Abstract
The overall success of human reproduction, either spontaneously or after IVF, is highly dependent upon maternal age. The main reasons for age-related infertility include reduced ovarian reserve and decreased oocyte/embryo competence due to aging insults, especially concerning an increased incidence of aneuploidies and possibly decreased mitochondrial activity. Age-related chromosomal abnormalities mainly arise because of meiotic impairments during oogenesis, following flawed chromosome segregation patterns such as non-disjunction, premature separation of sister chromatids, or the recent reverse segregation. In this review, we briefly discuss the main mechanisms putatively impaired by aging in the oocytes and the deriving embryos. We also report the main strategies proposed to improve the management of advanced maternal age women in IVF: fertility preservation through oocyte cryopreservation to prevent aging; optimization of the ovarian stimulation and enhancement of embryo selection to limit its effects; and oocyte donation to circumvent its consequences.
Highlights
Human reproduction success is highly dependent upon the age at which women attempt to conceive, which is progressively increasing worldwide [1, 2]
Ottolini and colleagues recently reported, via the karyomapping technique applied to artificially activated human oocytes and their polar bodies, that the most common non-canonical segregation pattern is reverse segregation [26]
According to this novel segregation scheme, which cannot be identified by conventional copy number analysis, the non-sister chromatids, instead of the homologous, segregate together in meiosis I
Summary
Human reproduction success is highly dependent upon the age at which women attempt to conceive, which is progressively increasing worldwide [1, 2]. The molecular and biochemical mechanisms involved in age-related infertility and their impact on oocyte and embryo quality remain to be clearly elucidated. Together with a progressive reduction of the ovarian reserve, woman aging involves a compromised competence of the oocytes/embryos because of defective physiological pathways, such as energy production and balance, metabolism, epigenetic regulation, cell cycle checkpoints, and increased meiotic missegregation [11, 12]. We provide a summary of the main putative causes for the age-related decrease in oocyte/embryo competence, along with the mechanisms underlying aging and the main clinical strategies proposed to prevent/limit the impact of AMA upon IVF success
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