Decline in Female Fertility After 40 Years

Abstract Important factor related to the conception possibility is women age. The decline in fertility with aging is proven and evident in literature. Infertility is increasing and many couples seek help in advanced techniques such as IVF (in vitro fertilization) in order to overcome the problem caused by aging, but the quality of the oocytes is a significant limiting factor. With the aging the quantity and quality of oocytes decreases, such as the quality of the embryo after fertilization. The accelerated rhythm of life, liberty and women inclusion in all kinds of professions brought many benefits to women, but also increasingly postponing births. Each person is unique individual, and can be more or less fertile compared to the average at same age. Unfortunately, some women has a rapid decline in fertility - accelerate aging, very early, already in the early twenties and when testing them with different methods and exams, the result is very low number of oocytes, low value of anti-Müllerian hormone and also very poor quality of these oocytes, or low ovarian reserve. The problem is that when you have accelerate aging, even IVF techniques can not be of great help in achieving pregnancy. The pregnancy rate (17,65%) and the childbirth rate (5,88%) with the patients older than 40 is very low, although comparable to the data from the scientific literature and speaks in favour of the fact that the success of assisted reproductive techniques is very modest with women older than 44.

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Chromosome aneuploidy analysis in embryos derived from in vivo and in vitro matured human oocytes

Journal of Translational Medicine ◽

10.1186/s12967-021-03080-1 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Jianhua Li ◽

Jing Chen ◽

Tiecheng Sun ◽

Shuiwen Zhang ◽

Tingting Jiao ◽

...

Keyword(s):

In Vitro Fertilization ◽

Clinical Decision Making ◽

Clinical Decision ◽

Poor Quality ◽

Vitro Fertilization ◽

Aneuploidy Rate ◽

Significant Difference

Abstract Background In vitro oocyte maturation (IVM) is being increasingly approached in assisted reproductive technology (ART). This study aimed to evaluate the quality of embryos generated by in-vitro matured immature follicles, as a guideline for further clinical decision-making. Methods A total of 52 couples with normal karyotypes underwent in vitro fertilization, and 162 embryos were donated for genetic screening. Embryos in IVF group were generated by mature follicles retrieved during gonadotrophin-stimulated in vitro fertilization (IVF) cycles. And embryos in IVM group were fertilized from IVM immature oocytes. Results The average age of the women was 30.50 ± 4.55 years (range 21–42 years) with 87 embryos from IVF group and 75 embryos from IVM group. The rate of aneuploid with 28 of the 87 (32.2%) embryos from IVF group and 21 of the 75 (28%) embryos from IVM group, with no significant difference. The frequency of aneuploid embryos was lowest in the youngest age and increased gradually with women’s age, whether in IVF group or IVM group and risen significantly over 35 years old. The embryos with morphological grade 1 have the lowest aneuploidy frequency (16.6%), and increase by the grade, especially in IVF group. In grade 3, embryos in IVM group were more likely to be euploid than IVF group (60% vs 40%, respectively). Conclusions IVM does not affect the quality of embryos and does not increase the aneuploidy rate of embryos. It is clinically recommended that women more than 35 years have a high aneuploidy rate and recommended to test by PGS (strongly recommended to screened by PGS for women more than 40 years). Women aged less than 35 years old for PGS according to their physical and economic conditions. Embryo with poor quality is also recommended to test by PGS, especially for grade III embryos.

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Book review: “It Starts with the Egg” by Rebecca Fett

Obstetrics Gynecology and Reproduction ◽

10.17749/2313-7347.2019.13.3.255-260 ◽

2019 ◽

Vol 13 (3) ◽

pp. 255-260

Author(s):

A. D. Makatsariya

Keyword(s):

Polycystic Ovary ◽

Recurrent Miscarriage ◽

Action Plan ◽

Reproductive Function ◽

Poor Quality ◽

Vitro Fertilization ◽

Wide Range ◽

Based Medicine

The licensed edition of Rebecca Fett's book, “It Starts with the Egg” has been published in Russian. Given its medical contents, it seems important to evaluate the information contained in the book from the perspective of a practicing obstetrician-gynecologist, focusing on the problem of miscarriage and pregravid preparation. Importantly, the book is based on evidence-based medicine: although the book is intended for a wide scope of readers, it contains a list of primary references similarly to that in peer-reviewed journals.The author analyzed and summarized the data from over 60 scientific articles. Although based on primary academic sources, the author used a simple and understandable language to explain the complex pathogenesis of infertility and the manipulations used in the assisted reproductive technology (ART).The book consists of 3 parts; each of them contains several chapters reviewing the causes of reproductive disorders and the ways to correct them. The first part addresses the reasons for poor quality of women’s eggs. The second part describes nutraceuticals and dietary supplements that can improve the quality of eggs. The third part of the book examines the diet, which helps improve this quality. A step-by-step action plan for improving reproductive function is also presented. The basic plan is suitable for those who are just thinking about pregnancy and those who have no reason to expect any difficulties, as well as for couples who have been struggling with infertility for several years. The mid-level plan is intended for those who already have some concerns about conceiving, but are not yet aware of personal problems with their reproductive function, as well as for women with polycystic ovary syndrome (PCOS) or irregular ovulation. The plan for those having serious problems is intended for women with recurrent miscarriage, as well as for couples with a decrease in the ovarian reserve who are trying to get pregnant using in vitro fertilization (IVF).Despite some remarks regarding the role of vitamin D and magnesium in pregravid preparation, the book contains a large number of useful and balanced recommendations that can improve the woman’s health and increase her chances to get pregnant and give birth to a healthy baby. Therefore, the book can be recommended for a wide range of readers.

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Micro-assisted fertilization

Reproduction Fertility and Development ◽

10.1071/rd9950831 ◽

1995 ◽

Vol 7 (4) ◽

pp. 831 ◽

Cited By ~ 3

Author(s):

D Payne

Keyword(s):

Poor Quality ◽

Male Factor Infertility ◽

Male Factor ◽

Vitro Fertilization ◽

Fertilization Rates ◽

Partial Zona Dissection ◽

Oocyte Cytoplasm ◽

Assisted Fertilization

In couples who undergo routine in vitro fertilization (IVF), 17% experience significant problems with fertilization and many others are unable to have routine IVF because the quality of their semen is too poor. Often, the only options previously available to these couples were to use sperm donated by fertile men or to remain childless. Micromanipulative assisted fertilization techniques have improved the treatment of severe male factor infertility significantly and this paper provides a brief overview of the recent methodologies. Initially, techniques such as zona drilling and partial zona dissection, in which a hole or slit is placed in the zona pellucida, demonstrated that fertilization and pregnancies could be achieved with semen of very poor quality, but successes were sporadic. Later, subzonal injection of spermatozoa provided more consistent results with many units reporting pregnancies; however, relatively low rates of fertilization (14-34%) and high rates of polyspermy remained unresolved problems. The latest technique, the injection of a single spermatozoon into the oocyte cytoplasm, although technically difficult in animal models, proved to be highly successful in the human, restoring fertilization rates to those seen in routine IVF (65%) and producing good pregnancy rates from transferred embryos. Intracytoplasmic sperm injection has become the method of choice in the treatment of severe male factor infertility and preliminary data suggest that there is no increase in congenital abnormality among babies born after the transfer of injected oocytes.

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No differences in development/quality of embryos cultured in sequential and single-step medium regarding of female age and method of in vitro fertilization: prospective study

10.26226/morressier.573c1511d462b80296c9842e ◽

2016 ◽

Author(s):

Liljana Bacer Kermavner

Keyword(s):

In Vitro Fertilization ◽

Prospective Study ◽

Single Step ◽

Female Age ◽

Vitro Fertilization

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Decreased miR-149 expression in sperm is correlated with the quality of early embryonic development in conventional in vitro fertilization

Reproductive Toxicology ◽

10.1016/j.reprotox.2021.02.005 ◽

2021 ◽

Vol 101 ◽

pp. 28-32

Author(s):

Hongping Li ◽

Lejun Li ◽

Chuanping Lin ◽

Minhao Hu ◽

Xiaozhen Liu ◽

...

Keyword(s):

In Vitro Fertilization ◽

Embryonic Development ◽

Early Embryonic Development ◽

Vitro Fertilization

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Sexual Function and Fertility Quality of Life in Women Using In Vitro Fertilization

Journal of Sexual Medicine ◽

10.1111/jsm.12824 ◽

2015 ◽

Vol 12 (4) ◽

pp. 985-993 ◽

Cited By ~ 19

Author(s):

Nicole K. Smith ◽

Jody Madeira ◽

Heather R. Millard

Keyword(s):

Quality Of Life ◽

In Vitro Fertilization ◽

Sexual Function ◽

Vitro Fertilization

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Andrology: An auto-controlled study in in-vitro fertilization reveals the benefit of Percoll centrifugation to swim-up in the preparation of poor-quality semen

Human Reproduction ◽

10.1093/oxfordjournals.humrep.a137949 ◽

1993 ◽

Vol 8 (11) ◽

pp. 1856-1862 ◽

Cited By ~ 18

Author(s):

F. Sapienza ◽

G. Verheyen ◽

H. Tournaye ◽

R. Janssens ◽

I. Pletincx ◽

...

Keyword(s):

In Vitro Fertilization ◽

Poor Quality ◽

Controlled Study ◽

Vitro Fertilization ◽

Percoll Centrifugation

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Insemination, in vitro fertilization, and intracytoplasmic sperm injection

Oxford Textbook of Endocrinology and Diabetes ◽

10.1093/med/9780199235292.003.9111 ◽

2011 ◽

pp. 1440-1447

Author(s):

Herman J. Tournaye

Keyword(s):

Assisted Reproduction ◽

Male Partner ◽

Specific Treatment ◽

Clinical Work ◽

Primary Treatment ◽

Assisted Reproductive Techniques ◽

Vitro Fertilization ◽

Reproductive Techniques ◽

Work Up

Anamnesis, physical examination, and additional tests may reveal a specific cause of reproductive failure in infertile men. Whenever this is found, a specific treatment or cure should be applied. When no such treatment is available, or when specific treatment has failed, techniques of assisted reproduction may be proposed to couples suffering from long-standing male infertility. The rationale behind these is to bring the spermatozoa closer to the oocyte in an attempt to enhance the fertilization process. In recent years the role of assisted reproduction has become more important, and it has often been stated that these techniques have made clinical work-up or specific treatment of the male partner pointless. However, this is far from true. Not only may correction of a specific dysfunction in the male avoid the use of assisted reproductive techniques, but careful work-up and treatment may also enhance the outcome of these treatments. Assisted reproductive techniques should not be viewed as a primary treatment option, but rather as a complementary treatment when other treatments have failed, or have been judged inadequate after a complete work-up.

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