Evidence that oocyte quality in younger women with diminished oocyte reserve is superior to those of women of advanced reproductive age

SummaryEvidence is provided supporting the hypothesis that the much improved prognosis for younger women with diminished oocyte reserve compared to women of advanced reproductive age is related to a difference in mechanism for oocyte depletion. For younger women the majority have had destruction of certain portions of their ovarian tissue but the remaining spared ovarian tissue has proportionately the same percentage of normal follicles as their age peers. The hypothesis continues that some factor that is responsible for earlier development of primary to antral follicles persists with the early conceptus and protects it from early programmed cell death. Thus by natural selection most women of advanced reproductive age have oocytes that fertilize normally and produce normal morphologic embryos, but lacking this apoptosis inhibiting factor dies very early between days 6 and 12 from fertilization.