Female Age in ART: When to Stop?

Abstract

With increasing age the probability of ongoing pregnancy established by the use of assisted reproduction technology (ART) decreases. As a result the question arises whether age limits for the application of ART should be established. From a literature review and ongoing research data it appears that the costs per child born greatly increase after the age of 40 for both intrauterine insemination with mild ovarian stimulation and in vitro fertilisation treatment, while in cases of 44 and over, prognosis is flat zero. The willingness to pay for extra costs will greatly determine whether and at what age strict limits should be applied. Fortunately, predictive factors for success, like the antral follicle count, may enable the identification of women over 40 and under 44 that still have favourable prospects, thereby decreasing the necessary costs per childbirth and allowing couples into ART programs that are often denied based solely on female age.

Resource allocation of in vitro fertilization: a nationwide register-based cohort study

“…We do not, however, consider this a drawback because all expenditures were inflated to correspond to 2005 prices, and we focused primarily on describing the differences in expenditures by women's age and socioeconomic position rather than the exact amount of euros. Furthermore, our cost estimation of a successful IVF cycle is in accordance with an earlier Finnish study [ 14 ] as well as earlier cost calculations by age that have included the same components as used in our study [ 10 ]. However, only some of the actual costs were taken into account, the costs excluded being non-routine radiological and laboratory tests and all indirect costs such as travel costs and sick leaves.…”

“…It is difficult to determine an optimal and equal age to stop the resource allocation for IVF. Treatment of selected women aged 40–43 has been found to be quite successful [ 10 , 19 ] and natural pregnancies also occur for women in their forties. However, a given age-limit could be a signal that encourages women to attempt to give birth during the normal fertile age.…”

“…Should women with "greater need" but less chance of success be favoured or should women with "more benefit" (younger and better chance of success) be favoured? Health care costs for IVF treatment by women's age have been described previously [ 10 ] but empirical data that would quantify this question have not been given, nor has the distribution of private and public expenditure been estimated. The purpose of this study is to describe the allocation of IVF resources by women's age, socioeconomic position, area of residence, and treatment sector (public vs. private), as well as to discuss whether the IVF resources are allocated fairly in Finland.…”

Letrozole co-treatment in infertile women 40 years old and older receiving controlled ovarian stimulation and intrauterine insemination

“…The decrease in fertility due to age cannot be compensated for by the current available ART and young women should be aware of this fact and plan their reproductive life accordingly (9). Candidates for COH-IUI should be carefully selected based on reliable predictors of success such as the levels of basal FSH and the antral follicle count (46). These women should be also advised of the increased risk of perinatal mortality and morbidity associated with a late pregnancy (47).…”

Mining of variables from embryo morphokinetics, blastocyst’s morphology and patient parameters: an approach to predict the live birth in the assisted reproduction service

“…Tan et al (2014) reported a decrease of 13.2% in clinical pregnancy for women aged 40-44 years, compared to women less than 30 years. As concluded by Broekmans and Klinkert (2004), Lintsen et al (2007) and Templeton et al (1996), women age is considered the most important predictor of IVF success.…”