Abstract
BackgroundWorldwide, there is an increase in uptake of assisted reproductive technology (ART) treatment. The impact of paternal age on ART outcomes is unclear. In view of the conflicting results reported by studies evaluating effect of paternal age on ART outcomes, we planned a study to investigate the impact of advanced paternal age in couples undergoing ART for non-male factor infertility. We conducted a retrospective cohort study at a university-level teaching hospital in South India. All couples who underwent ART for non-male factor infertility were included. The couples were divided into two groups based on the age of the male partner. Group I included couples with male partner’s age less than 40 years, taken as reference group. Group II included couples with male partners age more than or equal to 40 years. The primary outcome was live birth rate. Secondary outcomes included clinical pregnancy, miscarriage, fertilization, embryo development, and blastulation rates.ResultsA total of 809 cycles were included for the study. Following exclusion of 39 cycles, 770 cycles were analyzed for outcomes. Group I comprised of 556 (72%) cycles and group II comprised of 214 (28%) cycles. There was no significant difference in live birth rate per embryo transfer between groups I and II (31.8% vs. 29.4%; odds ratio, OR, 0.89; 95% CI 0.63 to 1.26). After adjustment for potential confounders, the live birth rate did not differ significantly (adjusted odds ratio, aOR, 1.10; 95% CI 0.74 to 1.65). The clinical pregnancy (39.4% vs. 36%; aOR 1.06; 95% CI 0.72 to 1.56) and the miscarriage rates (18.3% vs. 15.6%; aOR 0.73; 95% CI 0.32 to 1.66) were also similar between the two groups. There was significant decrease in the blastulation rate (36.8% vs. 32.1%; P 0.002) in the advanced paternal age group as compared to the reference group.ConclusionThe current study suggests that in couples undergoing ART for non-male factor, there is no detrimental effect of increasing paternal age on treatment outcomes.
Highlights
Worldwide, there is an increase in uptake of assisted reproductive technology (ART) treatment
There was no significant difference in live birth rate per embryo transfer between groups I and II (31.8% vs. 29.4%; odds ratio (OR) 0.89, 95% confidence interval (CI) 0.63 to 1.26; P 0.52)
There were no significant differences in fertilization (76.8% vs. 75.3%; OR 0.92; 95% CI 0.81 to 1.05; P 0.20) and the embryo development rates (96.2% vs. 95.6%; OR 0.86; 95% CI 0.63 to1.18; P 0.33), but there was a significant decrease in the blastulation rate (36.8% vs. 32.1%; OR 0.81; 95% CI 0.71 to 0.93; P 0.002) in the advanced paternal age group as compared to the reference group (Table 3)
Summary
In view of the conflicting results reported by studies evaluating effect of paternal age on ART outcomes, we planned a study to investigate the impact of advanced paternal age in couples undergoing ART for non-male factor infertility. There is an increase in uptake of assisted reproductive technology (ART) treatment [1] For many indications such as bilateral tubal damage, severe endometriosis, and male factor, ART remains the most effective treatment option [2]. Studies have reported a steep decline in live birth rates with ART after the age of 40 years [4,5,6]. This decline in live birth is mainly attributed to age-related decline in oocyte quality and quantity, increase in aneuploidy, reduced fertilization, and lower implantation rates [7, 8]
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