Ovarian aging is expressed with altered menstrual cyclicity, endocrine and biochemical profiles and impaired fertility. Shortening of the menstrual cycle may be the first signal of diminished ovarian reserve. Hormonal interplay in the aging ovary is manifested as a monotropic FSH rise, decreased inhibin B concentrations and fluctuating estradiol concentrations. Due to social changes, childbearing has been delayed, thus the group of women in their late thirties seeking infertility treatment has been increasing. Intrauterine insemination (IUI) usually precedes more sophisticated assisted reproductive technology (ART) treatments such as in vitro fertilization-embryo transfer (IVF-ET) and intracytoplasmic sperm injection (ICSI). We present the outcomes of ART treatments achieved in our institution in women over 38 compared to younger women. The pregnancy rate after IUI was 3.7% in women over 38 years, and 28.6% in women less than 38 years; after IVF-ET the cumulative pregnancy rate was 16% (the miscarriage rate 21%) in women over 38, and 28% (13%) in women less than 38 years; the cumulative pregnancy rate after ICSI was 9% (the miscarriage rate 26%) in women over 38, and 27% (the miscarriage rate 14%) in women younger than 38 years. Women in advanced age should therefore be properly counselled and informed about poor success rates, and about the high cost of infertility treatment.