ICSI in the management of age related infertility (ARI); reality or mirage ?

Document Type : Letters to the Editor

Author

1 Obstetrics and Gynecology, Department, Faculty of Medicine, Alexandria University, Egypt.

2 Egyptian Foundation of Reproductive Medicine and Embryology (EFRE), Egypt.

Abstract

Advanced maternal age (AMA) is associated with a decline in ovarian reserve, increase in the number of genetically abnormal embryos and increased risk of genetically abnormal pregnancy. This phenomenon starts from mid-thirties and when age exceeds 43 AMH declines below 0.1 and number of oocytes becomes less than 5000. It is estimated that for 95% of women by the age of 30 years only 12% of their maximum pre-birth non growing follicles (NGF) population is present and by the age of 40 years only 3% remain. Conventional ICSI, with no clinical or laboratory adds on is not a good treatment option for infertile women over 40 (ARI). Social freezing at young age preserves fertility and avoids ineffective treatment at later years. In absence of social freezing modification of laboratory (PGTA) or clinical protocols (adds on) may be carefully offered when possible. Chances of natural conception are realistic and have to be properly presented to the couples before they choose their treatment or after failure of ICSI attempt. Proper action plan can be only determined based on a well designed RCT which is definitely needed to solve current limitation of practice.

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