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Chapter 4 - Diagnostic Testing of Reproductive Aging

from Section 4 - Rethinking and Redefining “Family Planning” for the Twenty-First Century

Published online by Cambridge University Press:  15 September 2022

By
Tanya L. Glenn  and
David B. Seifer
Edited by
Dimitrios S. Nikolaou  and
David B. Seifer
Dimitrios S. Nikolaou
Affiliation:
Chelsea and Westminster Hospital, London
David B. Seifer
Affiliation:
Yale Reproductive Medicine, New Haven, CT
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Summary

Recently there has been an increase in age-related infertility, termed ‘reproductive aging’, in which both quantity and quality of oocytes decline. Various established ways to analyze oocyte quantity include assessing age, follicle stimulating hormone, antral follicle count, and anti-Mullerian hormone. Each test has strengths and weaknesses inherent to the test itself and there can be concern when the tests are discordant. Additionally, several algorithms have been proposed that assess multiple elements to predict live birth rates per transfer and most recently cumulative live birth rates per retrieval. Knowledge about fertility has been assessed in several survey-based studies. These surveys illustrate a limited understanding of the participants regarding the impact of age-related fertility decline and a lack of realistic expectations regarding the limitations of IVF or egg cryopreservation to preserve the age-related decline in fertility. Additionally, there are inconsistencies in whether women would choose to have ovarian reserve testing and whether this would alter management. Lastly, emotional response after receiving ovarian reserve testing is also highly variable. This encourages providers to have a conversation about potential ramifications of testing.

Keywords

Age-related infertilityovarian reserveoocyte quantityoocyte qualityageAFCAMHalgorithmsfertility knowledgeemotional response
Type
Chapter
Information
Optimizing the Management of Fertility in Women over 40 , pp. 39 - 55
Publisher: Cambridge University Press
Print publication year: 2022

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