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Chapter 7 - Optimal IVF Protocols for Women over 40 and Low Functional Ovarian Reserve

from Section 5 - Optimal Deployment of ART beyond 40

Published online by Cambridge University Press:  15 September 2022

By
David H. Barad  and
Norbert Gleicher
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

As women age, their response to ovulation induction is progressively diminished due to the continuous depletion of primordial follicles and to changes in the ovarian endocrine/paracrine microenvironment. While many couples faced with the reality of a diagnosis of low functional ovarian reserve may turn to the use of donor gametes to achieve a pregnancy, some still feel the need to try on their own, despite a poor prognosis. For such women careful preparation and hormonal priming in the months prior to beginning an IVF cycle can increase their chance of a successful outcome. Optimal treatment of these patients differs from the usual treatment of women with normal ovarian reserve in every aspect and needs to be highly individualized.

Keywords

Agingin vitro fertilizationovulation inductionovarian reservefunctional ovarian reserveovarian insufficiencypremature ovarian insufficiencyfolliculogenesisatresiaandrogenDHEAhuman growth hormoneplatelet rich plasma (PRP)
Type
Chapter
Information
Optimizing the Management of Fertility in Women over 40 , pp. 81 - 97
Publisher: Cambridge University Press
Print publication year: 2022

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