Egg freezing was initially introduced as a fertility preservation measure in women without a male partner who were about to undergo gonadotoxic treatments. The use of oocyte cryopreservation for social reasons has been an increasingly popular strategy for women to preserve their fertility potential, a term most referred to as ‘social egg freezing’ (SEF). As well as for career progression or waiting until they are financially more secure, some women may be single, or may decide to egg freeze to relieve pressure on a relationship, until they decide they are ready to have children with their partner. Upon introduction, success rates with SEF were low due to poor oocyte survival rates. With the advent of oocyte vitrification techniques, assisted reproductive technology (ART) procedures using frozen oocytes have shown a similar live birth rate (LBR) to those using fresh oocytes. Due to this growing evidence for the efficacy of egg freezing, both the European Society for Human Reproduction and Embryology (ESHRE) and the American Society for Reproductive Medicine (ASRM) changed their stances and no longer consider oocyte freezing to be an experimental technique.

Women have healthy babies in their 40s and the number presenting to antenatal services is increasing steadily. The statistics around maternal morbidity in the 40s are troubling. The number of women who are trying to conceive in their 40s and ask for help has also been increasing. What is possible today is significantly better than 15 years ago.

We have brought together a stellar group of international experts who diligently describe the best current evidence and their practice of treating women 40 and over who are trying to conceive. The table of contents includes chapters on demographic trends, contemporary insights from reproductive biology, optimal patient management, and support systems using patient experience architecture. Additional chapters include best practices in nutritional and preconceptual counseling, the most successful ART protocols and strategies as well as the most recent data on egg donation using fresh and frozen oocytes. Also included are chapters addressing optimal management of each stage of pregnancy, neonatal and long-term outcomes of children, ways to optimize these outcomes, and a discussion about the ethics of reproduction and fertility treatment in the 40 plus group. Rounding this off are sections on the discussion of emerging new reproductive technologies, rethinking and redefining family planning, or “fertility planning” for the twenty-first century including the most recent data on ovarian reserve assessment.

This chapter explores new technologies for overcoming the problem of deteriorating oocyte-quality with age. It includes brief discussions of the following: mitochondrial replacement therapy, cytoplasmic transfer, autologous germline mitochondrial energy transfer (AUGMENT), maternal spindle transfer (MTS), in vitro activation of dormant follicles, autologous activated platelet-rich plasma injections (PRP), in vitro gametogenesis, induced pluripotent stem cells (iPSCs), aneuploidy correction through gene-editing and artificial ovaries. Clinicians should exercise extreme caution in managing patient expectations regarding these novel technologies. While clinical application of stem cell technology for maternal age-related infertility does seem likely at some point in the future, the timeline remains uncertain.