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Presentation Marcelle
1.
How Old is
Too Old? Age, Genetics and Reproduction Marcelle I. Cedars, M.D. Director, Division of Reproductive Endocrinology UCSF
2.
3.
4.
5.
6.
7.
Normal Biological Decline
Gougeon, Maturitas, 30:137-142, 1998
8.
Percent Increase in
Birthrates CDC Vital and Health Statistics 2000 1976 1980 1985 1990 1995 35-39 30-34 40+ 15-19 25-29 20-24
9.
10.
Concurrent Loss in
Quantity AND Quality
11.
12.
Abnormalities in oocytes
increase with age
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
Antral follicle count
AFC = 18 AFC= 4
26.
27.
28.
29.
30.
31.
FSH Predicts Quantity,
but not Quality P=0.3 P=0.05 P=0.06 P=0.01
32.
AFC Predicts Quantity
and Quality p=0.014 p=0.048 p<0.001 p<0.001
33.
Age is
the Best Predictor of Quality IR = 28.4 IR = 15.9 p<0.001 PR = 28.7 PR = 46.7 p<0.001
34.
Quantity and Quality
IR 21.6% 22.6% P=0.78 IR Poor Responders 38.9% 14.5% P = 0.001
35.
Decreased AFC 10
20 30 40 AFC Age # Follicles Reproductive window
36.
37.
38.
39.
40.
Estradiol Priming addition
of luteal phase GnRH antagonist
41.
42.
Minimal Stimulation
43.
Minimal Stimulation Stimulation
Mild: closed Conventional: open
44.
45.
Androgen Pretreatment Balasch
et al., 2006 Transdermal testosterone 2.5mg over 5 days
46.
47.
48.
49.
50.
51.
IVF – Pregnancy
and Livebirth CDC 2004
52.
53.
54.
55.
Thank you for
your attention
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