive age will be discussed here. Preservation of fertility in patients undergoing sterilizing therapies is reviewed separately. (See "Fertility preservation in patients undergoing gonadotoxic treatment or gonadal resection".)
AGE-RELATED DECLINE IN FEMALE FERTILITY
The influence of female age on fertility has been clearly established by a number of observational studies, which have consistently demonstrated a decline in pregnancy rates with advancing maternal age. Furthermore, cycles that result in pregnancy are less likely to progress to live births because of higher rates of miscarriage among older women. These relationships are best illustrated by outcome data from clinics performing in vitro fertilization (table 1). (See "Effects of advanced maternal age on pregnancy".)To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- AGE-RELATED DECLINE IN FEMALE FERTILITY
- OPTIONS FOR FERTILITY PRESERVATION
- EMBRYO CRYOPRESERVATION
- CRYOPRESERVATION OF OOCYTES
- Mature oocytes
- - Procedure
- Intracytoplasmic sperm injection (ICSI) for zona pellucida hardening
- Use of cryoprotectants to avoid intracellular ice crystal formation
- Methods to limit toxicity of cryoprotectants and solutes
- - Slow freeze
- - Vitrification
- - Slow freeze versus vitrification
- Ovarian tissue
- Age at the time of the procedure
- Maximum age for oocyte cryopreservation
- Planned age of childbearing
- Risk of miscarriage
- - Obstetric and childhood outcomes
- - Aneuploidy
- - Congenital anomalies
- LOGISTICS AND COST
- SOCIETY GUIDELINE LINKS
- SUMMARY AND RECOMMENDATIONS