Objective: A growing body of literature suggests that,
among some infertility patient populations, mild approaches
in assisted reproductive technology (ART) may result in
similar outcomes when compared to those utilizing
controlled ovarian hyperstimulation (COH). Given the
well-recognized decline in success of conventional in vitro
fertilization (IVF) with age, it is unclear whether mild approaches
in ART should be considered for women older
than 35 years. It is the aim of this paper to characterize the
role of natural cycle IVF, minimal stimulation IVF and in
vitro maturation (IVM) for women of advanced reproductive age.
Methods: A review and summary of the literature on mild
approaches in ART for women over the age of 35 years is
presented.
Results: Available evidence regarding natural cycle IVF
and its variants suggest that it should not be routinely
offered to women of advanced reproductive age, especially
over the age of 39. Data from centers well-experienced with
minimal stimulation IVF report per cycle live birth rates for
several subgroups of women older than 35 years that are
comparable to those in the 2010 US Assisted Reproductive
Technology National Summary Report. Limited data on
IVM suggests that it can be considered up until the age
of 40.
Conclusions: Recent additions to the literature provide new
insight into the efficacy of mild approaches in ART to
women of advanced reproductive age. Suboptimal study
designs, heterogeneity of protocols and variation in center
experience make definitive conclusions difficult however
there are several treatment options which would appear to
be reasonable for select patient populations. Future studies
addressing patient satisfaction, dropout rates and cost will
further define the role of mild approaches in ART for this
group of women.