It has become a recent trend, for women to postpone their childbearing needs beyond the normal years, little realizing the speed of the biological clock or its impact. This being a common practice in the west has now found its way into the Indian scenario slowly but steadily. The demands on women during their peak reproductive years in the form of higher education, better career options and the need for stable relationships, although progressive , seems to be stretching the maternal age to beyond 35 for first pregnancies. What is the impact of age on fertility? For a starter, higher rates of chromosomal abnormalities and the resultant increase in spontaneous miscarriage rates, preterm labour, presence of medical disorders like hypertension and diabetes, a poor response to stimulation in ART cycles, an increase in the multifetal pregnancy rates and last but not the least a higher risk of neonatal morbidity and mortality(Trisomies/Growth Restriction/Respiratory Distress).

Recent literature have cited various methods to predict the ovarian reserve and prognosis for conception in treatment cycles, the most important and easily applicable ones being a day 2/3 serum FSH levels and ultrasound for antral follicle count and ovarian volume. In addition it may be noted that accelerated ovarian follicle depletion by apoptosis precedes natural menopause by 10 to 13 years, so much so that those women who attained menopause by 45 years had already started to lose their potential at age 32 despite regular monthly cycles! This can only be deduced retrospectively and possibly by determining the general age of menopause in the family.
Poor  responders  can  be  attributed  to  this  group  where   a   normal   FSH,   antral    follicle   count   and  regular   cycles,   fail   to   respond   to   conventional  stimulation    regimes.   Till   date   women   in   their  perimenopause,   menopause   and   those   suffering  from premature ovarian failure only had the option  of donor programme or adoption and always fared  very well with donor oocyte programme.

But with the current platter of oocyte cryopreservation, ovarian transplantation and stem cell research for use of progenitor cells that could replace the lost oocyte pool or reduce apoptosis rate,