Abstract
This is a short review of the basic molecular mechanisms of ovarian aging, written with a particular focus on the use of this data to improve the diagnostic and therapeutic protocols both for women affected by physiological (age-related) ovarian decay and for those suffering premature ovarian insufficiency. Ovarian aging has a genetic basis that conditions the ovarian activity via a plethora of cell-signaling pathways that control the functions of different types of cells in the ovary. There are various factors that can influence these pathways so as to reduce their efficiency. Oxidative stress, often related to mitochondrial dysfunction, leading to the apoptosis of ovarian cells, can be at the origin of vicious circles in which the primary cause feeds back other abnormalities, resulting in an overall decline in the ovarian activity and in the quantity and quality of oocytes. The correct diagnosis of the molecular mechanisms involved in ovarian aging can serve to design treatment strategies that can slow down ovarian decay and increase the quantity and quality of oocytes that can be obtained for an in vitro fertilization attempt. The available treatment options include the use of antioxidants, melatonin, growth hormones, and mitochondrial therapies. All of these treatments have to be considered in the context of each couple’s history and current clinical condition, and a customized (patient-tailored) treatment protocol is to be elaborated.
Highlights
The importance of issues related to ovarian aging has been increasing progressively over the past several decades since, increasingly, more couples in all developed countries choose to postpone parenthood to more advanced female ages [1]
This trend is associated with an increasing rate of aneuploidy in oocytes, causing chromosomal abnormalities in embryos resulting from natural conception, conventional in vitro fertilization (IVF), or intracytoplasmic sperm injection (ICSI) [2,3]
Primary ovarian insufficiency (POI) is the most frequent cause of early menopause, which occurs in about 10% of women before 45 years of age and in 1–2% before 40 years [4], while fertility impairment starts around 20 years before the menopause [7]
Summary
The importance of issues related to ovarian aging has been increasing progressively over the past several decades since, increasingly, more couples in all developed countries choose to postpone parenthood to more advanced female ages [1]. This trend is associated with an increasing rate of aneuploidy in oocytes, causing chromosomal abnormalities in embryos resulting from natural conception, conventional in vitro fertilization (IVF), or intracytoplasmic sperm injection (ICSI) [2,3]. A better knowledge of the factors and mechanisms causing age-related or premature ovarian decay is needed to optimize diagnostic tests and tune treatment options so as to reflect the individual condition of each couple. This minireview resumes different factors causing ovarian decay and their respective molecular mechanisms of action with the aim of elaborating a patient-tailored treatment regimen for each individual couple
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