28 - Evidence-based and cost-effective fertility investigation and treatment of older women: moving beyond NICE

Summary

Introduction

The management of infertility has been revolutionised by the development of assisted reproduction technology (ART), especially in vitro fertilisation (IVF), over the past 30 years. Many serious barriers to success have been overcome through being bypassed. Important examples include overcoming tubal damage by IVF and severe oligospermia/azoospermia being overcome through intracytoplasmic sperm injection (ICSI) in IVF, possibly in combination with epididymal or testicular sperm retrieval. An area where ART has not had such clear success has been in addressing the negative effect of a woman's age advancing to the stage where there is deterioration in ovarian response and/or egg quality. The consequence is a reduced chance of conception with advancing age.

There is no specific threshold age at which reproductive ageing becomes critical. However, it is possible to draw conclusions about average performance and it is clear that reproductive performance declines noticeably between the ages of 35 and 40 years. This affects outcomes at every level of intervention in infertility management but the effect is most readily measured in the IVF context because of the complete data sets that are available.

In general, where a woman is older and seeking fertility assistance it is important that any delay in initiating treatment is minimised. Similarly, it is important that such a couple would come forward to seek help relatively early in the manifestation of the problem.