Introduction: The desire for childbearing at very advanced maternal age (maternal age =45 years at the time of delivery) is becoming increasingly common. This has resulted in increased demand and utilization of assisted reproductive technologies to counteract the declining fecundity associated with the advanced maternal age. However, the older gravidas are at increased risk of having various medical conditions with potential adverse impact on their pregnancies making such pregnancies be considered as high risk pregnancies.
Case Series: We present two cases of very advanced maternal age pregnancies (54-year-old and 49-year-old), both conceived through assisted reproductive technology, we successfully managed through their pregnancies outlining the conception challenges, pregnancy complications and the subsequent management and outcomes. We further undertake a literature review to assess the challenges and outcomes of pregnancies at very advanced maternal age.
Conclusion: Childbearing at very advanced maternal age is challenging from conception to delivery. Owing to the age related decline in fertility, most of these women require assisted reproductive technology (ART). Moreover, they are more likely to have adverse pregnancy outcomes principally stemming from preterm births with a resultant greater maternal and perinatal mortality and morbidity. With the increasing trend towards delayed child bearing, and owing to the anticipated adverse pregnancy outcomes, the hospitals and physicians needs to equip themselves for the increased demand for ART and the need for sophisticated prenatal, perinatal and postpartum care.

Keywords: Anti-mullerian hormone (AMH), Assisted reproductive technology (ART), In vitro fertilization (IVF), Very advanced maternal age (VAMA)