To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure email@example.com
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Because studies of older and, otherwise, unfavorable patients going through in vitro fertilization (IVF) treatments with own (autologous) oocytes are sparse, we here present to a large degree the subjective experience of only one fertility center in New York City, which as of this point contributed a majority of published studies on this subject. As US national IVF data registries by the Center for Disease Control and Prevention (CDC) and the Society for Assisted Reproductive Technologies (SART) demonstrate, this center serves the by-far oldest patient population among over 500 reporting US IVF centers and, therefore, likely the oldest patient population of any IVF center in the world. While the median age of all US centers reporting to the CDC in 2016 was 36 years, this center’s median age was 42 years in 2016 and 43 years in 2017 and 2018. Over 90 percent of the center’s new patients in recent years reported prior failed IVF cycles, often at multiple centers. Over half of the center’s patients are so-called long-distance patients from outside the larger New York City Tri-State area, many from Canada and overseas. Finally, in excess of 95 percent of the center’s patients suffer from LFOR, which means that even younger patients usually demonstrate abnormally high age-specific follicle-stimulating hormone (FSH) and abnormally low anti-Müllerian hormone (AMH). This center, thus, overall, likely, serves the poorest-prognosis patient population of any IVF center in the world.
The utilization of dehydroepiandrosterone (DHEA) not only improves treatment results in women with diminished ovarian reserve (DOR) but also leads to a modified understanding of the ovarian aging process. The investigation of DHEA as a supplement to decrease aneuploidy among normal older patients, akin to folic acid for prevention of neural tube defects would seem useful. Accurate and timely diagnosis allows for timely treatments. Patients initiate treatment at least six weeks before in vitro fertilization (IVF), and continue supplementation until a second, normally rising pregnancy test (or treatment termination). All patients receive intravaginal and intra-muscular progesterone support in the luteal phase, based on the understanding that the functionally older ovary requires more progesterone support. DHEA-supplemented patients with DOR repeatedly outperformed controls in practically all IVF outcome parameters. Improving anti-mullerian hormone (AMH) values represent a positive prognostic sign during DHEA supplementation.