Fertility and Maternal Age

Strategies to Improve Pregnancy Outcome

Authors

  • LEWIS KREY,

    Corresponding author
    1. Program for In Vitro Fertilization, Reproductive Surgery, and Infertility, Department of Obstetrics and Gynecology, New York University School of Medicine, New York, New York 10016, USA
    • Address for correspondence: Lewis Krey, Ph.D., Program for In Vitro Fertilization, Reproductive Surgery, and Infertility, NYU School of Medicine, 660 First Avenue, New York, NY 10016. Voice: 263-6418; fax: 263-0059; KREYIVF@yahoo.com.

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  • HUI LIU,

    1. Program for In Vitro Fertilization, Reproductive Surgery, and Infertility, Department of Obstetrics and Gynecology, New York University School of Medicine, New York, New York 10016, USA
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  • JOHN ZHANG,

    1. Program for In Vitro Fertilization, Reproductive Surgery, and Infertility, Department of Obstetrics and Gynecology, New York University School of Medicine, New York, New York 10016, USA
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  • JAMIE GRIFO

    1. Program for In Vitro Fertilization, Reproductive Surgery, and Infertility, Department of Obstetrics and Gynecology, New York University School of Medicine, New York, New York 10016, USA
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Abstract

In humans, the live birth rate drops precipitously with increasing maternal age, and this decline is associated with increases in the incidence of oocyte and embryo aneuploidy. Preimplantation aneuploidy screening has improved pregnancy outcome by significantly lowering the miscarriage rate. Nevertheless, aneuploidy screening only identifies the affected embryos; it does not attempt to correct the underlying biologic problem. Anomalies in chromosome segregation can result from a dysfunctional first or second meiotic division in the egg or develop after fertilization during the first few mitoses of early embryonic development. In both instances, ooplasmic anomalies may account for the nuclear problem. Low cell levels of cytoplasmic proteins (e.g., cytoskeletal elements, enzymes, energy stores, cell cycle regulatory proteins) may lead to a dysfunctional division of chromosomes during egg maturation or following fertilization. Ooplasmic injection is a micromanipulation technique that has produced pregnancies in patients with a history of poor-quality, fragmented embryos. Germinal vesicle transfer is a research procedure used to investigate the ooplasmic-nuclear interplay regulating cell cycle, maturation, and fertilization. Both these techniques may prove to be effective in improving the quality of eggs from patients of advanced maternal age.

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