Natural cycle IVF is an excellent treatment option for women with advanced age

Abstract

OBJECTIVE: Women with advanced age have poor ART outcome. Controlled ovarian hyperstimulation is associated with multiple side effects. In this study, we are analyzing the outcome of nature cycle IVF in treating this group of patients. DESIGN: Retrospective cohort study. MATERIALS AND METHODS: After abtaining IRB approval, we reviewed nature cycle IVF data in our clinic from January to December 2008. All patients between 38 to 45 year old were analyzed. In nature cycle IVF, patients were closely monitored for their folliclular growth. When dominant follicle reachs 17-19 mm, patients were given GnRH agonist for triggering oocyte maturation. Oocyte retrievals were performed 32-34 hours later. Single embryo transfers were performed at 4-cell stage (day 2) or blastocyst (day 5). Clinical pregnancy was confirmed after fetal cardiac activity noted by ultrasound. We devided patients into 3 groups: A (age 38-40); B (age 41-43) and C (age 44 and 45). Oocyte retrieval rate, fertilization rate, embryo cleavage rate and clinical pregnancy rate were analyzed in each group. Chi-Square test was used for statistical analysis, and P<0.05 was considered statistically significant. RESULTS: Oocyte retrieval rates in each groups were A: 66.0% (401/608), B: 61.6% (252/409); and C: 56.4% (102/181), respectively. Fertilization rates were A: 77.8% (312/401), B: 81.3% (205/252), and C: 76.5% (78/102), respectively. Embryo cleavage rates were A: 71.1% (285/401), B: 71.4% (180/252), and C: 66.7% (66/102), respectively. Clinical pregnancy rates per embryo transfer were A: 29.8% (57/191), 20.8% (20/96), and 6.5% (2/31), respectively. No statistical differences were found among all groups except the clinical pregnancy rate. Patients with age 44-45 had significantly lower clinical pregnancy rate (P<0.05). CONCLUSIONS: Women with advanced age are associated with poor ovarian reserve and they also have poor ART outcome with conventional IVF. Nature cycle IVF provides an excellent option for this group of patients.