Publication:

Impact of advanced maternal age on assisted reproductive technology outcomes: biological mechanisms, clinical implications and management strategies

Delayed childbearing has increased the number of women of advanced maternal age (AMA) seeking assisted reproductive technology (ART). AMA, defined as ≥35 years, is linked to reduced ovarian reserve, poor oocyte quality, and higher pregnancy risks. Despite advances in IVF, ICSI and frozen embryo transfer (FET), maternal age remains a key factor affecting success rates. This review summarizes the biological changes associated with reproductive aging and their impact on ART outcomes such as implantation, pregnancy rates, miscarriage and perinatal outcomes. Literature shows that aging leads to mitochondrial dysfunction, chromosomal abnormalities and reduced embryo quality, resulting in lower pregnancy and live birth rates and higher miscarriage rates in women ≥35 years. While FET may improve uterine conditions, it cannot fully overcome the decline in oocyte quality. AMA is also associated with increased risks such as hypertension, gestational diabetes and preterm birth. In conclusion, advanced maternal age significantly affects ART outcomes, and careful patient counselling and individualized treatment strategies are essential to improve success rates.