Abstract
Purpose
To evaluate intracytoplasmic sperm injection (ICSI) outcome of women over age 39 and to determine when to discourage such couples to undergo IVF using their own oocytes.
Methods
Four hundred ninety-five consecutive women (n = 668 cycles) over age 39 were evaluated by year-by-year age increments to discriminate the independent prognostic factors for the achievement of pregnancy.
Results
Although the ovarian hyperstimulation performance (COH) and embryological data were not too diverse, the clinical pregnancy rates per embryo transfer decreased from 26 to 13% from age 40 to 44. According to logistic regression, the female age seems to be the only variable in order to predict an ongoing pregnancy. The miscarriage rate increased with advancing female age. It was 33% at age 40 but increased to 100% by age 45.
Conclusions
The performance of COH and embryological data is not discouraging among women over 39 years in ICSI cycles. However, increased miscarriages as well as decreased implantation rate are mainly responsible for the poor performance of patients with advanced female age. Irrespective of the ovarian reserve testing, ICSI may be refused at age 45 and thereafter.
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References
Grimbizis G, Vandervorst M, Camus M, Tournaye H, Van Steirteghem A, Devroey P (1998) Intracytoplasmic sperm injection, results in women older than 39, according to age and the number of embryos replaced in selective or non-selective transfers. Hum Reprod 13:884–889. doi:10.1093/humrep/13.4.884
Klipstein S, Regan M, Ryley DA, Goldman MB, Alper MM, Reindollar RH (2005) One last chance for pregnancy: a review of 2,705 in vitro fertilization cycles initiated in women age 40 years and above. Fertil Steril 84:435–445. doi:10.1016/j.fertnstert.2005.02.020
Lass A, Croucher C, Duffy S, Dawson K, Margara R, Winston RM (1998) One thousand initiated cycles of in vitro fertilization in women ≥40 years of age. Fertil Steril 70:1030–1034. doi:10.1016/S0015-0282(98)00353-7
Levi AJ, Raynault MF, Bergh PA, Drews MR, Miller BT, Scott RT Jr (2001) Reproductive outcome in patients with diminished ovarian reserve. Fertil Steril 76:666–669. doi:10.1016/S0015-0282(01)02017-9
Ron-El R, Raziel A, Strassburger D, Schachter M, Kasterstein E, Friedler S (2000) Outcome of assisted reproductive technology in women over the age of 41. Fertil Steril 74:471–475. doi:10.1016/S0015-0282(00)00697-X
Spandorfer SD, Bendikson K, Dragisic K, Schattman G, Davis OK, Rosenwaks Z (2007) Outcome of in vitro fertilization in women 45 years and older who use autologous oocytes. Fertil Steril 87:74–76. doi:10.1016/j.fertnstert.2006.05.081
Wright VC, Chang J, Jeng G, Macaluso M (2008) Assisted reproductive technology surveillance—United States, 2005. MMWR Surveill Summ 57:1–23
Smith KE, Buyalos RP (1996) The profound impact of patient age on pregnancy outcome after early detection of fetal cardiac activity. Fertil Steril 65:35–40
Munne S, Cohen J, Sable D (2002) Preimplantation genetic diagnosis for advanced maternal age and other indications. Fertil Steril 78:234–236. doi:10.1016/S0015-0282(02)03239-9
Committee on Gynecologic Practice of American College of Obstetricians and Gynecologists; Practice Committee of American Society for Reproductive Medicine (2008) Age-related fertility decline: a committee opinion. Fertil Steril 90:486–487. doi:10.1016/j.fertnstert.2008.08.006
Faddy MJ, Gosden RG, Gougeon A, Richardson SJ, Nelson JF (1992) Accelerated disappearance of ovarian follicles in mid-life: implications for forecasting menopause. Hum Reprod 7:1342–1346
Tatone C, Amicarelli F, Carbone MC, Monteleone P, Caserta D, Marci R et al (2008) Cellular and molecular aspects of ovarian follicle ageing. Hum Reprod Update 14:131–142. doi:10.1093/humupd/dmm048
Wright VC, Chang J, Jeng G, Chen M, Macaluso M (2007) Assisted reproductive technology surveillance—United States, 2004. MMWR Surveill Summ 56:1–22
Wright VC, Schieve LA, Reynolds MA, Jeng G (2003) Assisted reproductive technology surveillance—United States, 2000. MMWR Surveill Summ 52:1–16
Gleicher N, Weghofer A, Barad D (2007) Too old for IVF: are we discriminating against older women? J Assist Reprod Genet 24:639–644. doi:10.1007/s10815-007-9182-1
Widra EA, Gindoff PR, Smotrich DB, Stillman RJ (1996) Achieving multiple-order embryo transfer identifies women over 40 years of age with improved in vitro fertilization outcome. Fertil Steril 65:103–108
Yarali H, Esinler I, Polat M, Bozdag G, Tiras B (2008) Antagonist/letrozole protocol in poor ovarian responders for intracytoplasmic sperm injection: a comparative study with the microdose flare-up protocol. Fertil Steril [Epub ahead of print]
Hull MG, Fleming CF, Hughes AO, McDermott A (1996) The age-related decline in female fecundity: a quantitative controlled study of implanting capacity and survival of individual embryos after in vitro fertilization. Fertil Steril 65:783–790
van Rooij IA, Bancsi LF, Broekmans FJ, Looman CW, Habbema JD, te Velde ER (2003) Women older than 40 years of age and those with elevated follicle-stimulating hormone levels differ in poor response rate and embryo quality in in vitro fertilization. Fertil Steril 79:482–488. doi:10.1016/S0015-0282(02)04839-2
Weghofer A, Barad D, Li J, Gleicher N (2007) Aneuploidy rates in embryos from women with prematurely declining ovarian function: a pilot study. Fertil Steril 88:90–94. doi:10.1016/j.fertnstert.2006.11.081
Garcia-Velasco JA, Isaza V, Caligara C, Pellicer A, Remohi J, Simon C (2003) Factors that determine discordant outcome from shared oocytes. Fertil Steril 80:54–60. doi:10.1016/S0015-0282(03)00545-4
Adonakis G, Camus M, Joris H, Vandervorst M, Van Steirteghem A, Devroey P (1997) The role of the number of replaced embryos on intracytoplasmic sperm injection outcome in women over the age of 40. Hum Reprod 12:2542–2545. doi:10.1093/humrep/12.11.2542
Broekmans FJ, Kwee J, Hendriks DJ, Mol BW, Lambalk CB (2006) A systematic review of tests predicting ovarian reserve and IVF outcome. Hum Reprod Update 12:685–718. doi:10.1093/humupd/dml034
Homburg R, Meltcer S, Rabinson J, Zohav E, Anteby EY, Orvieto R (2008) Do stimulation characteristics of the first in vitro fertilization cycle predict pregnancy in women of 40 years old and over? Fertil Steril 91:1311–1313
Twisk M, Haadsma ML, van der Veen F, Repping S, Mastenbroek S, Heineman MJ et al (2007) Preimplantation genetic screening as an alternative to prenatal testing for Down syndrome: preferences of women undergoing in vitro fertilization/intracytoplasmic sperm injection treatment. Fertil Steril 88:804–810. doi:10.1016/j.fertnstert.2006.12.033
Frydman N, Madoux S, Hesters L, Duvernoy C, Feyereisen E, Le Du A et al (2006) A randomized double-blind controlled study on the efficacy of laser zona pellucida thinning on live birth rates in cases of advanced female age. Hum Reprod 21:2131–2135. doi:10.1093/humrep/del124
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Yarali, H., Bozdag, G., Polat, M. et al. Intracytoplasmic sperm injection outcome of women over 39: an analysis of 668 cycles. Arch Gynecol Obstet 281, 349–354 (2010). https://doi.org/10.1007/s00404-009-1116-y
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DOI: https://doi.org/10.1007/s00404-009-1116-y