Genetics, age, and infertility

Objective: To review the genetics of aging specifically as it pertains to h uman fertility, as well as the recent advancements in the diagnosis of gene tic diseases prior to embryo implantation. Methods: A review of our own exp erience as well as the scientific literature with regards to the decline in female fertility with age, the success of IVF in women of older reproducti ve age, and the role of preimplantation genetic diagnosis (PGD) in the eval uation of the patient at risk for fetal genetic anomalies. Results: The dec line in female fertility occurs primarily as a result of a decline in oocyt e quality as well as quantity. The frequency of chromosomal anomalies in re cognized abortuses increases in parallel with the age-specific rise in the incidence of spontaneous abortions. PGD is an accurate diagnostic tool for exclusion of genetically deficient embryos prior to initiation of pregnancy . Conclusion: Reproductive failure in women of older age appears to be dire ctly related to ovarian age. Recent techniques such as cytoplasmic or germi nal vesicle transfer are designed to replace the senescent cellular machine ry believed to be responsible for genetic errors that occur during early ce ll division. PGD can accurately identify embryos with genetic deficiencies prior to implantation. (C) 1998 Elsevier Science Ireland Ltd. All rights re served.