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Advanced Reproductive Age and Fertility

Because the ART industry is largely unregulated, we have very little data on who uses these technologies. Until 2003, the only national data collected was through the Fertility Clinic Success Rate and Certification Act of 1992, which requires that fertility clinics report the number of pregnancies and live births from ART, which the Act defines narrowly as “fertility treatments in which both eggs and sperm are handled in the laboratory” (e.g., in vitro fertilization and related procedures) and excludes treatments such as fertility drugs or alternative insemination (also known as artificial insemination). The only demographic data collected is women’s. | SOGC CLINICAL PRACTICE GUIDELINE No. 269 November 2011 Advanced Reproductive Age and Fertility Abstract This clinical practice guideline has been prepared by the Reproductive Endocrinology and Infertility Committee reviewed by the Family Physicians Advisory Committee and the Maternal-Fetal Medicine Committee and approved by the Executive and Council of the Society of Obstetricians and Gynaecologists of Canada. PRINCIPAL AUTHORS Kimberly Liu MD Toronto ON Allison Case MD Saskatoon SK REPRODUCTIVE ENDOCRINOLOGY AND INFERTILITY COMMITTEE Anthony P. Cheung MD Co-Chair Vancouver BC Sony Sierra MD Co-Chair Toronto ON Saleh AlAsiri MD Vancouver BC Belina Carranza-Mamane MD Sherbrooke QC Allison Case MD Saskatoon SK Cathie Dwyer RN Toronto ON James Graham MD Calgary AB Jon Havelock MD Burnaby BC Robert Hemmings MD Montreal QC Francis Lee MD Winnipeg MB Kimberly Liu MD Toronto ON Ward Murdock MD Fredericton NB Vyta Senikas MD Ottawa ON Tannys D.R. Vause MD Ottawa ON Benjamin Chee-Man Wong MD Calgary AB Disclosure statements have been received from all members of the committee. Key Words Ovarian aging advanced reproductive age assisted reproductive technology Objective To improve awareness of the natural age-related decline in female and male fertility with respect to natural fertility and assisted reproductive technologies ART and provide recommendations for their management and to review investigations in the assessment of ovarian aging. Options This guideline reviews options for the assessment of ovarian reserve and fertility treatments using ART with women of advanced reproductive age presenting with infertility. Outcomes The outcomes measured are the predictive value of ovarian reserve testing and pregnancy rates with natural and assisted fertility. Evidence Published literature was retrieved through searches of PubMed or Medline CINAHL and The Cochrane Library in June 2010 using appropriate key words ovarian aging ovarian reserve advanced maternal age advanced paternal