Abstract
This chapter addresses the role of the ovary in assisted reproductive technology (ART), the organ with the largest impact on ART success. It describes the decline in fertility with age and the relationship between increased aneuploidy and decreased oocyte quality and ovarian reserve. It also discusses ovarian stimulation, specifically the approach to low responders, hyperresponders, and the role of luteinizing hormone (LH) in ovarian stimulation. Assisted reproductive technology (ART) has become increasingly prevalent each year, with more than 360 ART programs available in 1999 and more than 88,000 cycles in the United States alone. In oocyte donor programs, rates were higher with a delivery rate per transfer of 41%, which is consistent with early research that showed higher success rates for older patients using oocytes from young donors. Therefore, the most important factor for the success of ART is oocyte quality, which is affected by ovarian age, whereas the age of the endometrium is less important. The biggest challenge continues to be treating women of advanced reproductive age who wish to use their own eggs.
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