Assisted reproduction counseling in women aged 40 and above: a cohort study
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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.
KeywordsAge 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.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
- 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
- 12.International Committee Monitoring Assisted Reproductive Tecnologies (ICMART). http://www.icmartivf.org/current-activities.html 2007.
- 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
- 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.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