Managing Assisted Reproduction in Women of Advanced Age

There are significant ethical considerations and medical (maternaland fetal) complications related to pregnancy in peri- andpost-menopausal women.Female infertility, pregnancy loss, fetal anomalies, stillbirth,and obstetric complications are more common in advanced reproductiveage.Oocyte donation reverses the age-related decline in implantationand birth rates of women in their ۴۰s and ۵۰s and restorespregnancy potential beyond menopause.The risk of medical complications can be mitigated by carefulmedical screening of the mother and the use of ARTs in healthywomen. In these instances, a woman of advanced maternal agewho is otherwise healthy can carry a pregnancy with a similarrisk profile to that of her younger counterparts when usingdonated oocytes. However, obstetrical complications in olderpatients remain high, particularly related to operative deliveryand hypertensive and cardiovascular risks. A thorough medicalevaluation designed to assess the physical fitness of a patientfor pregnancy before deciding to attempt transfer of embryos toany woman of advanced reproductive age (>۴۵ years). Embryotransfer should be strongly discouraged or denied to women ofARA with underlying conditions that increase or exacerbateobstetrical risks. Because of concerns related to the high-risknature of pregnancy, as well as longevity, treatment of womenover the age of ۵۵ should generally be discouraged.