What is the role of assisted reproduction technology in the management of age-related infertility?

Marinakis, G.; Nikolaou, Dimitrios

doi:10.3109/14647273.2010.549162

Cited by 20 publications

(11 citation statements)

References 34 publications

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“…We can conclude that these success rates are representative for this age group and this type of treatment. Moreover these "low" success rates are confirmed in several other papers [7,16].…”

Section: Discussionsupporting

confidence: 60%

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

Brucker

Tournaye

Haentjens

et al. 2013

J Assist Reprod Genet

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Purpose 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. Methods 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. Results 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 %). Conclusion 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.

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“…We can conclude that these success rates are representative for this age group and this type of treatment. Moreover these "low" success rates are confirmed in several other papers [7,16].…”

Section: Discussionsupporting

confidence: 60%

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

Brucker

Tournaye

Haentjens

et al. 2013

J Assist Reprod Genet

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“…The increase in older women pursuing pregnancy is taking place against a background of considerable skepticism and even resistance from the U.S. government, the insurance industry and many colleagues in the medical community [30,35,36]. …”

Section: Resultsmentioning

confidence: 99%

The “graying” of infertility services: an impending revolution nobody is ready for

Gleicher

Kushnir

Weghofer

et al. 2014

Reprod Biol Endocrinol

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BackgroundAs demand for infertility services by older women continues to grow, because achievable in vitro fertilization (IVF) outcomes are widely underestimated, most fertility centers do not offer maximal treatment options with use of autologous oocytes. Limited data suggest that clinical IVF outcomes in excess of what the American Society for Reproductive Medicine (ASRM) considers “futile” can, likely, be achieved up to at least age 45 years.MethodsIn an attempt to point out an evolving demographic trend in IVF, we here report our center’s IVF data for 2010-2012 and national U.S. data for 1997-2010. Though our center’s data are representative of only one IVF center’s patients, they, likely, are unique since they probably represent the most adversely selected IVF patient population ever reported and, thus, are predictive of future demographic trends. In addition we performed a systematic review of the literature on the subject based on PubMed, Medline and Google Scholar searches till year-end 2013. The literature search was performed using key words and phrases relevant to fertility treatments in older women.ResultsAs demonstrated by our center’s patient demographics and national U.S. data, IVF centers are destined to treat increasingly adversely selected patients. Despite our center’s already extremely adversely selected patient population, age-specific IVF cycle outcomes in women above age 40 years, nevertheless, exceeded criteria for “futility” by the ASRM and widely quoted outcome expectations in the literature for patient ages. Age 43 discriminates between better and poorer clinical pregnancy and live birth rates.Conclusions“Graying” of the infertility populations in the developed world, a problem with potentially far-reaching medical and societal consequences, has so far been only insufficiently addressed in the literature. As women’s postmenopausal life spans already exceed postmenarcheal life spans at the start of the 20th century, the “graying” of infertility services can be expected to further accelerate, no longer as in recent decades bringing only women in their 40s into maternity wards but also women in their 50s and 60s. Medicine and society better get ready for this revolution.

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“…In the last years, a number of variables, either alone or in combination, have been used to develop prediction models of IVF outcome, so far with limited success [17,18]. AMH is an established marker of OR, and previous work showed its value in predicting the ovarian response to COS [5,19].…”

Section: Discussionmentioning

confidence: 99%

IVF results in patients with very low serum AMH are significantly affected by chronological age

Revelli

Biasoni

Gennarelli

et al. 2016

J Assist Reprod Genet

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Purpose The aims of this study were to assess the outcome of in vitro fertilization (IVF) in women with very low circulating anti-müllerian hormone (AMH) and to investigate factors affecting their probability of pregnancy. Methods The outcome of 448 IVF cycles in 361 women with circulating AMH <0.5 ng/ml was retrospectively analyzed. Results Cycle cancellation rate was 14.5 %; patients whose cycle was cancelled had significantly lower AMH than women who reached oocyte pickup (OPU). Among those who reached OPU, age significantly affected the success rate: despite comparable AMH levels, patients below 35 years obtained significantly more oocytes and a better clinical pregnancy rate (CPR)/OPU than patients aged 35-39 or 40-43 (31 % vs. 23.2 % vs. 10.2 %, respectively; p = 0.001). Differently, comparable IVF results were observed stratifying patients for AMH levels in the range 0.14-0.49 ng/ml. Multivariable logistic regression analysis confirmed that the probability of pregnancy was significantly affected by age, but not by small differences in AMH level. Conclusions Women with very low (<0.5 ng/ml) AMH levels undergoing IVF still have reasonable chances of achieving a pregnancy, but their prognosis is significantly affected by chronological age. Very low AMH levels are associated with a relevant risk of cycle cancellation but should not be considered a reason to exclude a couple from IVF.

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What is the role of assisted reproduction technology in the management of age-related infertility?

Cited by 20 publications

References 34 publications

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

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

The “graying” of infertility services: an impending revolution nobody is ready for

IVF results in patients with very low serum AMH are significantly affected by chronological age

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