One last chance for pregnancy: a review of 2,705 in vitro fertilization cycles initiated in women age 40 years and above

Objective

To describe live birth rates and predictors of success in 1-year age increments for women ≥40 years when initiating assisted reproductive technologies (ART).

Design

Retrospective database analysis.

Setting

A large university-affiliated infertility center.

Patient(s)

One thousand two hundred sixty-three women undergoing 2,705 ART cycles at age 40 or above.

Intervention(s)

Couples undergoing ART.

Main Outcome Measure(s)

Pregnancy and live birth rates per cycle start were determined based on 1-year increments in women aged ≥40. Predictors of success, including number of embryos transferred, number of fetal heartbeats, availability of embryos for cryopreservation, and cycle day 3 FSH levels, were analyzed.

Result(s)

The overall live birth rate per cycle start was 9.7%. Cumulative live birth rates in women ranged from 28.4% if starting ART at age 40 to 0 by age 46. The overall spontaneous abortion rate was 32.6% (range, 23.9%–66.7%). Higher pregnancy rates were predicted by the greater number of embryos available for transfer, by the availability of excess embryos for cryopreservation, and by the presence of two fetal heartbeats on ultrasound. The outcome of the first IVF cycle did not predict the outcome of subsequent cycles.

Conclusion(s)

Assisted reproductive technology has a reasonable chance for success (>5%) up until the end of the forty-third year. Twins on initial ultrasound, large numbers of embryos available for transfer, and the presence of excess embryos for cryopreservation predict higher live birth rates.

Key Words:  Advanced maternal age , ART , spontaneous abortion , multiple pregnancy rates