The effect of yearly increments of age and day 3 serum follicle stimulating hormone (FSH) on pregnancy outcome following in vitro fertilization-embryo transfer (IVF-ET) in women aged 40-44

Abstract

OBJECTIVE: To determine the effect of age increments of 1 year and oocyte reserve on pregnancy rates (PRs) following IVF-ET in women of advanced reproductive age.DESIGN: Retrospective cohort comparison.MATERIALS AND METHODS: Retrospective 10 year review of clinical (live fetus at 8 weeks) and live delivered pregnancy rates (LDPR) and implantation rates according to age at 40, 41, 42, 43, and 44. Also the influence of FSH ranges of <12 mIU/mL, 12 to 15 or >16 mIU/mL was determined. Only minimal FSH stimulation protocols were used for women with serum day 3 FSH >12 mIU/mL.RESULTS: For serum FSH <12 mIU/mL the clinical pregnancy rate/transfer (CPRT) was for ages 40-44: 24.5% (56/229), 28.6% (56/196), 19.2% (37/193), 13.1% (19/145) and 10.6% (9/85). For serum FSH 12-15, the CPRT were 26.9% (7/26), 10.0% (2/20), 16.1% (5/31), 4.8% (1/21), and 1/21 (4.8%). For FSH >16 the CPRT were 18.2% (4/22), 11.1% (3/27), 9.1% (2/32), 5.6% (1/18), and 20.0% (3/15). The live delivered PRs (LDPRT) for FSH <12 were 17.0%, 18.4%, 9.8%, 6.9%, and 2.4%; for FSH 12-15: 19.2%, 0%, 6.5%, 4.8%, and 4.8% and for FSH >16 were 9.1%, 11.1%, 9.1%, 0% and 6.7%. The implantation rates (%) for the 3 FSH categories for women aged 40 was 11.9, 15.1 and 12.1; for 41: 12.1, 5.4, 7.7; for 42: 8.1, 9.6, 6.9; for 43: 6.1, 2.2, 5.0, and 44: 4.1, 3.0, 17.6.CONCLUSIONS: Women aged 40 and 41 with normal oocyte reserve have similar CPRT and LDPRTs as do women 40 with FSH 12-15. Live delivered pregnancies are possible in women with severe oocyte depletion (FSH >16) even in women aged 44 but the rates are 50% less in those aged 40-42 when compared to women aged 40-41 with normal reserve and only 1/3 as good in women 43 and 44. Age 42 seems to be the age where PRs drop to 50% even in those with normal oocyte reserve. OBJECTIVE: To determine the effect of age increments of 1 year and oocyte reserve on pregnancy rates (PRs) following IVF-ET in women of advanced reproductive age. DESIGN: Retrospective cohort comparison. MATERIALS AND METHODS: Retrospective 10 year review of clinical (live fetus at 8 weeks) and live delivered pregnancy rates (LDPR) and implantation rates according to age at 40, 41, 42, 43, and 44. Also the influence of FSH ranges of <12 mIU/mL, 12 to 15 or >16 mIU/mL was determined. Only minimal FSH stimulation protocols were used for women with serum day 3 FSH >12 mIU/mL. RESULTS: For serum FSH <12 mIU/mL the clinical pregnancy rate/transfer (CPRT) was for ages 40-44: 24.5% (56/229), 28.6% (56/196), 19.2% (37/193), 13.1% (19/145) and 10.6% (9/85). For serum FSH 12-15, the CPRT were 26.9% (7/26), 10.0% (2/20), 16.1% (5/31), 4.8% (1/21), and 1/21 (4.8%). For FSH >16 the CPRT were 18.2% (4/22), 11.1% (3/27), 9.1% (2/32), 5.6% (1/18), and 20.0% (3/15). The live delivered PRs (LDPRT) for FSH <12 were 17.0%, 18.4%, 9.8%, 6.9%, and 2.4%; for FSH 12-15: 19.2%, 0%, 6.5%, 4.8%, and 4.8% and for FSH >16 were 9.1%, 11.1%, 9.1%, 0% and 6.7%. The implantation rates (%) for the 3 FSH categories for women aged 40 was 11.9, 15.1 and 12.1; for 41: 12.1, 5.4, 7.7; for 42: 8.1, 9.6, 6.9; for 43: 6.1, 2.2, 5.0, and 44: 4.1, 3.0, 17.6. CONCLUSIONS: Women aged 40 and 41 with normal oocyte reserve have similar CPRT and LDPRTs as do women 40 with FSH 12-15. Live delivered pregnancies are possible in women with severe oocyte depletion (FSH >16) even in women aged 44 but the rates are 50% less in those aged 40-42 when compared to women aged 40-41 with normal reserve and only 1/3 as good in women 43 and 44. Age 42 seems to be the age where PRs drop to 50% even in those with normal oocyte reserve.