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This chapter reviews the literature on the effects of age on fertility in the perimenopausal woman. The effect of age on female fertility is difficult to assess because of confounding variables such as coital frequency and other biological causes associated with infertility, the use of contraception and the social and economical constraints that limit family size. The most effective assisted reproductive technology (ART) treatment for perimenopausal women is oocyte donation. Infertility treatment in the perimenopausal woman raises many ethical questions. All fertility centers should establish guidelines based on the literature and their success rates to appropriately counsel patients about the likelihood of live birth based on age. These guidelines would also allow both the physician and the patient to justify treatment in those cases when the odds of success are low but are not nonexistent.
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