Journal of Assisted Reproduction and Genetics

, Volume 30, Issue 11, pp 1431–1438 | Cite as

Assisted reproduction counseling in women aged 40 and above: a cohort study

  • Michaël De BruckerEmail author
  • Herman Tournaye
  • Patrick Haentjens
  • Greta Verheyen
  • John Collins
  • Michel Camus
Assisted Reproduction Technologies



Fertility treatment in women aged ≥40 year old remains difficult and controversial. All available studies in older women report results of one specific method of ART, i.e. IUI, IVF/ICSI or oocyte donation, and success rates are always published per attempt but never per patient. Randomized studies are not available because of the obvious heterogeneity in patient populations and treatment options.

This prospective observational study aimed at analyzing the outcome in a consecutive cohort of patients above 40 undergoing various methods of ART.


A total number of 909 women older than 40 attended our fertility centre during a 3 years period. A flowchart showing the consecutive ART treatments with their respective outcome was constructed. Any delivery after 22 weeks gestation (or 500 g.) was taken as primary endpoint. Crude cumulative delivery rates (CDRs) and binomial exact 95 % confidence limits (95 % CLs) were calculated for each group of interest.


ART treatment could be proposed to 737 patients (81 %) and eventually 585 patients (64 %) started ART treatment: 111 patients started IUI, 439 patients started IVF/ICSI and 35 patients started oocyte donation as a primary approach ART. Ten patients got pregnant spontaneously and delivered before starting any treatment. In the 909 patients consulting for infertility, 111 deliveries were achieved after ART, i.e. a crude CDR of 12.2 % (95 % CL 10.1 % to 14.5 %).


Only 10 % of patients aged 40 and above could achieve delivery of their genetically-own child, while 1 % conceived spontaneously. More than one third of patients consulting never started any treatment for different reasons, i.e. anticipated poor prognosis, financial restrictions, illness or spontaneous pregnancy.


Age Cumulative delivery rates Delivery ART 40 years and above 



The authors thank Dr Stoop of the Centre for Reproductive Medicine for his literature advice concerning egg donation and results of this technique.


  1. 1.
    Abma JC, Chandra A, Mosher WD, Peterson LS, Piccinino LJ. Fertility, family planning, and women’s health: new data from the 1995 National Survey of Family Growth. Vital Health Stat. 1997;23:1–114.Google Scholar
  2. 2.
    Belloc S, Cohen-Bacrie P, Benkhalifa M, Cohen-Bacrie M, De Mouzon J, Hazout A, et al. Effect of maternal and paternal age on pregnancy and miscarriage rates after intrauterine insemination. Reprod Biomed Online. 2008;17(3):392–7.PubMedCrossRefGoogle Scholar
  3. 3.
    Broekmans FJ, Soules MR, Fauser BC. Endocr Rev. 2009;30(5):465–93. Review.PubMedCrossRefGoogle Scholar
  4. 4.
    De Brucker M, Haentjens P, Evenepoel J, Devroey P, Collins J, Tournaye H. Cumulative delivery rates in different age groups after artificial insemination with donor sperm. Hum Reprod. 2009;24(8):1891–9.PubMedCrossRefGoogle Scholar
  5. 5.
    De Brucker M, Tournaye H. The effect of age on the outcome of intrauterine insemination: a review. Facts, View & Vision In ObGyn. 2010; MONOGRAPH: 42–50.Google Scholar
  6. 6.
    De Brucker M, Camus M, Haentjens P, Verheyen G, Collins J, Tournaye H. Assisted reproduction using donor sperm in women aged 40 and above: the high road or the low road? Reprod Biomed Online. 2013. doi: 10.1016/j.rbmo.2013.02.008.PubMedGoogle Scholar
  7. 7.
    Elizur SE, Lerner-Geva L, Levron J, Shulman A, Bider D, Dor J. Cumulative live birth rate following in vitro fertilization: study of 5,310 cycles. Gynecol Endocrinol. 2006;22(1):25–30.PubMedCrossRefGoogle Scholar
  8. 8.
    Evers JL. Female subfertility. Lancet. 2002;360:151–9.PubMedCrossRefGoogle Scholar
  9. 9.
    Frederick JL, Denker MS, Rojas A, Horta I, Stone SC, Asch RH, et al. Is there a role for ovarian stimulation and intra-uterine insemination after age 40? Hum Reprod. 1994;9(12):2284–6.PubMedGoogle Scholar
  10. 10.
    Goverde AJ, McDonnell J, Vermeiden JP, Schats R, Rutten FF, Schoemaker J. Intrauterine insemination or in-vitro fertilisation in idiopathic subfertility and male subfertility: a randomised trial and cost-effectiveness analysis. Lancet. 2000;355(9197):13–8.PubMedCrossRefGoogle Scholar
  11. 11.
    Haebe J, Martin J, Tekepety F, Tummon I, Shepherd K. Success of intrauterine insemination in women aged 40–42 years. Fertil Steril. 2002;78(1):29–33.PubMedCrossRefGoogle Scholar
  12. 12.
    International Committee Monitoring Assisted Reproductive Tecnologies (ICMART). 2007.
  13. 13.
    Leridon H. Can assisted reproduction technology compensate for the natural decline in fertility with age? A model assessment. Hum Reprod. 2004;19:1548–53.PubMedCrossRefGoogle Scholar
  14. 14.
    Leridon H. Demographic effects of the introduction of steroid contraception in developed countries. Hum Reprod Update. 2006;12:603–16.PubMedCrossRefGoogle Scholar
  15. 15.
    Malizia B, Kacker MR, Penzias AS. Cumulative live-birth rates after in vitro fertilization. New Engl J Med. 2009;360:236–43.PubMedCrossRefGoogle Scholar
  16. 16.
    Marinakis G, Nikolaou D. What is the role of assisted reproduction technology in the management of age-related infertility? Hum Fertil (Camb). 2011;14(1):8–15. Review.CrossRefGoogle Scholar
  17. 17.
    Merviel P, Heraud MH, Grenier N, Lourdel E, Sanguinet P, Copin H. Predictive factors for pregnancy after intrauterine insemination (IUI): an analysis of 1038 cycles and a review of the literature. Fertil Steril. 2010;93(1):79–88. Review.PubMedCrossRefGoogle Scholar
  18. 18.
    Nuojua-Huttunen S, Tomas C, Bloigu R, Tuomivaara L, Martikainen H. Intrauterine insemination treatment in subfertility: an analysis of factors affecting outcome. Hum Reprod. 1999;14(3):698–703.PubMedCrossRefGoogle Scholar
  19. 19.
    Nyboe Andersen A, Goossens V, Bhattacharya S, Ferraretti AP, Kupka MS, de Mouzon J, et al. Assisted reproductive technology and intrauterine inseminations in Europe, 2005: results generated from European registers by ESHRE: ESHRE. The European IVF Monitoring Programme (EIM), for the European Society of Human Reproduction and Embryology (ESHRE). Hum Reprod. 2009;24:1267–87.PubMedCrossRefGoogle Scholar
  20. 20.
    Osmanogaoglu K, Tournaye H, Camus M, Vandervorst M, Van Steirteghem A, Devroey P. Cumulative delivery rates after intracytoplasmic sperm injection: 5 year follow up of 498 patients. Hum Reprod. 1999;14:2651–5.CrossRefGoogle Scholar
  21. 21.
    Osmanagaoglu K, Tournaye H, Kolibianakis E, Camus M, Van Steirteghem A, Devroey P. Cumulative delivery rates after ICSI in women aged 37 years. Hum Reprod. 2002;17:940–4.PubMedCrossRefGoogle Scholar
  22. 22.
    Papanikolaou E, D’haeseleere E, Verheyen G, Van de Velde H, Camus M, Van Steirteghem A, et al. Live birth is significantly higher after blastocyst transfer than after cleavage-stage embryo transfer when at least four embryos are available on day 3 of embryo culture: a randomized prospective study. Hum Reprod. 2005;20:3198–203.PubMedCrossRefGoogle Scholar
  23. 23.
    Papanikolaou E, Bourgain C, Kolibianakis E, Tournaye H, Devroey P. Steroid receptor expression in late follicular phase endometrium in GnRH antagonist IVF cycles is already altered, indicating initiation of early luteal phase transformation in the absence of secretory changes. Hum Reprod. 2005;20:1541–7.PubMedCrossRefGoogle Scholar
  24. 24.
    Stone BA, Vargyas JM, Ringler GE, Stein AL, Marrs RP. Determinants of the outcome of intrauterine insemination: analysis of outcomes of 9963 consecutive cycles. Obstet Gynecol. 1999;180:1522–64.CrossRefGoogle Scholar
  25. 25.
    Stoop D, De Munck N, Jansen E, Platteau P, Van den Abbeel E, Verheyen G, et al. Clinical validation of a closed vitrification system in an oocyte-donation programme. Reprod Biomed Online. 2012;24(2):180–5.PubMedCrossRefGoogle Scholar
  26. 26.
    Spira A. The decline of fecundity with age. Maturitas (Suppl). 1988;1:15–22.CrossRefGoogle Scholar
  27. 27.
    Templeton A, Morris JK, Parslow W. Factors that affect outcome of in vitro fertilisation treatment. Lancet. 1996;348:1402–6.PubMedCrossRefGoogle Scholar
  28. 28.
    teVelde ER, Pearson PL. The variability of female reproductive ageing. Hum Reprod Update. 2002;8:141–54.CrossRefGoogle Scholar
  29. 29.
    Wang YA, Farquhar C, Sullivan EA. Donor age is a major determinant of success of oocyte donation/recipient program. Hum Reprod. 2012;27(1):118–25.PubMedCrossRefGoogle Scholar
  30. 30.
    Wood JW. Fecundity and natural fertility in humans. Oxf Rev Reprod Biol. 1989;11:61–109.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Michaël De Brucker
    • 1
    Email author
  • Herman Tournaye
    • 1
  • Patrick Haentjens
    • 2
  • Greta Verheyen
    • 1
  • John Collins
    • 3
    • 4
    • 5
  • Michel Camus
    • 1
  1. 1.Centre for Reproductive MedicineUniversitair Ziekenhuis Brussel, Vrije Universiteit BrusselBrusselsBelgium
  2. 2.Centre for Outcomes Research and Laboratory for Experimental SurgeryUniversitair Ziekenhuis Brussel, Vrije Universiteit BrusselBrusselsBelgium
  3. 3.McMaster UniversityHamiltonCanada
  4. 4.Dalhousie UniversityHalifaxCanada
  5. 5.Mahone BayCanada

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