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• W2163137316 abstract "For centuries, it has been clear that fertility declines dramatically as women age beyond their mid-thirties, with only rare pregnancies beyond age 45. In the past 10 years, markers of ovarian reserve in infertile patients have also been shown to strongly influence the potential for pregnancy and have come to guide the approach to diagnosis and treatment. These markers have included assessments of FSH, LH, estradiol, and inhibin in the early follicular (“basal”) phase and after ovarian stimulation (with a clomiphene citrate challenge test or GnRH agonist stimulation test, for example). In the current issue, van Rooij et al. (1van Rooij I.A. Bancsi L.F. Broekmans F.J. Looman C.W. Habbema J.D. te Velde E.R. Women older than 40 years of age and those with elevated follicle-stimulating hormone levels differ in poor response rate and embryo quality in in vitro fertilization.Fertil Steril. 2003; 3: 482-488Abstract Full Text Full Text PDF Scopus (159) Google Scholar) present a cohort study that neatly illustrates an important biological distinction between the effects of age and ovarian reserve, a distinction that has important clinical ramifications: ovarian reserve is a better predictor of egg production capacity than of egg quality, whereas age affects egg quality more than quantity. In that study, younger women with reduced ovarian reserve had a higher risk of cycle cancellation and produced fewer eggs than did women older than 40 years of age, but once eggs were retrieved, the younger women had near-normal implantation and pregnancy rates. In contrast, older women with normal ovarian reserve produced embryos with low pregnancy potential. This observation is not new (2Poe-Zeigler R. Toner J.P. Oehninger S. Muasher S.J. Basal FSH affects IVF pregnancy rates primarily by influencing oocyte numbers and not their quality.Fertil Steril. 1994; 63 ([abstract]): S8Google Scholar), but it serves as an important reminder. Accordingly, young women with abnormal ovarian reserve should be counseled differently than older women. Young women with abnormal reserve are at high risk for cycle cancellation and are apt to make few eggs no matter what stimulation protocol is used, but if some eggs are obtained, those eggs usually do well; overall pregnancy rates in these cases are typically higher than those in older women with normal ovarian reserve. (This principle is not likely to apply, however, when the FSH level is extremely elevated.) On the other hand, normal ovarian reserve in women older than 40 years of age does not predict high pregnancy rates and thus does not erase the effect of age. As a rule of thumb, remember that age is the better predictor of egg quality, and basal FSH level is the better predictor of egg number. Thus, ART can be attempted in young women with a high FSH level, since those who do not experience cycle cancellation often become pregnant despite low egg production." @default.
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• W2163137316 date "2003-03-01" @default.
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• W2163137316 title "Age = egg quality, FSH level = egg quantity" @default.
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• W2163137316 doi "https://doi.org/10.1016/s0015-0282(02)04840-9" @default.
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