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Chapter 8 - Fertility Counseling beyond 40

from Section 5 - Optimal Deployment of ART beyond 40

Published online by Cambridge University Press:  15 September 2022

By
Amir Mor  and
David B. Seifer
Edited by
Dimitrios S. Nikolaou  and
David B. Seifer
Dimitrios S. Nikolaou
Affiliation:
Chelsea and Westminster Hospital, London
David B. Seifer
Affiliation:
Yale Reproductive Medicine, New Haven, CT
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Summary

Two main fertility challenges women over 40 face are decreased oocyte quality and quantity. Age is the most significant predictor of oocyte quality. There is no reliable test aimed at evaluating a single oocyte quality in vivo or in vitro following oocyte retrieval or just prior to fertilization. On the other hand, there are good ovarian reserve tests aimed at estimating the residual follicular pool in aging women: AMH, AFC, and cycle day 2-4 FSH. Each have acceptable specificity for detecting diminished ovarian reserve. The majority of clinicians prefer AMH over AFC and FSH due to its technical simplicity, lower intra- and intercycle variability and increased prognostic value in the context of older women 43,44. Once stating a desire to conceive, women who are 40 or older should have an immediate comprehensive infertility evaluation that must include prompt ovarian reserve testing. Lifestyle changes including nutrition, vitamins, exercise, stress reduction and adequate sleep can only assist in the goal. Lastly, preparation, engagement and support of a team of professionals are essential to approach conceiving over the age of 40.

Keywords

Clinical counsellingwomen over 40fertilitypregnancy ratesolder womenoler mothers assisted conceptioninfertilityovarian reserve tests
Type
Chapter
Information
Optimizing the Management of Fertility in Women over 40 , pp. 98 - 105
Publisher: Cambridge University Press
Print publication year: 2022

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References

American College of Obstetricians and Gynecologists Committee on Gynecologic Practice and Practice Committee. Female age-related fertility decline. Committee Opinion No. 589. Fertil Steril 2014;101:633–4.Google Scholar
Stein, ZA. A woman’s age: childbearing and child rearing. Am J Epidemiol 1985;121:327–42.CrossRefGoogle ScholarPubMed
Gosden, RG. Maternal age: a major factor affecting the prospects and outcome of pregnancy. Ann N Y Acad Sci 1985;442:45–57.CrossRefGoogle Scholar
Baker, TG. A Quantitative and Cytological Study of Germ Cells in Human Ovaries. Proc R Soc Lond B Biol Sci 1963;158:417–33.Google ScholarPubMed
Vaskivuo, TE, Anttonen, M, Herva, R, et al. Survival of human ovarian follicles from fetal to adult life: apoptosis, apoptosis-related proteins, and transcription factor GATA-4. J Clin Endocrinol Metab 2001;86:3421–9.Google ScholarPubMed
Markstrom, E, Svensson, E, Shao, R, Svanberg, B, Billig, H. Survival factors regulating ovarian apoptosis – dependence on follicle differentiation. Reproduction 2002;123:23–30.Google Scholar
te Velde, ER, Pearson, PL. The variability of female reproductive ageing. Hum Reprod Update 2002;8:141–54.Google Scholar
Richardson, SJ, Senikas, V, Nelson, JF. Follicular depletion during the menopausal transition: evidence for accelerated loss and ultimate exhaustion. J Clin Endocrinol Metab 1987;65:1231–7.Google Scholar
Faddy, MJ, Gosden, RG. A model conforming the decline in follicle numbers to the age of menopause in women. Hum Reprod 1996;11:1484–6.Google Scholar
Battaglia, DE, Goodwin, P, Klein, NA, Soules, MR. Influence of maternal age on meiotic spindle assembly in oocytes from naturally cycling women. Hum Reprod 1996;11:2217–22.CrossRefGoogle ScholarPubMed
Gougeon, A, Ecochard, R, Thalabard, JC. Age-related changes of the population of human ovarian follicles: increase in the disappearance rate of non-growing and early-growing follicles in aging women. Biol Reprod 1994;50:653–63.Google Scholar
Jacobs, SL, Metzger, DA, Dodson, WC, Haney, AF. Effect of age on response to human menopausal gonadotropin stimulation. J Clin Endocrinol Metab 1990;71:1525–30.CrossRefGoogle ScholarPubMed
Block, E. A quantitative morphological investigation of the follicular system in newborn female infants. Acta Anat (Basel) 1953;17:201–6.Google Scholar
Nasmyth, K. Disseminating the genome: joining, resolving, and separating sister chromatids during mitosis and meiosis. Annu Rev Genet 2001;35:673–745.Google Scholar
Pellestor, F, Anahory, T, Hamamah, S. Effect of maternal age on the frequency of cytogenetic abnormalities in human oocytes. Cytogenet Genome Res 2005;111:206–12.Google Scholar
Pellestor, F, Andreo, B, Arnal, F, Humeau, C, Demaille, J. Maternal aging and chromosomal abnormalities: new data drawn from in vitro unfertilized human oocytes. Hum Genet 2003;112:195–203.Google Scholar
Pellestor, F, Andreo, B, Anahory, T, Hamamah, S. The occurrence of aneuploidy in human: lessons from the cytogenetic studies of human oocytes. Eur J Med Genet 2006;49:103–16.CrossRefGoogle ScholarPubMed
Hassold, T, Chiu, D. Maternal age-specific rates of numerical chromosome abnormalities with special reference to trisomy. Hum Genet 1985;70:11–17.Google Scholar
Noci, I, Borri, P, Chieffi, O, et al.I. Aging of the human endometrium: a basic morphological and immunohistochemical study. Eur J Obstet Gynecol Reprod Biol 1995;63:181–5.Google Scholar
Abdalla, HI, Burton, G, Kirkland, A, et al. Age, pregnancy and miscarriage: uterine versus ovarian factors. Hum Reprod 1993;8:1512–7.CrossRefGoogle ScholarPubMed
Borini, A, Bafaro, G, Violini, F, Bianchi, L, Casadio, V, Flamigni, C. Pregnancies in postmenopausal women over 50 years old in an oocyte donation program. Fertil Steril 1995;63:258–61.CrossRefGoogle Scholar
Melnick, AP, Rosenwaks, Z. Oocyte donation: insights gleaned and future challenges. Fertil Steril 2018;110:988–93.Google Scholar
Kidd, SA, Eskenazi, B, Wyrobek, AJ. Effects of male age on semen quality and fertility: a review of the literature. Fertil Steril 2001;75:237–48.Google Scholar
Eskenazi, B, Wyrobek, AJ, Sloter, E, et al. The association of age and semen quality in healthy men. Hum Reprod 2003;18:447–54.Google Scholar
Vermeulen, A, Kaufman, JM. Ageing of the hypothalamo-pituitary-testicular axis in men. Horm Res 1995;43:25–8.Google Scholar
Almeida, S, Rato, L, Sousa, M, Alves, MG, Oliveira, PF. Fertility and sperm quality in the aging male. Curr Pharm Des 2017;23:4429–37.Google Scholar
Nybo Andersen, AM, Urhoj, SK. Is advanced paternal age a health risk for the offspring? Fertil Steril 2017;107:312–8.Google Scholar
Mihm, M, Gangooly, S, Muttukrishna, S. The normal menstrual cycle in women. Anim Reprod Sci 2011;124:229–36.Google Scholar
Sowers, MR, Eyvazzadeh, AD, McConnell, D, et al. Anti-mullerian hormone and inhibin B in the definition of ovarian aging and the menopause transition. J Clin Endocrinol Metab 2008;93:3478–83.Google Scholar
Bukman, A, Heineman, MJ. Ovarian reserve testing and the use of prognostic models in patients with subfertility. Hum Reprod Update 2001;7:581–90.Google Scholar
Roberts, JE, Spandorfer, S, Fasouliotis, SJ, Kashyap, S, Rosenwaks, Z. Taking a basal follicle-stimulating hormone history is essential before initiating in vitro fertilization. Fertil Steril 2005;83:37–41.Google Scholar
Abdalla, H, Thum, MY. Repeated testing of basal FSH levels has no predictive value for IVF outcome in women with elevated basal FSH. Hum Reprod 2006;21:171–4.CrossRefGoogle ScholarPubMed
Buyalos, RP, Daneshmand, S, Brzechffa, PR. Basal estradiol and follicle-stimulating hormone predict fecundity in women of advanced reproductive age undergoing ovulation induction therapy. Fertil Steril 1997;68:272–7.Google Scholar
Pache, TD, Wladimiroff, JW, de Jong, FH, Hop, WC, Fauser, BC. Growth patterns of nondominant ovarian follicles during the normal menstrual cycle. Fertil Steril 1990;54:638–42.CrossRefGoogle ScholarPubMed
Scheffer, GJ, Broekmans, FJ, Dorland, M, Habbema, JD, Looman, CW, te Velde, ER. Antral follicle counts by transvaginal ultrasonography are related to age in women with proven natural fertility. Fertil Steril 1999;72:845–51.Google Scholar
Frattarelli, JL, Lauria-Costab, DF, Miller, BT, Bergh, PA, Scott, RT. Basal antral follicle number and mean ovarian diameter predict cycle cancellation and ovarian responsiveness in assisted reproductive technology cycles. Fertil Steril 2000;74:512–7.Google Scholar
Kupesic, S, Kurjak, A, Bjelos, D, Vujisic, S. Three-dimensional ultrasonographic ovarian measurements and in vitro fertilization outcome are related to age. Fertil Steril 2003;79:190–7.Google Scholar
Themmen, AP. Anti-Mullerian hormone: its role in follicular growth initiation and survival and as an ovarian reserve marker. J Natl Cancer Inst Monogr 2005;34:18–21.CrossRefGoogle Scholar
Fleming, R, Seifer, DB, Frattarelli, JL, Ruman, J. Assessing ovarian response: antral follicle count versus anti-Mullerian hormone. Reprod Biomed Online 2015;31:486–96.Google Scholar
Hehenkamp, WJ, Looman, CW, Themmen, AP, de Jong, FH, Te Velde, ER, Broekmans, FJ. Anti-Mullerian hormone levels in the spontaneous menstrual cycle do not show substantial fluctuation. J Clin Endocrinol Metab 2006;91:4057–63.Google Scholar
Broer, SL, Broekmans, FJ, Laven, JS, Fauser, BC. Anti-Mullerian hormone: ovarian reserve testing and its potential clinical implications. Hum Reprod Update 2014;20:688–701.Google Scholar
Gnoth, C, Schuring, AN, Friol, K, Tigges, J, Mallmann, P, Godehardt, E. Relevance of anti-Mullerian hormone measurement in a routine IVF program. Hum Reprod 2008;23:1359–65.Google Scholar
Goswami, M, Nikolaou, D. Is AMH level, independent of age, a predictor of live birth in IVF? J Hum Reprod Sci 2017;10:24–30.Google Scholar
Tal, R, Seifer, DB, Tal, R, Grainger, E, Wantman, E, Tal, O. AMH highly correlates with cumulative live birth rate in women with diminished ovarian reserve independent of age. J Clin Endocrinol Metab 2021;106:2754–66.CrossRefGoogle Scholar
Navot, D, Rosenwaks, Z, Margalioth, EJ. Prognostic assessment of female fecundity. Lancet 1987;2:645–7.Google Scholar
Yong, PY, Baird, DT, Thong, KJ, McNeilly, AS, Anderson, RA. Prospective analysis of the relationships between the ovarian follicle cohort and basal FSH concentration, the inhibin response to exogenous FSH and ovarian follicle number at different stages of the normal menstrual cycle and after pituitary down-regulation. Hum Reprod 2003;18:35–44.Google Scholar
Csemiczky, G, Harlin, J, Fried, G. Predictive power of clomiphene citrate challenge test for failure of in vitro fertilization treatment. Acta Obstet Gynecol Scand 2002;81:954–61.Google Scholar
Hendriks, DJ, Broekmans, FJ, Bancsi, LF, de Jong, FH, Looman, CW, Te Velde, ER. Repeated clomiphene citrate challenge testing in the prediction of outcome in IVF: a comparison with basal markers for ovarian reserve. Hum Reprod 2005;20:163–9.Google Scholar
Practice Committee of the American Society for Reproductive Medicine. Smoking and infertility: a committee opinion. Fertil Steril 2018;110:611–18.Google Scholar
Ladanyi, C, Mor, A, Christianson, MS, Dhillon, N, Segars, JH. Recent advances in the field of ovarian tissue cryopreservation and opportunities for research. J Assist Reprod Genet 2017;34:709–22.Google Scholar
Girum, T, Wasie, A. Return of fertility after discontinuation of contraception: a systematic review and meta-analysis. Contracept Reprod Med 2018;3:9.Google Scholar
Barnhart, KT, Schreiber, CA. Return to fertility following discontinuation of oral contraceptives. Fertil Steril 2009;91:659–63.Google ScholarPubMed
Wei, D, Shi, Y, Li, J, et al. Effect of pretreatment with oral contraceptives and progestins on IVF outcomes in women with polycystic ovary syndrome. Hum Reprod 2017;32:354–61.Google Scholar
Farquhar, C, Rombauts, L, Kremer, JA, Lethaby, A, Ayeleke, RO. Oral contraceptive pill, progestogen or oestrogen pretreatment for ovarian stimulation protocols for women undergoing assisted reproductive techniques. Cochrane Database Syst Rev 2017;5:CD006109.Google Scholar
Kloss, JD, Perlis, ML, Zamzow, JA, Culnan, EJ, Gracia, CR. Sleep, sleep disturbance, and fertility in women. Sleep Med Rev 2015;22:78–87.Google Scholar
Palomba, S, Daolio, J, Romeo, S, Battaglia, FA, Marci, R, La Sala, GB. Lifestyle and fertility: the influence of stress and quality of life on female fertility. Reprod Biol Endocrinol 2018;16:113.Google Scholar
Joseph, DN, Whirledge, S. Stress and the HPA axis: balancing homeostasis and fertility. Int J Mol Sci 2017;18.Google Scholar
Kaser, DJ, Goldman, MB, Fung, JL, Alper, MM, Reindollar, RH. When is clomiphene or gonadotropin intrauterine insemination futile? Results of the Fast Track and Standard Treatment Trial and the Forty and Over Treatment Trial, two prospective randomized controlled trials. Fertil Steril 2014;102:1331–7 e1.Google Scholar
Reindollar, RH, Regan, MM, Neumann, PJ, et al. A randomized clinical trial to evaluate optimal treatment for unexplained infertility: the fast track and standard treatment (FASTT) trial. Fertil Steril 2010;94:888–99.Google Scholar
Mochizuki, L, Gleicher, N. The PGS/PGT-A controversy in IVF addressed as a formal conflict resolution analysis. J Assist Reprod Genet 2020;37:677–87.Google Scholar
Tal, R, Seifer, DB. Ovarian reserve testing: a user’s guide. Am J Obstet Gynecol 2017;217:129–40.Google Scholar
Beroukhim, G, Esencan, E, Seifer, DB. Impact of sleep patterns upon female neuroendocrinology and reproductive outcomes: a comprehensive review. Reprod Biol Endocrinol 2022;20:16.Google Scholar

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