Article Type: Original Article
Abstract:

According to the statistics on age and female fertility, pregnancy rates begin to decline in early 30's and it becomes more substantial in late 30's and early 40's. In addition to decline in pregnancy, miscarriage rates also increase as the mother ages and very few women over 44 are still fertile. The same trend is seen in pregnancy rate following infertility treatment as in vitro fertilization success rates start dropping in the early 30's and fall faster around age 38. The chance of having a successful pregnancy at age 44 and over by IVF using patient‟s own eggs is less than 5%, however, female age has no effect on pregnancy rate when the eggs from a young and fertile donor are used. Thus, infertility in older women is directly associated with a poor developmental potential of aged oocytes. As women and oocytes age and oocyte mitochondrial energy production decreases, many of the processes of oocyte maturation, especially nuclear spindle activity and chromosomal segregation, become impaired. This results in an increased rate of aneuploidy especially trisomies in the offspring of older women. The mechanism of oocyte aneuploidy is not proven but an energy-dependent mechanism is supported by data demonstrating that mitochondrial mutations in follicular cells increase with age. Therefore, it is reasonable to suggest that the documented relationship between maternal age and chromosomal abnormalities with diminished mitochondrial activity in the oocyte might lead both to chromosomal non-disjunction and to arrested embryo development. Mitochondrial nutrients are naturally occurring vitamins that have been used successfully to treat conditions associated with diminished energy production from mitochondria, and appear to be very safe in the doses studied. We hypothesize that dietary supplementation of mitochondrial nutrients may improve mitochondrial energy production for the maturing oocyte and developing embryo, thereby reducing the rate of chromosomal non-disjunction and improving implantation in elderly infertile patients.