The influence of age on reproductive outcome in preimplantation genetic diagnosis (PGD)

Abstract

OBJECTIVE: The aim of this study was to compare the pregnancy outcome in PGD cycles between different group of ages and to estimate the maximum female age at which clinical application of these techniques can be considered useful. DESIGN: Prospective observational study. MATERIALS AND METHODS: Between 1993-2005, the relationship between patient age and pregnancy outcome was assessed at a large academic referral centre for PGD. Subgroup analysis was performed between age groups per 5 years. Bivariate analysis (T-test) was used to determine the effect of age on clinical, ongoing and live birth delivery rate per oocyte collection cycle (OCC). Kaplan-Meier analysis of cumulative live birth delivery rate was used and Cox regression analysis was performed for the effect of age on cumulative outcome. RESULTS: During 9 years, a total of 2753 cycles of PGD for monogenic disorders, numerical and structural chromosomal abnormalities (1453) and preimplantation genetic screening for aneuploidy (PGS) (1300) on 1498 patients were performed, resulting in the birth of 583 children. Based on Kaplan-Meier analysis the observed cumulative delivery rate was 29% vs 64% expected cumulative delivery rate. Our Cox regression analysis model demonstrates that the effect of age on cumulative live birth delivery rate is highly significant (p<0,01) between the age group ≥ 40years (11.3% real cumulative delivery rate) and the other age groups (<25years: 48.5% real cumulative delivery rate, 25-29 years: 38.8%, 30-34 years: 33.8% and 35-39 years: 28%). Cumulative reproductive outcome is not influenced significantly by mode of inheritance, fertility status and type of ovarian stimulation protocol used. Over the age of 40, the reproductive outcome related to age difference is not significantly different, but shows a trend towards lower success as from the age of 42. CONCLUSIONS: Age has a significantly negative effect on reproductive outcome in PGD especially over the age of 40. Mode of inheritance, fertility status and type of ovarian stimulation protocol does not influence success rates in PGD.