Increase in older women presenting as unexplained subfertility may explain overuse of in vitro fertilisation.

Kamphuis and colleagues analysed the overuse of in vitro fertilisation (IVF) treatment, focusing on the newer indications. The incidence of unexplained subfertility as an indication for IVF has undoubtedly increased, but why?With cited incidences being based on registries fromWestern countries, the most likely reason is the increase in female childbearing age and ovarian senescence in older women presenting as unexplained subfertility. Since IVF registries were set up, the proportion of older women seeking IVF and the proportion of IVF cycles offered for unexplained subfertility have increased in parallel. 3 Human biology dictates that the chances of conception decrease with advancing female age. Although the success of IVF has increased greatly over the years with advances in technology, success in women aged 40 years or more has changed little, with live birth rates being less than 10%. However, many couples view IVF as a “fix all” for voluntarily postponing childbearing. Is IVF a cure for ovarian senescence, which is often diagnosed as unexplained infertility in older women? What is the management pathway for fertility in these women? The studies cited by Kamphuis and colleagues on natural conception rates in women with unexplained subfertility involve younger women, 5 and it would be incorrect to extrapolate their findings to older women. Paucity of evidence to guide management of the ever increasing numbers of older women seeking fertility treatment is perhaps leading to IVF being overused. As the authors pointed out, randomised controlled trials of effectiveness for new indications are needed. Nevertheless, could the epidemic of ovarian ageing and subfertility be tackled by promoting fertility awareness among women and society? Education would help with health economics and might be a remedy for “too much medicine.”