Advanced age not only affects ovarian response during ovulation induction but also hampers embryo implantation rates and increases the risk of natural miscarriage. Although effective methods to overcome the challenges faced by older women are still lacking, identifying patients with poor ovarian reserve before treatment and finding ways to improve ovulation induction and embryo implantation can greatly assist these older women in achieving pregnancy.

 

Advanced age not only affects ovarian response during ovulation induction but also hampers embryo implantation rates and increases the risk of natural miscarriage. Although effective methods to overcome the challenges faced by older women are still lacking, identifying patients with poor ovarian reserve before treatment and finding ways to improve ovulation induction and embryo implantation can greatly assist these older women in achieving pregnancy.

 

A woman's fertility declines with increasing age. Looking at the monthly fertility rate for women, it is approximately 30% for those aged 19-25, 28% for 25-30, 17% for 30-35, 13% for 35-39, and 14% for 40-45. When considering the annual conception rate, it can reach 85% before the age of 34, 67% between 35-39, but only 40% beyond the age of 40. This is primarily due to the limited number of germ cells (eggs) in a woman's reproductive system, which cannot be replenished.

 

During fetal development (around 20 weeks), there can be as many as 6-7 million oogonia (egg precursor cells). At birth, this number reduces to 400,000-500,000, decreases to approximately 300,000 during puberty, and further declines to only about 25,000 by the age of 38. While women only release less than 400 eggs in their lifetime, the significant reduction in the number of ovarian follicles becomes apparent with age. These reductions are associated with a slight increase in follicle-stimulating hormone (FSH) and a decrease in inhibin, changes that cannot be detected through specific symptoms or significant alterations in menstrual cycles.

Furthermore, as age increases, the ability to release eggs decreases gradually, leading to anovulatory menstrual cycles. Even in cases of ovulation, the aging of eggs results in decreased fertility. Insufficient production of progesterone is also more common, affecting the implantation of fertilized eggs. Even if successful implantation occurs, spontaneous miscarriages are more likely.

 

Statistics show that the miscarriage rate at the age of 30 is 10%, but it increases to a staggering 35% for women over the age of 40. These factors contribute to the reduced likelihood of successful pregnancy for women over the age of 35. Therefore, women who desire to conceive should be aware of the timing and should assess ovarian reserve after the age of 35. Early consultation with a medical professional and discussion of appropriate strategies and technologies are essential for achieving a successful pregnancy.