Due to temporary social trends, many women elect to postpone their first pregnancy to a later stage in life. Pregnancy and labor later in life entail major risks to both the mother and the neonate. Furthermore, a large part of this population will be infertile by the time they opt to conceive, mainly because of decreasing ovarian reserve and low oocyte quality. Assessment of the fertility potential of the elderly nullipara includes clinical measurements of early follicular FSH and estradiol, clomiphene citrate test and ultrasonographic evaluation of the ovaries. A fast track step-by-step fertility evaluation is the procedure for women above 35 years of age. Only empirical treatment modalities may be offered to the elderly infertile patient, with the exception of ovum donation.