The influence of ovarian response on gamete intra-Fallopian transfer outcome in older women

Abstract

Fecundity declines with increasing age in women. The pregnancy rate is lower in in-vitro fertilization/embryo transfer (IVF/ET) in women aged greater than or equal to 40 years. We analysed 349 consecutive gamete intra-Fallopian transfer (GIFT) cycles in women aged greater than or equal to 40 years to identify factors which affected the outcome. A maximum of four oocytes were transferred in GIFT as recommended by the Interim Licensing Authority; 61 women (17.5%) had a positive serum beta-human chorionic gonadotrophin, 35 (10%) had a miscarriage and 26 (7.5%) delivered live infants. The pregnancy rate was lower than with younger women while the conception loss was higher. Pregnancy and delivery rates increased as the number of oocytes retrieved increased but declined again if greater than 10 oocytes were retrieved. If 1-3 oocytes were retrieved, the pregnancy rate was 9.7% and the delivery rate was 3.9%; if 4-10 oocytes were retrieved, the pregnancy rate was 22.1% and the delivery rate was 10.1%, and when greater than 10 oocytes were retrieved, the rates were 17.6 and 5.9% respectively. The highest pregnancy rate was when four oocytes were transformed in GIFT (22.4%) and the delivery rate was 10.0%. An adequate response to long down-regulation with gonadotrophin-releasing hormone agonist was also a factor associated with high delivery rates (13.5%). We conclude that the delivery rate after GIFT in women aged greater than or equal to 40 years is low, but there is a subgroup who have an acceptable delivery rate because of a good ovarian response. In this group, pituitary down-regulation improves the outcome of treatment.

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“…Using only women with azoospermic husbands, they controlled for reduced fecundity due to a decrease in frequency of sexual intercourse, male subfertility, and a possible decrease in male fertility with increasing age. These findings are supported by studies of both in vitro fertilization with embryo transfer (IVF/ET) and gamete intrafallopian transfer (GIFT) (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13). Piette et al (5) showed a significant decrease in assisted reproduction outcome from 37 years, while Segal and Casper (7) and Kenny (6) found a decline after 35 years.…”

“…The results of donor insemination programs support a natural decline in fecundity with advancing age (1,2). Two studies of artificial insemination of donor semen in women with azoospermic husbands found a significant decrease in female fertility from 31 years (3,4), with an even greater decrease from 35 years (3). Using only women with azoospermic husbands, they controlled for reduced fecundity due to a decrease in frequency of sexual intercourse, male subfertility, and a possible decrease in male fertility with increasing age.…”

What Factors Affect Intracytoplasmic Sperm Injection Outcomes?

“…Previous studies indicate that a decrease in fertility in women is first noted at 35 years, with a dramatic decline noted at age 40, and virtually complete infertility by age 45 years (41,42). This trend is mirrored in couples undergoing standard IVF (35)(36)(37)(38)(39)(40)(41). To date, most studies also correlate poorer ICSI outcomes with advancing maternal age.…”

“…There is a definite correlation between maternal age and pregnancy outcomes with both naturally conceived and IVF-conceived children (35)(36)(37)(38)(39)(40)(41)(42). Previous studies indicate that a decrease in fertility in women is first noted at 35 years, with a dramatic decline noted at age 40, and virtually complete infertility by age 45 years (41,42).…”

Pharmacokinetics, safety, and tolerability of Pentoxifylline intravaginal gel for subfertile/ infertile couples with low sperm quality: phase I randomized controlled clinical trial in healthy women

“…[Evidence level 3]A cohort study has shown that pregnancy rates decline significantly after the age of 40 years, and again after the age of 42 years 753. [Evidence level 2b]Several other studies have shown that pregnancy rates following IVF treatment decline after the age of 35 years,[754][755][756][757] 37 years 758 and 40 years 334,[724][725][726][759][760][761][762][763].…”