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Treating Infertility as We Age

There are now many different treatments available for infertility. However, a woman’s options for treatment become more limited as she ages and ovarian function declines. Some problems can be corrected surgically, but these options can delay a woman’s ability to try to achieve a pregnancy for many months or longer. Conservative hormonal therapies (such as clomiphene citrate or gonadotropins combined with intrauterine insemination) can be effective for younger women (usually under age 40), but these options are typically less effective in older women.
First introduced more than 25 years ago, in vitro fertilization (IVF) continues to be the most effective therapy for women who hope to conceive using their own eggs. However, the live birth rate with IVF drops off considerably in women after age 40. Unfortunately, there is no treatment currently available that can restore or improve a woman’s egg quality (ovarian reserve). For that reason, women should be treated with the most effective options as early in their reproductive years as possible to have the very best chance of success (fig. 6).
Chance of Pregnancy per Month with Different Therapies
fig. 6 – Even with the use of advanced forms of infertility treatment, a woman’s chance of achieving a pregnancy using her own eggs continues to decline with age.
Women with abnormal ovarian reserve testing have lower fertility rates regardless of age. In October 2001 the medical journal Fertility and Sterility reported on a study of almost 10,000 women where about 10% had abnormal ovarian reserve on the basis of basal FSH measurement. Among the women with abnormal ovarian reserve measures, only 28 (2.7%) achieved a pregnancy. Of those, 20 resulted in miscarriage. Only 0.7% of women in the study with abnormal ovarian reserve recorded a successful live birth (fig. 7).

Pregnancy Loss Rate and Ovarian Reserve
fig. 7 – In a recent study, only 0.7% of women with abnormal ovarian reserve reported a successful pregnancy and live birth. Compared to women with normal ovarian reserve (blue), those women with abnormal ovarian reserve (yellow) who became pregnant were much more likely to have a miscarriage.
While pregnancy rates are low for women with abnormal ovarian reserve who try to become pregnant using their own oocytes, these women can consider other options such as oocyte donation. With oocyte donation, a woman with normal ovarian reserve donates her eggs to be used to help a couple achieve a pregnancy. This treatment option can make it possible for women to experience pregnancy and childbirth regardless of her ovarian function. As seen in fig. 8, oocyte donation results have relatively high success rates for women treated during her reproductive years, regardless of age. This again demonstrates the important role that egg quality plays in helping women to achieve a successful pregnancy at any age.

Oocyte Donation Pregnancy and Delivery Rates
fig. 8 – Women treated with oocyte donation at any age during their reproductive years show consistent and relatively high pregnancy rates.
fig. 6: RMA pregnancy data. Data on file.
fig. 7: Levi A, et al. Fertil Steril 75:666, 2001
fig. 8: RMA pregnancy data. Data on file