An unfortunate group of women, often in their mid- to late 30s, find themselves in the position of being perimenopausal prematurely. For a few, this may occur because of loss of oocytes due to chemotherapy or autoimmune disease. However, for the majority, the reason for the low ovarian reserve is unclear, perhaps simply having fewer oocytes colonising the gonads ab initio. These women often are identified for the first time when they seek help for subfertility and are found to have raised, or sometimes normal, follicle-stimulating hormone levels but are found to be less responsive than expected to follicular induction for in vitro fertilisation (IVF).

Currently, little can be offered other than receipt of oocytes from another source or adoption. Oocyte donation in itself brings both practical and ethical problems (see Chapters 21 and 26). Not surprisingly, owing to demand of the desperate, a number of alternatives have been entertained. The use of fetal oocytes from the many therapeutic abortions undertaken annually has been an option considered. Although a source of numerous oocytes, the mere suggestion provoked a furore of correspondence and public and professional condemnation. The thought that a resulting child would have no identifiable genetic mother or would have ‘a dead fetus as a mother’ made it unacceptable. Reproductive cloning where a somatic cell nucleus from the woman could be used as the source for maintaining the genetic link has also been considered.