Management of infertility over forty

Joelle Belaisch Allart (FR)

[Belaisch Allart] centre hospitalier des 4 villes

Management of infertility over forty Joelle Belaisch Allart Centre Hospitalier des 4 Villes 92110 Saint Cloud France. The population attempting pregnancy and having babies is ageing. The declining fertility potential and the late age of motherhood is increasing significantly the number of patients over forty consulting infertility specialists. Assisted reproductive technologies (ART) cannot compensate for the natural decline in fertility with age. In France, in public hospital, ART ( intra uterine insemination [IUI] or IVF/ICSI) is free of charge for women until 43 years , over 43 , social insurance does not reimburse ART, hence 43 years is the usual limit ,but between 40 and 42 is treatment useful and which treatment IUI or IVF/ICSI ? The answer varies according to physicians, couples or society. At the medical level, the etiology of the infertility must be taken into account. If there is an explanation to infertility (male or tubal infertility) ART is better than abstention. If the infertility is only due to age the question is raised. In France the reimbursement by the society of a technique with very low results is discussed. However efficacy is not absolutely compulsory in Medicine. On the opposite to give false hopes may be discussed too. To obtain a reasoned consensus is rather difficult. Oocyte preservation would offer an alternative to egg’s donation or to IVF/ICSI treatments with low results.