Obstetric risks and pregnancy outcomes specific to patients with very advanced maternal age (over 45)

We are assisting with a progressive shift in the reproductive behavior of modern-day society, with a significant delay in the average age at which couples pursue parenthood for the first time. This postponement has generalized pregnancy at advanced maternal age to an extent in which even its definition (i.e., a pregnancy occurring at an age of 35 years old or above) has become trivial, leading to the need for alternative subclassifications, including pregnancy at very advanced maternal age (i.e., at the age of 45 years old or above). Reports on the impact of a very advanced maternal age describe that the probability of a spontaneous conception achieving a live birth is below 3%, odds that do not seem to improve significantly following ART treatments when using autologous oocytes. However, in the last decades, oocyte donation has increasingly become a more accepted and effective strategy to treat female age–related infertility, leading to a sharp increase of pregnancies at very advanced maternal age. This sudden surge stresses the need for a more comprehensive reflection and understanding among the medical community of the associated obstetric risks at an age when women, until recently, were seldomly expecting.