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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

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.

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Publisher: Cambridge University Press
Print publication year: 2022

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