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Evidence based IVF management in aging women

Evidence based IVF management in aging women. Prof. Bart CJM Fauser , MD, PhD Dept. Reprod Medicine & Gynecology University Medical Center, Utrecht, The Netherlands. Effect of age of women on fertility rate. Esablished populations Hutterites (1921-1930) Geneva (1600-1649)

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Evidence based IVF management in aging women

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  1. Evidence based IVF management in aging women Prof. Bart CJM Fauser, MD, PhD Dept. Reprod Medicine & Gynecology University Medical Center, Utrecht, The Netherlands

  2. Effect of age of women on fertility rate • Esablished populations • Hutterites (1921-1930) • Geneva (1600-1649) • Canada (1700-1730) • Normandy (1760-1790) • Tunis (1840-1859) • Normandy (1674-1742) • Norway (1874-1876) • Iran (1940-1950) Mencken, Science 1986

  3. Effect of age of women on miscarriage rate Nyboe Anderson, BMJ 2000

  4. HR 2009 Percentage of women

  5. Effect of age of women on live birth rate in IVF Templeton, Lancet 1996

  6. F&S 2010 OD=oocyte donation DS=donor sperm

  7. Pregnancy complication in nulliparous women in relation to age Gilbert, OG 1999

  8. The need for more patient tailoredovarian stimulation for IVF ? Hyperresponse = danger Hyporesponse = pooroutcome Ovarian response • Individualization; • femaleage • BMI • smoking • AMH / AFC • genetic markers Ovarian stimulation

  9. Accuracy of markers predicting poor response HRU 2006

  10. variability in menopausalage is related to preceedingdecreasedfertility

  11. Association poor response and menopause

  12. JCEM 2011 11.2 yr interval

  13. Desired outcome from ovarian stimulation for IVF

  14. Interventions aiming to increase the number of oocytes retrieved

  15. F&S 2009

  16. Advocated low response approaches- systemic review and meta-analysis Kyrou F&S 2009

  17. Conclusions 2011

  18. IVF in aged women- concluding statements • Age of women undergoing IVF is increasing every year • Ovarian aging gives rise to decreased outcomes • Ovarian aging/low response is irreversible • No effective intervention exists (next to oocyte donation) • Insufficiently studied area, deserves more attention

  19. Ovarian follicles in relation to age “we cannot stimulate follicles which do NOT exist” (Garcia Velasco)

  20. Reproductive Research GroupPhD students, and collaborators Rotterdam Pache, Schoot, vSantbrink, Schipper, Imani, de Jong, vHeusden Eijkemans, Mulders, Hohmann, Heijnen, Baart, de Klerk, vdGaast Blok, Laven, Macklon Utrecht Verberg, Knauff, vDisseldorp Janse, Voorhuis, Kasius, Verhulst, Broer, Hamdin, Sterrenburg Goverde, Broekmans, Heijnen International collaborations; Devroey (Brussels), Bouchard (Paris) Tarlatzis (Greece), Hsueh (Stanford)

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