Advanced age couples, defined by the medical community as women over 35 years of age, are considered advanced maternal age or advanced maternal age, which implies health risks for the mother and the risk of having a malformed child. There is no uniform definition for men, but it is generally accepted that male fertility is also affected by age, and most believe that being over 40 years old is also a major risk factor for fertility. The impact of advanced age on fertility is decreasing year by year for both men and women, especially for women, and the quality of eggs is decreasing: the most common question patients ask their doctors when seeking assisted reproductive technology is “Can I get pregnant with IVF?” “How long will it take to conceive?”, these are also difficult questions for doctors. Problems faced by senior women in assisted reproduction 1. Decline in gamete quality In the process of seeking help for pregnancy, senior women may have poor ovarian response during ovulation promotion due to the decline in ovarian reserve capacity, low number of follicles, low rate of egg acquisition and embryo loss during fertilization and embryo culture, and eventually fail to complete the whole process of IVF-ET; in addition, egg quality declines year by year as age increases. The possible reason for this is the first meiosis of the egg, which causes an increase in oocyte chromosome aneuploidy and reduces the fertilization ability of the egg and the developmental potential of the embryo. Studies have found that the incidence of aneuploidy in women under 35 years of age is about 10%, but increases to 30% at age 40, 40% at age 43, and nearly 100% in women over 45 years of age. Most studies have shown a decreasing trend in sperm density, motility and normal sperm morphology in older men, and an increase in sperm DNA fragmentation, all of which can lead to low pregnancy rates and high miscarriage rates in older couples. 2. Organic lesions of uterus in elderly women As age increases, DNA content in endometrial stromal cells decreases, estrogen and progesterone receptors in endometrial cells decrease, endometrial blood flow decreases, and the probability of organic lesions of uterus increases; some pathological changes in endometrium, such as endometrial polyps, can lead to a decrease in endometrial tolerance; uterine fibroids can change uterine contractility and affect gametes’ The endometrium of the uterus can be affected by fibroids, which can alter the contractility of the uterus and affect the transport of gametes and embryo transfer, and can also cause congestion and dilatation of the muscular wall and endometrial veins, making the intrauterine environment unfavorable for egg implantation or insufficient blood supply for embryo development, especially for submucosal fibroids, where the endometrium on the surface of the fibroids can have insufficient blood supply and affect the implantation of fertilized eggs. The increased risk of medical comorbidities in elderly women and the health of the offspring at an advanced age are all issues that need to be considered before seeking assistance for elderly couples. 1. Artificial insemination: For couples with patent fallopian tubes, normal semen examination of the male partner and acceptable ovarian reserve function, artificial insemination can also be chosen to help conception. 2.In vitro fertilization – embryo transfer (IVF-ET) The live birth rate of IVF-ET for women over 40 years old is about 3.5%-10%, and the live birth rate decreases significantly with each additional year, and the miscarriage rate is as high as 33%-43%. 5.1% for 43-44 years old and 1.5% for over 45 years old, despite the low live birth rate, IVF is still the first choice of treatment for senior infertile couples. The choice of conventional IVF or ICSI depends on the quality of the male partner’s sperm and the condition of the egg zona pellucida, and it is not beneficial to choose ICSI simply because of advanced age. According to studies, the pregnancy rate of donor eggs can be as high as 40% per cycle, and women in their 60s can conceive offspring through egg donation and hormonal support, but the pregnancy complications associated with advanced pregnancy are not easy to ignore. The social and ethical issues associated with egg donation should not be overlooked. For this reason, ART regulations restrict egg donation to 20 or more mature eggs from assisted reproductive treatment cycles with 15 retained eggs. The embryos can only be thawed after six months of testing for HIV and other related diseases. Recent developments in nuclear transfer techniques have provided new solutions for egg reconstruction by separating germinal vesicles from immature eggs of older women and fusing them with the cytoplasm of younger women who have had their germinal vesicles removed, and then fertilizing the eggs after they have been matured in vitro using ICSI to develop embryos. However, the use of this technique is currently prohibited in China because of the low number of eggs obtained from older women and the possibility that the mitochondrial DNA in the egg plasma of the donor may be carried into the genes of the recipient. In conclusion, the use of assisted reproductive technology for advanced infertility couples involves a wide range of issues, including the physical fitness of advanced women for pregnancy, the increased complications of pregnancy, and the burden on the family and society of having an unhealthy child, and the social and ethical pressure to use donor eggs. In the face of the increasing number of advanced infertility couples, it is important to inform them in advance of the low probability of pregnancy and the high risks involved, and to make a comprehensive assessment of the patient’s physical condition and ovarian reserve in order to choose the appropriate assisted reproductive treatment for them or to abandon the difficult decision of assisted reproductive technology.