Reversing the Natural Decline in Human Fertility

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Abstract
Objective. —To evaluate the effect of age on pregnancy success rates in functionally agonadal women undergoing oocyte donation. Design. —A prospective study of 100 consecutive patients using oocyte donation for the treatment of infertility. Patients. —Women aged 40 years and above requesting oocyte donation (N=104) were required to undergo medical, reproductive, and psychological screening. Suitable candidates (n=65) were matched with an oocyte donor whose cycle was synchronized with that of the potential recipient, prior to the donor's undertaking ovarian hyperstimulation and transvaginal ultrasound—directed follicle aspiration. Outcomes were compared with those of two groups undergoing therapy at the same time: (1) women below 40 years of age undergoing oocyte donation for premature ovarian failure (n=35) and (2) women 40 years of age and above undergoing standard in vitro fertilization and embryo transfer using their own oocytes (n=57). Main Outcome Measures. —Embryo implantation and pregnancy rates. Setting. —The in vitro fertilization program of the University of Southern California and the California Medical Center, Los Angeles. Results. —Improved outcomes were observed with regard to fertilization rates in vitro, number of embryos transferred, embryo implantation rate, clinical pregnancy rates, and ongoing or successfully completed pregnancy rates when women undergoing oocyte donation regardless of age were compared with women 40 years of age and above using their own oocytes. No age-related decline in fertility was demonstrable when oocyte donation was used, with a mean age of 44.3±3.1 years for those successfully conceiving (range, 40 to 52 years). Perinatal outcomes (n=27) were generally uncomplicated, with a mean gestational age at delivery of 38.4±2.1 weeks (range, 34 to 42 weeks), although multiple births occurred in 24.1% of cases. Conclusions. —The age-related decline in female fertility may be reversed in couples electing to use donated oocytes from a younger woman, and women of advanced reproductive age may conceive, carry, and give birth to infants with success rates similar to those of their younger counterparts using assisted reproductive methods. (JAMA. 1992;268:1275-1279)