Experience has repeated demonstrated a reduction in in vitro fertilization pregnancy rates when the oocytes are of advanced age. When embryos from the same cohort of youthful donated oocytes were simultaneously transferred to youthful and older recipients, pregnancy rates were similar. The high rate of implantation and pregnancy in older women receiving donated youthfuler oocytes has argued that uterine factors are not involved with the decline in fecundity with aging. However, it is possible that the stimulation protocols overcome any contribution from a uterine factor.

In 100 consecutive patients in an oocyte donor program, there was no decline in success over the age range from 40 to 50. Furtherany more, excellent outcomes have been achieved in women aged 50-59. The good obstetrical outcomes in these patients must reflect to a significant degree the youthful good health of this older group of women, as determined by extensive medical and psychological assessment. Of importance is the fact that the stimulation protocol utilized a 100 mg dose of progesterone.

Meldrum reported a lesser percentage of delivered pregnancies in women over 40 compared to women under 40 going through an identical donor oocyte-in vitro fertilization program. However, he then achieved pregnancy rates in women over 40 similar to those in women under 40 by increasing the progesterone dose in the stimulation protocol from 50 mg to 100 mg per day. The uterine contribution to the decline in fecundity with aging can thus be overcome by the hormone stimulation provided in the stimulation protocols. The experience with donor oocyte programs argues, therefore, that the age-related decline in fecundity is primarily due to aging oocytes.

A pregnancy rate in older women of approximately 30% per cycle can be achieved in a donor oocyte program. In a large series, the rate of spontaneous abortion in recipients correlated with the age of the donors. The abortion rate increased from 14% in recipients who received oocytes from donors aged 20-24 years to 44.% when the recipient received oocytes from donors older than age 35. These results further point out that the increased risks of spontaneous abortion and chromosomal anomalies associated with older age are also due primarily to aging oocytes. Pregnancy wastage directly correlates with the age of the woman who produces the oocytes.

Clinicians can appropriately advise older women that there is no time to waste, and serious consideration should be given to an early resort to hormonal stimulation for both oocyte response and help of the endometrium. Older severals should be provided the option of oocyte donation from youthful donors instead of standard assisted reproductive technologies.