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Reproductive ageing in women is caused by declining number and quality of oocytes. The Royal College of Obstetricians and Gynaecologists (RCOG) should promote the view of a shared responsibility in addressing the problems associated with reproductive ageing and encourage an acknowledgement that personal and social circumstances play a role rather than placing blame on individuals. The RCOG should urge greater transparency and accuracy in depicting assisted reproductive technology success rates, including the cost and clinical efficiency of full cycles (full cycle implies cryopreservation of embryos). There are no contraceptive methods contraindicated by age alone. Older women may use combined hormonal contraception unless they have co-existing diseases or risk factors. Further research is needed into characterisation of existing and novel ovarian biomarkers to provide clinically useful prediction of current and future fertility. National data collection covers live births and terminations of pregnancy but should be expanded to include information about miscarriage.
This chapter presents a discussion between an number of experts on fertility. Each person presents his/her views on future fertility insurance. According to Herman Tournaye, vitrification will completely change the clinical approach that is present today. On the other hand Helen Picton says that even with vitrification, we have to have good eggs to vitrify. If we can get the quality of the egg right, vitrification of metaphase II (MII)'s is what we will see being used in clinical practice, and successfully. Roger Gosden feels that embryo freezing should be offered where possible. There is need to raise awareness of the possibility of 'early ovarian ageing'. When discussing screening for early ovarian ageing, and fertility insurance, the question is whether any of these tests could be transferred from the field of assisted reproduction to the general population to be used in asymptomatic young women to predict their future fertility.
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