State of the art in assisted reproductive technologies for patients with advanced maternal age.

According to the World Health Organization, the female reproductive age lasts up to 49 years, but problems with the realization of women's reproductive rights may arise much earlier. Significant numbers of factors affect the state of reproductive health: socioeconomic, ecological, lifestyle features, the level of medical literacy, and the state of the organization and medical care quality. Among the reasons for fertility decline in advanced reproductive age are the loss of cellular receptors for gonadotropins, an increase in the threshold of sensitivity of the hypothalamic-pituitary system to the action of hormones and their metabolites, and many others. Furthermore, negative changes accumulate in the oocyte genome, reducing the possibility of fertilization, normal development and implantation of the embryo and healthy offspring birth. Another theory of ageing causing changes in oocytes is the mitochondrial free radical theory of ageing. Taking into account all these age-related changes in gametogenesis, this review considers modern technologies aimed at the preservation and realization of female fertility. Among the existing approaches, two main ones can be distinguished: methods allowing the preservation of reproductive cells at a younger age using ART intervention and cryobanking, as well as methods aimed at improving the basic functional state of advanced-age women's oocytes and embryos.

Characteristics of positive-interaction parenting style among primiparous teenage, optimal age, and advanced age mothers in Canada.

BACKGROUND: Positive-interaction parenting early in childhood is encouraged due to its association with behavioural development later in life. The objective of this study was to examine if the level of positive-interaction parenting style differs among teen, optimal age, and advanced age mothers in Canada, and to identify the characteristics associated with positive-interaction parenting style separately for each age group. METHODS: This was a cross-sectional secondary analysis of the National Longitudinal Survey of Children and Youth. First-time mothers with children 0-23 months were grouped into: teen (15-19 years, N = 53,409), optimal age (20-34 years, N = 790,960), and advanced age (35 years and older, N = 106,536). The outcome was positive-interaction parenting style (Parenting Practices Scale); maternal socio-demographics, health, social, and child characteristics were considered for backward stepwise multiple linear regression modeling, stratified for each of the age groups. RESULTS: Teen, optimal age, and advanced age mothers reported similar levels of positive- interaction parenting style. Covariates differed across the three age groups. Among optimal age mothers, being an ever-landed immigrant, childcare use, and being devoted to religion were found to decrease positive-interaction parenting style, whereas, higher education was found to increase positive-interaction parenting style. Teen mothers were not found to have any characteristics uniquely associated with positive-interaction parenting. Among advanced age mothers, social support was uniquely associated with an increase in positive-interaction parenting. Very good/excellent health was found to be positively associated with parenting in teens but negatively associated with parenting in advanced age mothers. CONCLUSION: Characteristics associated with positive-interaction parenting varied among the three age groups. Findings may have public health implications through information dissemination to first-time mothers, clinicians, researchers, and public health facilities.

Characteristics of Social Support Among Teenage, Optimal Age, and Advanced Age Women in Canada: An Analysis of the National Longitudinal Survey of Children and Youth.

Background Social support is highly valued and beneficial for women, especially after childbirth. The objective was to examine the differences of social support reported among teen, optimal age, and advanced age women, and to identify the characteristics associated with social support separately for each age group. Methods This was a cross-sectional analysis of the National Longitudinal Survey of Children and Youth. Primiparous women with infants were grouped into: teen (15-19 years), optimal age (20-34 years), and advanced age (35 years and older). The outcome was social support (Social Provisions Scale), and demographic, socio-economic, health, community, and infant characteristics were considered for stepwise linear regression, separately for the groups. Results Total of 455,022 mothers was analyzed. Teens had the lowest social support (Mean = 17.56) compared to other groups (Means = 19.07 and 19.05; p < 0.001). Teens' volunteer involvement was associated with an increase in social support (Adjß 2.77; 95%CI 0.86, 4.68), and depression was associated with a decrease (Adjß -0.12; 95%CI -0.22, -0.02). Optimal age women's support significantly increased with maternal age (Adjß 0.07; 95%CI 0.02,0.12), working status (Adjß 0.60; 95%CI 0.13,1.07), and with chronic condition(s) (Adjß 0.59; 95%CI 0.16,1.02), while it decreased with depression (Adjß -0.05; 95%CI -0.10, -0.01) and ever-immigrants (Adjß -1.67; 95%CI -2.29, -1.04). Use of childcare was associated with increased support among women in advanced age group (Adjß 1.58; 95%CI 0.12, 3.04). For all groups, social support was significantly associated with neighbourhood safety. Conclusion The characteristics associated with social support varied among the three age groups. The findings may help promote awareness of the essential needs to increase support, especially for teens.

A Prospective Randomized Controlled Study of Laser-Assisted Hatching on the Outcome of First Fresh IVF-ET Cycle in Advanced Age Women.

There is no sufficient data to conclude the benefit of assisted hatching (AH) for advanced age patients. However, AH is routinely performed for advanced age patients undergoing in vitro fertilization (IVF) in China based on some retrospective evidence. It is important to assess the benefit of AH procedure for advanced age patients, especially by analyzing the data from China. This is a prospective randomized controlled trial to evaluate the effect of laser AH in the advanced age patients undergoing IVF. A total of 256 patients conformed to the inclusion criteria, and 78 were excluded by exclusion criteria. A total of 178 patients were eligible and randomized to 2 groups (82 AH group and 96 control group). Laser AH (zona thinning) was performed in the AH group. There were no statistical significance in basic clinical parameters between the 2 groups. No difference was found in implantation rate (AH vs control, 32.45% vs 39.29%) and clinical pregnancy rate (AH vs control, 48.78% vs 59.38%). Our data did not find any benefit of laser AH in improving implantation or pregnancy rates in advanced age women. Due to the potential risk and increasing financial burden, AH should not be routinely performed in first fresh IVF embryo transfer cycle for advanced age women.