An insight to women 40+: a paradigm shift from "the more is better" to "maximizing the outcome from few oocytes".

Document Type : Editorial

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1 Obstetrics and Gynecology department, Alexandria University, Egypt.

2 Egyptian Foundation of Reproductive Medicine and Embryology, Alexandria, Egypt.

Abstract

Low-dose ovarian stimulation protocols have gained increasing attention, particularly in the context of older women undergoing IVF, primarily due to concerns about diminished ovarian reserve, oocyte quality, and the potential risks associated with high-dose stimulation. These protocols aim to balance efficacy with reduced patient burden and potential side effects. The potential advantages are more natural approach, lower treatment burden and cost, and potential better oocyte quality and endometrial receptivity. Potential disadvantages include Need for careful patient selection, higher cycle cancellation, lower number of oocytes, and Lack of robust evidence for superiority in older women because most of the studies are underpowered. The age-related increase in oocyte aneuploidy remains a significant hurdle, regardless of the stimulation protocol. While low-dose protocols might optimize the quality of the few oocytes retrieved, they do not address the fundamental issue of increased aneuploidy rates. Preimplantation genetic testing for aneuploidy (PGT-A) might be considered in conjunction with low-dose protocols to select euploid embryos, but this adds to the cost and complexity of treatment, and the lower number of embryos available might limit its utility. In addition artificial intelligence predictive models will soon become an integral part of IVF 40+ management

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