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Hum. Reprod. Advance Access published online on February 23, 2006
Human Reproduction, doi:10.1093/humrep/del009
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© The Author 2006. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
Received June 1, 2005
Revised January 1, 2006
Accepted January 9, 2006

Article

The paradox of declining fertility but increasing twinning rates with advancing maternal age

S.N. Beemsterboer 1, R. Homburg 1 *, N.A. Gorter 1, R. Schats 1, P.G.A. Hompes 1, and C.B. Lambalk 1

1 Division of Reproductive Medicine, Department of Obstetrics & Gynaecology, Vrije University Medical Centre, Amsterdam, The Netherlands

* To whom correspondence should be addressed.
R. Homburg, E-mail: r.homburg{at}vumc.nl


  Abstract

BACKGROUND: Advancing female age is associated with declining fertility potential due to decreasing numbers and quality of oocytes but also with a distinct increase in dizygotic twinning rates, a phenomenon that has never been explained. METHOD: An analysis of follicle development was made in 959 spontaneous ovulatory cycles of 507 women. RESULTS: Multiple ovarian follicular development (>1 follicle >14 mm) and, by implication, multiple rather than single ovulations occurred in 105 women whose mean age (36.1 versus 34.6 years) and mean basal FSH concentrations (10.3 versus 7.7 IU/l) were significantly greater than those with monofollicular development (P < 0.01). The prevalence of multifollicular development increased with age. CONCLUSIONS: Dizygotic twinning must be associated with the development of >1 large follicle, which we found to be a significantly more frequent occurrence in older women. It is hypothesized that the response of pituitary release of FSH to the decreased negative feedback induced by impending ovarian failure often ‘overshoots’, causing multiple follicular development. In the presence of two good-quality oocytes, a twin pregnancy may result.

Keywords: advanced maternal age/dizygotic twins/fertility/follicle development.
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