Prominent fertility experts challenge current IVF practice in older women that automatically resorts to third-party egg donation
For release on June 9, 2020
June 9, 2020 (New York, NY) - The U.S. is suffering from a number of unprecedented trends in national reproduction: Except for older women over age 38 in whom birth rates actually have been increasing, national birth rates are at the lowest in recent history. This trend is fed by two related phenomena: (i) women are delaying childbirth; and (ii) women are delaying childbirth into ever-older ages. Consequently, patients seeking out fertility services have been increasing in numbers and are getting older and older.
At the same time, the potential that a woman will successfully conceive and deliver a healthy child, whether spontaneously or through infertility treatments, declines with advancing age and does so especially rapidly after ages 38-40. This decline is mostly caused by declining pregnancy potential of eggs, which translates into declining pregnancy potential for embryos produced with these eggs. If a woman's own eggs are used, after ages 42-43, even most advanced fertility treatments, including in vitro fertilization (IVF), result in very limited treatment success. National annual IVF outcome statistics reported by the Centers for Disease Control and Prevention (CDC) demonstrate that the overwhelming number of IVF cycles performed in the U.S. in women after ages 42-43 utilize the eggs of young third-party egg donors, rather than the patients' own eggs. Donor egg cycles offer much higher pregnancy chances because of the young age of egg donors. Interestingly, the age of the uterus that receives embryos in an IVF cycle hardly matters.
Three prominent fertility experts now have challenged this current clinical practice in a just published paper , arguing that current IVF practice is the consequence of a self-fulfilling prophecy: As older women are pushed into egg donation by default, not only are they automatically deprived of any chance of genetic maternity and the right of self-determination as to what medical care to receive (an overwhelming majority of women, of course, would greatly prefer use their own eggs) but, in addition for decades, not even a minimal research effort has been mounted to improve IVF outcomes in older women with use of their own eggs.
In this context, the authors note the almost complete absence of studies in the global medical literature on how IVF outcomes could be improved in women above age 42-43. Uniquely, the IVF field has simply "given-up" on trying to improve IVF outcomes in older women with use of their own eggs. To emphasize this point, the authors point out that during early days of IVF in the 1980s, the IVF field was unable to achieve pregnancies in women above age 38. Had research then not advanced capabilities, even women as young as age 38 would still be treated with third-party egg donation to this day.
The three authors furthermore point out that the limited literature that is available regarding treatment of older women with use of their own eggs does demonstrate a degree of progress in at least selected older women. They urge in their commentary a more liberal clinical approach toward use of a woman's own eggs and increased research to improve IVF outcomes in older women with use of own eggs.
 Gleiche N, Barad DH, Adashi EY. Why is use of donor eggs not viewed as treatment failure? A call for improvements in treatments with autologous oocytes. J Assist Reprod Genet. 2020; http://doi.org/10.1007/s10815-020-01847-x
The lead author of the manuscript, Norbert Gleicher, MD, Medical Director and Chief Scientist of The Center for Human Reproduction (CHR) in NYC is available for further comments. Center for Human Reproduction (CHR) is a leading fertility clinical and research center with worldwide reputation for innovative and effective treatments for women with particularly difficult cases of infertility, with focus on diminished ovarian reserve (DOR) and associated conditions.
Norbert Gleicher, MD, FACOG, FACS
Norbert Gleicher, MD, leads CHR’s clinical and research efforts as Medical Director and Chief Scientist. A world-renowned specialist in reproductive endocrinology, Dr. Gleicher has published hundreds of peer-reviewed papers and lectured globally while keeping an active clinical career focused on ovarian aging, immunological issues and other difficult cases of infertility.
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