Optimizing the Management of Fertility in Women over 40

Dimitrios Nikolaou is a clinician sub-specialist and educator with long experience in the management of fertility in women over 40. He leads the Reproductive Ageing and Fertility Program at Chelsea and Westminster Hospital in London, UK, and the school of Reproductive Medicine, including the sub-specialty training program. He is a champion for patient support and the development of organizational systems to optimize patient experience. He introduced 'Early ovarian ageing' and has lectured internationally, contributing to a re-thinking of the concept of family planning as fertility-planning. He convened the 56th RCOG working group on Reproductive ageing and co-edited the accompanying book. He is the founder of 'fertility for life'. David B. Seifer, MD is a board-certified reproductive endocrinologist at Yale Medicine Fertility Center in Orange, CT and is a Professor of Obstetrics, Gynecology and Reproductive Sciences at Yale School of Medicine and Fellowship Director of the Yale Reproductive Endocrinology and Infertility fellowship. Dr. Seifer has 30 years of clinical experience in reproductive endocrinology and infertility and is a past president of the Society for Assisted Reproductive Technology (SART), the primary national organization that sets clinical and laboratory guidelines and standards for safety and quality metrics for IVF in the United States. He has served as Co-Editor in- Chief of Reproductive Biology and Endocrinology since 2016 and has been actively conducting clinical and translational research with anti-mullerian hormone (AMH) as a marker of ovarian reserve for several decades.

'This is a much-needed book for physicians and fellows working with the infertile patient over 40. It offers both a factual guide and review of the up-to-date literature on ART and pregnancy management of women over 40, which is a group that will only continue to grow as a part of our infertility practices.' Sarah Capelouto, Doody's Reviews

• Introduction Dimitrios S. Nikolaou and David B. Seifer; Part I. Demographic Trends:1. Is 40 the new 30? Increasing reproductive intentions and fertility rates beyond age 40 Éva Beaujouan and Tomáš Sobotka; Part II. The Biological Basis of Female Reproductive Aging: What Happens To The Ovaries And The Uterus As They Age?: 2. The biological basis of female reproductive aging: What happens to the ovaries and uterus as they age? Jacquelyn Shaw, Jennifer K. Blakemore, David L. Keefe; Part III. Lifestyle, Environment and Optimizing Reproduction in the 40s: 3. What lifestyle adjustments can maximize the chance of a natural conception and healthy pregnancy in women over 40? Alexandra Kermack; Part IV. Re-Thinking and Re-Defining “Family Planning” For The 21st Century: 4. Diagnostic testing of reproductive aging David B. Seifer and Tanya Glenn; 5. Fertility preservation for 'Social' reasons Tim Bracewell-Milnes and Dimitrios Nikolaou; Part V. Optimal Deployment of Art Beyond 40: 6. When to use art beyond 40, how often, how many attempts, when to stop Steven D. Spandorfer and Pietro Bartoletto; 7. Optimal IVF protocols for women over 40 and low functional ovarian reserve David H. Barad and Norbert Gleicher; 8. Fertility counselling beyond 40 Amir Mor and David B. Seifer; 9. Support systems and patient experience architecture for fertility care of women over 40 in the 2020s Dimitrios S. Nikolaou and David B. Seifer; Part VI. Obstetric Management Beyond 40: 10. The optimal management of first-trimester pregnancy beyond 40 Beth Cartwright and Aditi Naik; 11. Optimal management of pregnancy beyond 12 weeks, labour and the puerperium for woman over 40 Shane Duffy, Pritha Dasmahapatra; Part VII. The Children of Older Parents: 12. What do we know about the children of women over 40 and what can older mothers do to optimize their children's development? Vickie Schafer and Winifred Mak; Part VIII. What Are Realistic Alternatives to Conceiving With Autologous Eggs?: 13. Practical egg donation in women over 40 James P Toner and Lauren Rouleau; Part IX. New Technologies: 14. Is it likely that reproductive aging could be delayed or reversed using advanced technologies in the future? Paula Amato and Dimitrios Nikolaou; Part X. Ethics: 15. Ethical issues in the use of assisted reproductive technology in women over age 40 Nicole Yoder and Gwendolyn P. Quinn; Final thoughts David B. Seifer and Dimitrios S. Nikolaou; Index.