Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
  1. Home
  2. Search

Refine search

Refine search

Access:
Content type:
Publication date:
Apply   From and To filters
Subject: Show more
Journals Show more
Publishers: Show more
Societies Show more
Series: Show more
Collections: Show more

Actions for selected content:

Select all | Deselect all
  • View selected items
  • Export citations
  • Download PDF (zip)
  • Save to Kindle
  • Save to Dropbox
  • Save to Google Drive

Save Search

You can save your searches here and later view and run them again in "My saved searches".

Please provide a title, maximum of 40 characters.
Cancel
×

5 results

  • Chapter 8 - Fertility Counseling beyond 40

  • from Section 5 - Optimal Deployment of ART beyond 40
  • Edited by Dimitrios S. Nikolaou, David B. Seifer
  • Book:
    Optimizing the Management of Fertility in Women over 40
    Published online:
    15 September 2022
    Print publication:
    06 October 2022, pp 98-105

  • 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.

  • Chapter 19 - Infertility counseling

  • Edited by Gab Kovacs
  • Book:
    The Subfertility Handbook
    Published online:
    06 December 2010
    Print publication:
    11 November 2010, pp 211-224

  • Summary

    Women are delaying childbirth and trying to conceive when they are over 35 years old and at this age their chances of achieving a pregnancy with their own oocytes suffer a progressive and dramatic drop. The main indications for which a woman undergoes oocyte donation are usually occult ovarian failure, advanced age and repeated failure of in vitro fertilization (IVF). The women who donate oocytes are young, with no previous pathology and with a high reproductive potential. This explains the high clinical pregnancy rates that are usually achieved with this treatment. Patients with ovarian failure due to Turner syndrome attend hospitals asking to be included in the oocyte-donation programs. It is very important to remember that in women with Turner syndrome, the risk of aortic dissection or rupture during pregnancy may be 2% and the risk of death during pregnancy is increased as much as 100-fold.

  • 14 - Surgical management of anovulatory infertility in polycystic ovary syndrome

  • Edited by Adam Balen, University of Leeds, Stephen Franks, Roy Homburg, Sean Kehoe
  • Book:
    Current Management of Polycystic Ovary Syndrome
    Published online:
    05 July 2014
    Print publication:
    01 October 2010, pp 165-172

  • Summary

    The surgical management of anovulatory infertility in polycystic ovary syndrome (PCOS) has traditionally involved the use of clomifene citrate and then gonadotrophin therapy or laparoscopic ovarian surgery in those who are clomifene-resistant. Laparoscopic ovarian surgery is a useful therapy for anovulatory women with PCOS who need a laparoscopic assessment of their pelvis or who live too far away from the hospital to be able to attend for the intensive monitoring required for gonadotrophin therapy. Commonly employed methods for laparoscopic surgery include monopolar electrocautery (diathermy) and laser. The risk of periovarian adhesion formation can be reduced by abdominal lavage and early second-look laparoscopy, with adhesiolysis if necessary. The chance of achieving a continuing pregnancy within 6 months is less than with carefully conducted ovulation induction with gonadotrophins but, if adjuvant ovulation induction agents are used in those who do not initially respond, the 12-month pregnancy rates are similar.

  • 28 - Evidence-based and cost-effective fertility investigation and treatment of older women: moving beyond NICE

  • from SECTION 8 - FERTILITY TREATMENT: SCIENCE AND REALITY – THE NHS AND THE MARKET
  • Edited by Susan Bewley, William Ledger, University of New South Wales, Sydney, Dimitrios Nikolaou
  • Book:
    Reproductive Ageing
    Published online:
    05 February 2014
    Print publication:
    01 June 2009, pp 293-302

  • Summary

    Summary data from the Human Fertilisation and Embryology Authority (HFEA) give a comprehensive overview of outcomes of in vitro fertilization (IVF) in the UK. The National Institute for Health and Clinical Excellence (NICE) guideline took an evidence-based approach to the whole literature on infertility management and encompassed activity across primary, secondary and tertiary care. The tertiary care aspect was largely focused on assisted reproductive technologies (ART) and advanced pelvic surgery. NICE funding advice is based on complex cost-effectiveness modelling designed to provide cost per quality-adjusted life years (QALYs) gained as a result of the intervention under consideration. Pregnancy rates are affected by the factors that include the case mix of the clinic, with clinics that predominantly treat less complex cases. Fewer older women or cases with less extended durations of failure to conceive being likely to have higher success rates.