Search

It has been very well documented that fertility rates decrease with age in women. However, there appears to be a grey zone as to when this decrease commences. It would appear in general that this decline becomes pronounced over the age of 35 due to a decreased ovarian reserve. There have been numerous ways of assessing ovarian function including baseline estradiol and FSH levels, clomiphene citrate challenge test (CCCT), and GnRH agonists stimulation testing. These tests do have their drawbacks, however they appear to be a better indicator of ovarian reserve than age alone. Furthermore, there also appears to be a decline in endometrial receptivity with age although this is not as pronounced as the decrease in ovarian reserve. This decline in endometrial receptivity can be ameliorated to some extent by giving superphysiologic doses of progesterone. When decreased ovarian reserve is found in the mature woman, success rates are best with the use of donor eggs. In addition, there appears to be an increased risk of pregnancy complications in the mature gravida. These include an increased risk of spontaneous abortion, chromosomal abnormalities, hypertension, pre-eclampsia, and Caesarean section. Furthermore, with modem trends in obstetrical practice, the perinatal mortality has decreased with increasing age. Therefore, in mature women with decreased ovarian reserve there is a possiblity to achieve pregnancy with the use of donor eggs, and in patients who have been adequately screened for medical problems, and with close supervision in pregnancy, the risk of complications can be minimized.