Assis ted Reproduction Techniques Challenges andManagement Options

Reproductive aging has become an important social and medicalissue. Today, in our modern society, the proportion of womenwho delay childbearing until the fourth decade of life has increased increasedgreatly over time. The reasons can be associated withthe high education level, the career goals, the desire of economicindependence of woman, the highly effective contraception, thelegalization of abortion and, las t but not the leas t, the commonidea that assis ted reproductive technology (ART) can compensatefor the natural decline in infertility with age. This misperceptionabout the “rejuvenation effect” of ART is due to thelack of knowledge of their reproductive sys tems and to growingpopularity ART. This trend is presenting new challenges to fertilityspecialis ts who are witnessing an increase in the number ofwomen seeking a pregnancy after ۳۵ years. Routinely, a womanat ۳۵ or more than ۳۵ years old is defined woman with advancedmaternal age (AMA). However the blas tocys t aneuploidy rateincreases after ۳۵ but it becomes more pronounced after age ۴۰infact up to an embryonic aneuploidy rate of ۹۰% when womenare ۴۴ years old. This phenomenon means that the percentagesto obtain a live birth at ۴۳-۴۴ is approximately ۵%. For this reasonin women with AMA, rather than trying to conceive for oneyear prior to having an infertility evaluation, the infertility workup is recommended after ۶ months of regular unprotected intercourseor as soon as possible if there are any known clinical conditionsthat can negatively impact reproductive potential. Thisevaluation will include the evaluation of ovarian reserve markerssuch as AMH and AFC, as well as all the possible factorsthat could have an impact on getting pregnant including not onlyuterine factor, thyroid function, coagulation disorders, previouschlamydial infections, tubal patency but also sperm quality. Ofnote, there are no specific additional tes ts or set guidelines forAMA patients candidate for IVF. However, ca. ۲۵% of couplesmay be affected from unexplained infertility and the goalbecomes to achieve a pregnancy even without treating any specificpathology (idiopathic infertility). Unfortunately, althoughthe decrease of woman fertility with age is well known, manytimes an increasing number of women arrive too late for the firs tinfertility counseling. Moreover, the growing use of ART andthe incorrect information from mass media, determined in thepeople the wrong idea that the right moment of life for becomingparents can be delayed beyond the physiological fertile age.To provide the right treatment for the right patient at the righttime is an important duty, which requires solid knowledge in thefields of ovulatory physiology and disorders, pharmacotherapyand surgical management, but also in IVF s trategies, as advancesin reproductive medicine are extremely rapid and often involvethe introduction of new Methods, protocols, and technologies.Finally, although many different IVF add-ons are available, butvery few are supported by s trong scientific evidence of safetyand effectiveness. For this reason, it is important to considerwhen you chose any add-ons: cos t, risk and Evidence.