Introduction
With changing social norms and increasing numbers of women delaying childbirth, advanced maternal age (AMA)—typically defined as 35 years and older—has become a focal point in fertility medicine. A recent meta-analysis and systematic review over 151 studies provides vital insights for patients and clinicians navigating IVF success rates, treatment options, and challenges for AMA patients.
No One-Size-Fits-All Protocol: Evidence shows there’s no clear advantage of a specific IVF stimulation protocol, type of FSH medication, or routine addition of LH for AMA patients. The review found similar clinical pregnancy and live birth rates across most protocols, highlighting the need for individualized treatment decisions.
Limited Benefit from Routine Interventions: Strategies like ICSI (intracytoplasmic sperm injection), assisted hatching (AH), and routine use of preimplantation genetic testing for aneuploidy (PGT-A) do not consistently improve live birth rates for older patients. In fact, meta-analysis points to a potential harmful effect from routine AH, with lower live birth rates observed.
Embryo Transfer and Genetic Testing: Transferring multiple embryos may increase birth rates but also raises risks of multiple pregnancies; single embryo transfer is preferred when possible. PGT-A showed similar live birth rates as no testing, warranting financial and clinical discussion before use.
Ongoing Research Needed: The study concludes that more high-quality randomized controlled trials are needed to guide optimal IVF care for advanced maternal age patients, as evidence is sparse and sometimes conflicting.
Challenges for Advanced Maternal Age IVF Patients
The natural decline in ovarian reserve, increased rates of egg aneuploidy, and higher miscarriage risks make IVF outcomes less predictable and more complex for older women. As one expert states, “While AMA patients present with lower ovarian reserve and poorer embryo quality, the right treatment strategy remains elusive and must be adapted to individual needs”. The review encourages clinicians and patients to weigh risks, long-term safety data, and costs of interventions carefully.
Conclusion
For women undergoing IVF at an advanced maternal age, there is no universally superior protocol or intervention. Instead, the review suggests a personalized approach, informed by the latest evidence and aligned with patient values and clinical realities. As research continues, ongoing dialogue between patient and clinic remains key in navigating the complex world of fertility medicine for older patients.
"Available evidence does not support routine interventions in IVF solely due to advanced maternal age.”
