1. Fertility at midlife
Prof. Duru Shah

2. The need for fertility at midlife
Career oriented women
Late marriages
Delayed childbearing
 rate of divorces
Re-marriage
Childhood cancer survivors  young women with low ovarian reserve

3. Infertility increases with age
29%
22%
15%
% infertility 9% 7%
Courtesy American Society for Reproductive Medicine 2007

4. Causes of poor Results in older women
Follicular atresia
↑ Spontaneous abortion rates due ↑ aneuploidy
↓ Endometrial Receptivity
↓ Oocyte Quality

5. The Rise And Fall Of Ovarian Reserve
7.0
5.0
3.0
1.0
0.3
Age (months) Age ( yrs )
Birth
5th month in uterus
7 million germ cells
Birth
2.6 to 4.7 million eggs/ovary
Menarche
5,00,000 eggs
Reproductive age
Follicles month
Menopause
Follicles  to < 100
Prevalence of diminished OR is 10% in the general infertility practice
Ref : N. S. Macklon Seminars in Reproductive Medicine 2005

6. Quantitative & Qualitative decline of follicle pool
Ref : Broekmans FJ et al Hum Reprod Update 12(6) , 2006