Analysis of 2,386 consecutive cycles of in vitro fertilization or intracytoplasmic sperm injection using autologous oocytes in women aged 40 years and above

Objective

To estimate the live-birth and miscarriage rates in 1-year age increments for women aged ≥40 years undergoing in vitro fertilization or intracytoplasmic sperm injection (ICSI–IVF) with autologous oocytes.

Design

Retrospective database and chart analysis.

Setting

Egyptian IVF and embryo transfer center.

Patient(s)

One thousand six hundred forty-five women aged ≥40 years undergoing 2004 fresh nondonor IVF–ICSI cycles.

Intervention(s)

ICSI–IVF using ejaculate or surgically retrieved sperm.

Main Outcome Measure(s)

Pregnancy and live-birth rates per initiated cycle based on 1-year age increments.

Result(s)

The overall live-birth rate per initiated cycle was 6.7% (range: 10% to 0.5%). The pregnancy loss rate was 44.8% (range: 39.0% to 75.0%). The cutoff age was 43 years, when the pregnancy rate became statistically significantly lower. The live-birth rate per initiated cycle was statistically significantly higher for women <43 years old, 132 out of 1766 (7.4%) compared with women ≥43 years old, 7 out of 620 (1.1%). The miscarriage rate was 127 out of 295 (43.1%) compared with 15 out of 23 (65.2%) for the two age groups, respectively.

Conclusion(s)

The success rate of ICSI–IVF as measured by live-birth rate per initiated cycle was statistically significantly higher for women aged <43 years as compared with women aged ≥43 years. Once women have attained age 43 years, alternative methods such as oocyte donation cycles or previously cryopreserved embryos are likely to be more effective.

Key Words: ART, autologous oocytes, ICSI, IVF, live birth, multiple pregnancy rates, spontaneous miscarriage, women aged ≥40