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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.
Â
4.
5.
6.
Â
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.
Â
10.
Concurrent Loss in
Quantity AND Quality
11.
12.
Abnormalities in oocytes
increase with age
13.
Â
14.
15.
Â
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
Antral follicle count
AFC = 18 AFC= 4
26.
27.
Â
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 ï Poor Responders 38.9% 14.5% P = 0.001
35.
Decreased AFC 10
20 30 40 AFC Age # Follicles Reproductive window
36.
37.
Â
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.
Â
47.
Â
48.
49.
Â
50.
Â
51.
IVF â Pregnancy
and Livebirth CDC 2004
52.
53.
54.
55.
Thank you for
your attention