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Fertility Treatment Options in Women Over 40 Years Old

  • Chapter
Perimenopause

Part of the book series: Serono Symposia USA ((SERONOSYMP))

Abstract

The choice of fertility treatments in women over 40 years old must in some cases be inferred from results achieved in younger women because specific information about women over 40 is often lacking. Expectations can be estimated from knowledge of the normal quantitative decline in fertility rates as age advances, and of the underlying mechanisms. The first evidence clearly demonstrating the true age-related decline inherent in women came from donor insemination studies, which completely control for coital frequency and the spouse’s age and fertility (Fig. 23.1) (1). Other early evidence of the impact of age on fertility treatment came from gonadotropin therapy to induce ovulation, by which coital timing should be optimized (Fig. 23.2) (2). These studies demonstrate, first, that some treatments are inherently inefficient, and are therefore unsuited to women over 40, who have no time to waste. Figure 23.1 shows that standard cervical insemination using cryopreserved semen, as is now mandatory, offers at best—in young women—less than a 10% chance of pregnancy each cycle, amounting to about 60% after 12 cycles. Figure 23.2 demonstrates that, at the time of the study (1980), gonadotropin treatment to induce ovulation in women with polycystic ovaries is similarly inefficient. More refined treatment regimens and monitoring including ovarian ultrasonography have recently been reported to have much improved the chance of success in women with polycystic ovaries (PCO) (3), but specific information related to age is lacking.

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Authors
  1. Michael G. R. Hull
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Editors and Affiliations

  1. Department of Obstetrics and Gynecology College of Physicians and Surgeons, Columbia University, New York, NY, 10032, USA

    Rogerio A. Lobo M.D.

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Hull, M.G.R. (1997). Fertility Treatment Options in Women Over 40 Years Old. In: Lobo, R.A. (eds) Perimenopause. Serono Symposia USA. Springer, New York, NY. https://doi.org/10.1007/978-1-4612-2288-0_23

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  • DOI: https://doi.org/10.1007/978-1-4612-2288-0_23

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4612-7488-9

  • Online ISBN: 978-1-4612-2288-0

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