This chapter explores new technologies for overcoming the problem of deteriorating oocyte-quality with age. It includes brief discussions of the following: mitochondrial replacement therapy, cytoplasmic transfer, autologous germline mitochondrial energy transfer (AUGMENT), maternal spindle transfer (MTS), in vitro activation of dormant follicles, autologous activated platelet-rich plasma injections (PRP), in vitro gametogenesis, induced pluripotent stem cells (iPSCs), aneuploidy correction through gene-editing and artificial ovaries. Clinicians should exercise extreme caution in managing patient expectations regarding these novel technologies. While clinical application of stem cell technology for maternal age-related infertility does seem likely at some point in the future, the timeline remains uncertain.

In the Federal Republic of Germany, intentional alteration of the genome of germline cells and embryos is prohibited by criminal law. This ban is the result of legislation that was adopted more than twenty-five years ago. However, the rapid emergence of genome manipulation techniques, coupled with recent technological developments, is increasingly exposing the senescence of the regulatory framework. With the advent of genome editing, there has been a shift in the national debate on the use of genetic engineering. Until recently, the discussion regarding the use of genome altering methods had been more about the application of genetic engineering to plants (so-called ‘green genetic engineering’) than to humans (so-called ‘red genetic engineering’). After all, green genetic engineering has been present in the fields for years, and sometimes even on the plate, while most red genetic engineering efforts have been unspectacular cell biology basic research, slowed down by both technical and legal hurdles. However, the emergence of more precise, safer and more predictable genome editing methods has now brought the issue into German public discourse and, as evidenced by this volume, around the world.