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One thousand seventy-eight autologous IVF cycles in women 45 years and older: the largest single-center cohort to date

  • Assisted Reproduction Technologies
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Abstract

Purpose

The purpose of this study was to determine IVF outcomes in women 45 years and older using autologous oocytes.

Methods

This is a retrospective cohort study reviewing all IVF cycles in women ≥ 45 years old from January 1995 to June 2015 that were conducted at one academic medical center. One thousand seventy-eight fresh, autologous IVF cycles met inclusion criteria. PGD/S, natural IVF, and donor egg cycles were excluded. Outcomes were analyzed for the different age groups (age 45, n = 773; age 46, n = 221; age 47, n = 57; age 48, n = 22; age 49, n = 5). Primary outcome measures included IVF cycle characteristics, total pregnancy loss, clinical pregnancy, and live birth rates, and were stratified according to patient age.

Results

Mean age of patients in the study cohort was 45.4 ± 0.72. 11.7% of patients did not start due to an elevated FSH or cyst and 28.5% of patients were canceled prior to oocyte retrieval. The overall pregnancy rate per transfer was 18.7% (117/626), of which 82.1% ended in a pregnancy loss. The overall clinical pregnancy and live birth rates per transfer were 9.6 and 3.4%, respectively, which did not differ between age groups. Per cycle start women aged 45 had significantly higher positive pregnancy rates compared to women aged 46 and 47 (14.1 vs. 8.6 vs. 5.9%, p = 0.04). For women 45 years old, the live birth rate was 2.9% per cycle start and was 4.4% per embryo transfer. Of the 21 live births, 20 were in women aged 45 and one live birth was in a 46-year-old woman. There were no live births in any patient with ≤ 4 oocytes retrieved.

Conclusion

Autologous IVF in women aged 45 with acceptable ovarian reserve is not futile; however, it does carry very low prognosis. Patients aged 46 and older should be counseled appropriately that a live birth seems highly unlikely.

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References

  1. National Vital Statistics Reports. National Vital Statistics Reports. 2016;1–70.

  2. National Center for Health Statistics. Births in the United States, 2015; 2016: 1–8.

  3. Menken J, Trussell J, Larsen U. Age and infertility. Science. 1986;233:1389–94.

    Article  CAS  PubMed  Google Scholar 

  4. Pellestor F, Andréo B, Arnal F, Humeau C, Demaille J. Maternal aging and chromosomal abnormalities: new data drawn from in vitro unfertilized human oocytes. Hum Genet. 2003;112:195–203.

    PubMed  Google Scholar 

  5. Franasiak JM, Forman EJ, Hong KH, Werner MD, Upham KM, Treff NR, et al. The nature of aneuploidy with increasing age of the female partner: a review of 15,169 consecutive trophectoderm biopsies evaluated with comprehensive chromosomal screening. Fertil Steril. 2014;101:656–663.e1.

    Article  PubMed  Google Scholar 

  6. Spandorfer SD, Davis OK, Barmat LI, Chung PH, Rosenwaks Z. Relationship between maternal age and aneuploidy in in vitro fertilization pregnancy loss. Fertil Steril. 2004;81:1265–9.

    Article  PubMed  Google Scholar 

  7. Female age-related fertility decline. Committee Opinion No. 589. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2014;123:719–21.

  8. Rosenwaks Z, Davis OK, Damario MA. The role of maternal age in assisted reproduction. Hum Reprod. 1995;10 Suppl 1:165–73.

    Article  CAS  PubMed  Google Scholar 

  9. Van Kooij RJ, Looman C, Habbema J. Age-dependent decrease in embryo implantation rate after in vitro fertilization. Fertil Steril. 1996;6:769–75.

    Article  Google Scholar 

  10. Sunderam S, Kissin DM, Crawford SB, Folger SG, Jamieson DJ, Warner L, et al. Assisted reproductive technology surveillance—United States, 2013. MMWR Surveill Summ. 2015;64:1–25.

    Article  Google Scholar 

  11. Rani G, Goswami S, Chattopadhyay R, Ghosh S, Chakravarty B, Ganesh A. Live birth in a 50-year-old woman following in vitro fertilization–embryo transfer with autologous oocytes: a rare case report. Fertil Steril. 2015;103:414–6.

    Article  PubMed  Google Scholar 

  12. Trolice MP. Live birth from a 46-year-old using fresh autologous oocytes through in vitro fertilization. Fertil Steril. 2014;102:96–8.

    Article  PubMed  Google Scholar 

  13. Huang JYJ, Rosenwaks Z. Assisted reproductive techniques. Methods Mol Biol. 2014;1154:171–231.

    Article  PubMed  Google Scholar 

  14. Reichman D, Rosenwaks Z. GnRH antagonist-based protocols for in vitro fertilization. In: Rosenwaks Z, Wassarman P, editors. Human fertility. Methods in molecular biology, vol 1154. New York: Humana Press; 2014. p. 289–304.

  15. Cabry R, Merviel P, Hazout A, Belloc S, Dalleac A, Copin H, et al. Management of infertility in women over 40. Maturitas. 2014;78:17–21.

    Article  PubMed  Google Scholar 

  16. Ron-El R, Raziel A, Strassburger D, Schachter M, Kasterstein E, Friedler S. Outcome of assisted reproductive technology in women over the age of 41. Fertil Steril. 2000;74:471–5.

    Article  CAS  PubMed  Google Scholar 

  17. Cetinkaya MB, Siano LJ, Benadiva C, Sakkas D, Patrizio P. Reproductive outcome of women 43 years and beyond undergoing ART treatment with their own oocytes in two Connecticut university programs. J Assist Reprod Genet. 2013;30:673–8.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Lass A, Croucher C, Duffy S, Dawson K, Margara R, Winston RM. One thousand initiated cycles of in vitro fertilization in women > or = 40 years of age. Fertil Steril. 1998;70:1030–4.

    Article  CAS  PubMed  Google Scholar 

  19. Klipstein S, Regan M, Ryley DA, Goldman MB, Alper MM, Reindollar RH. One last chance for pregnancy: a review of 2,705 in vitro fertilization cycles initiated in women age 40 years and above. Fertil Steril. 2005;84:435–45.

    Article  PubMed  Google Scholar 

  20. Hourvitz A, Machtinger R, Maman E, Baum M, Dor J, Levron J. Assisted reproduction in women over 40 years of age: how old is too old? Reprod BioMed Online. 2009;19:599–603.

    Article  PubMed  Google Scholar 

  21. Serour G, Mansour R, Serour A, Aboulghar M, Amin Y, Kamal O, et al. Analysis of 2,386 consecutive cycles of in vitro fertilization or intracytoplasmic sperm injection using autologous oocytes in women aged 40 years and above. Fertil Steril. 2010;94:1707–12.

    Article  PubMed  Google Scholar 

  22. Tsafrir A, Simon A, Revel A, Reubinoff B, Lewin A, Laufer N. Retrospective analysis of 1217 IVF cycles in women aged 40 years and older. Reprod BioMed Online. 2007;14:348–55.

    Article  CAS  PubMed  Google Scholar 

  23. Rubio C, Bellver J, Rodrigo L, Bosch E, Mercader A, Vidal C, et al. Preimplantation genetic screening using fluorescence in situ hybridization in patients with repetitive implantation failure and advanced maternal age: two randomized trials. Fertil Steril. 2013;99:1400–7.

    Article  PubMed  Google Scholar 

  24. Lee H-L, McCulloh DH, Hodes-Wertz B, Adler A, McCaffrey C, Grifo JA. In vitro fertilization with preimplantation genetic screening improves implantation and live birth in women age 40 through 43. J Assist Reprod Genet. 2015;32:435–44.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Moayeri M, Saeidi H, Modarresi MH, Hashemi M. The effect of preimplantation genetic screening on implantation rate in women over 35 years of age. Cell J. 2016;18:13–20.

    PubMed  PubMed Central  Google Scholar 

  26. Twisk M, Mastenbroek S, Hoek A, Heineman MJ, van der Veen F, Bossuyt PM, et al. No beneficial effect of preimplantation genetic screening in women of advanced maternal age with a high risk for embryonic aneuploidy. Hum Reprod. 2008;23:2813–7.

    Article  PubMed  Google Scholar 

  27. Hardarson T, Hanson C, Lundin K, Hillensjo T, Nilsson L, Stevic J, et al. Preimplantation genetic screening in women of advanced maternal age caused a decrease in clinical pregnancy rate: a randomized controlled trial. Hum Reprod. 2008;23:2806–12.

    Article  CAS  PubMed  Google Scholar 

  28. Twisk M, Mastenbroek S, Van Wely M, Heineman MJ, Van der Veen F, Repping S. Preimplantation genetic screening for abnormal number of chromosomes (aneuploidies) in in vitro fertilisation or intracytoplasmic sperm injection (review). Cochrane Database Syst Rev. 2006.

  29. Rubio C, Bellver J, Rodrigo L, Castillon G, Guillen A, Vidal C, et al. In vitro fertilization with preimplantation genetic diagnosis for aneuploidies in advanced maternal age: a randomized, controlled study. Fertil Steril. 2017;107:1122–9.

    Article  PubMed  Google Scholar 

  30. Ubaldi FM, Cimadomo D, Capalbo A, Vaiarelli A, Buffo L, Ferrero S, et al. Preimplantation genetic diagnosis for aneuploidy testing in women older than 44 years: a multicenter experience. Fertil Steril. 2017;107:1173–80.

    Article  PubMed  Google Scholar 

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Correspondence to Vinay Gunnala.

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This study was approved by the Weill Cornell Medical College Institutional Review Board.

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The authors declare that they have no conflict of interest.

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For this type of study, formal consent is not required.

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Gunnala, V., Irani, M., Melnick, A. et al. One thousand seventy-eight autologous IVF cycles in women 45 years and older: the largest single-center cohort to date. J Assist Reprod Genet 35, 435–440 (2018). https://doi.org/10.1007/s10815-017-1088-y

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  • DOI: https://doi.org/10.1007/s10815-017-1088-y

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