Effect of ageing on ART success rates

Many older women turn to assisted reproductive technology (ART) in the hope that it can reverse the biological clock. Clinical Research Fellow Dr. Yvonne O’Brien recently carried out a study on the effect of increasing female age on IVF and ICSI success rates. This study found that ART success rates decrease after 40, and live birth rates can drop dramatically at age 42 years. Dr. O’Brien concludes that there is a responsibility to inform, educate, and empower women about their fertility options.


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Clinical indicators to identify women who should consider egg freezing

The average age at which women have their first child continues to increase worldwide. Advancing maternal age has a significant impact on fertility, and with increased education and access to health screening, women are turning to healthcare providers for an accurate assessment of whether they can delay starting a family. To make such an assessment, gynecologists need reliable tests, in addition to age, to predict a woman’s reproductive lifespan, and thus estimate her ovarian reserve.

A study led by Dr. Fiona Martyn (Consultant Obstetrician and Gynaecologist, MFC and NMH) and colleagues on 991 women attending fertility clinics at MFC and NMH found a significant relationship between serum AMH levels and endometriosis or a family history of premature ovarian insufficiency (POI). Among women with an AMH level of less than 5 pmol/L, the only significant risk factor was a family history of POI. This finding implies that many women with a very low AMH level will not be identified as at risk of early ovarian aging by clinical history alone.

Based on the findings of this study, Dr. Martyn concludes that with the advent and reliability of AMH testing, age should no longer be exclusively used to guide a woman about when to start a family. Clinicians are also advised to pay attention to a history of endometriosis and a family history of POI because these factors should prompt earlier testing of ovarian reserve and treatment if necessary or desired. Morever, universal AMH screening should be considered for all women in their 30s who are not ready to try to conceive. This work was recently published in the International Journal of Gynecological Obstetrics.

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Natural Killer Cells and Infertility

The role of natural killer (NK) immune cells in infertility is the subject of much controversy in reproductive medicine. It is important to note that circulating blood NK cells and NK cells found in the uterus have very different profiles and functions. Scientific studies in animals indicate that NK cells are in fact essential for pregnancy and development of the placental blood supply.

A recent collaborative study between Merrion Fertility Clinic and Trinity College Dublin found more immature uNK cells known as progenitors in endometrial tissue from women with endometriosis as compared to healthy patients, suggesting that uNK development is altered in the endometriotic uterus. Further analysis of these endometrial tissue samples revealed reduced levels of a growth factor called SCF in women with endometriosis, which may underlie the impaired maturation of uNK cells.


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Inflammatory Bowel Disease: Impact on Fertility and Pregnancy

Inflammatory bowel disease, including ulcerative colitis and Crohn’s disease, is increasing in the developed world. Disease onset is typically between the ages of 15-35 years old, i.e. at peak reproductive age. While women whose IBD is in remission appear to have fertility rates and pregnancy outcomes comparable with the general population, IBD disease activity is an established risk factor for adverse outcomes in pregnancy. As such, patients are advised to conceive during non-active or quiescent stages of disease and to maintain quiescence throughout pregnancy. Despite the associations of disease activity with infertility and adverse pregnancy outcomes, the biology underlying this association remains poorly understood. Beyond immediate pregnancy outcomes, there is even less known about how maternal disease during pregnancy may affect the child’s risk for developing IBD.

To outline some of the potential mechanisms involved, Prof Mary Wingfield and Dr. Louise Glover, in collaboration with the University of Colorado, recently conducted a literature review of the field. This review article, entitled Inflammatory Bowel Disease: Influence and Implications in Reproduction was published in November 2016 in the journal Inflammatory Bowel Diseases. 

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