Currently, no therapy exists to counteract infertility in women of advanced maternal age and we can only try to limit this biological and social issue.

First, fertility preservation through egg freezing (egg banking) provides a valuable option to all women (not only oncological patients) aiming to prevent the natural decline of oocyte competence. The age at which fertility preservation is performed is critical (<35 years is preferable), and results are very encouraging,

Second, tailoring the controlled-ovarian-stimulation is crucial to increase the number of oocytes collected, thereby also increasing the chance of success after IVF for each individual patient. A higher number of oocytes collected per IVF cycle might indeed compensate for the decrease in both oocyte quantity (i.e., ovarian reserve) and quality (i.e., competence). Therefore, novel strategies, such as oocyte/embryo accumulation (banking) in consecutive cycles, or double ovarian stimulation in the same ovarian cycle, have been proposed to shorten the time invested by women with low ovarian reserve patients in their pursuit of a live birth.

Third, the enhancement of embryo selection through preimplantation-genetic-testing (PGS) represents another important option. In fact, the goal of ART is to achieve the birth of a healthy child minimizing the risks for the patient, and this is particularly true in women of advanced age when the incidence of embryonic chromosomal abnormalities (aneuploidies) dramatically increases. This approach, by avoiding the transfer of abnormal (aneuploid) blastocysts and their related risks (i.e., implantation failures, miscarriages, and affected child), should result in an increased efficiency of each IVF treatment. Importantly, once an euploid blastocyst is identified, its implantation potential is independent of maternal age (around 50%), thereby allowing the adoption of a single-embryo-transfer policy also in older patients, concurrently lowering the risk for multiple gestations and their related obstetrical/perinatal risks and increased cost to the health system.

Finally, egg donation represents a very effective approach to circumvent the age-related fertility decline. Recently, the optimization of egg freezing techniques and the constitution of egg-banking facilities have allowed us to avoid the complexity of synchronization of cycles between donors and recipients. Indeed, similar success rates derive from either fresh or frozen eggs.

For further information please call Sher Fertility Institute New York at (646) 792-7476