YOUNG EGGS IN AN OLD BASKET – IS THERE A MATERNAL AGE LIMIT FOR EMBRYO TRANSFER?

Abstract

The current paradigm for in vitro fertilization (IVF) with embryo transfer (ET) suggests that the age of the uterus does not impact pregnancy outcomes. However few studies to date have focused on patients of very advanced maternal age. The objective of this study was to compare ET outcomes of women of advanced maternal age utilizing donor oocytes to determine whether age plays a role in reproductive outcomes. This was a retrospective cohort study conducted at a large University-affiliated fertility center. All ET cycles from 2012 to 2020 with single euploid blastocyst transfer that utilized donated oocytes were included. Cycles were divided into four groups by maternal age: less than 40 years, 40-44 years, 45-49 years, and 50 years or older. Primary outcomes were rates of positive serum hCG, clinical pregnancy, ongoing pregnancy (defined as presence of fetal heartbeat at discharge), miscarriage, and live birth. Continuous variables were analyzed with one-way analysis of variance (ANOVA) or Kruskal-Wallis test, while categorical variables with Pearson’s Chi-squares or Fischer-exact test. A total of 1,080 cycles were included (Table 1). Average patient age was 42.4 ± 4.9 years with a mean BMI of 26.5 ± 6.1 kg/m2. Average donor age was 27.4 ± 3.8 years with a mean antimullerian hormone (AMH) of 4.7 ± 2.0 ng/ml. Patient BMI, donor age, and donor AMH were similar between groups. There was no difference in the rates of positive hCG, clinical pregnancy, ongoing pregnancy or live birth between groups. There was a higher rate of first trimester miscarriage in patients over 50 (p < 0.01).Table 1Pregnancy outcomes of patients undergoing single, euploid ET using donor oocytesPatient age in yearTotal (n = 1080)<40 (n = 289)40-44 (n = 441)45-49 (n = 309)50+ (n = 41)p valuePositive serum hCG, n (%)833 (77.1%)225 (77.9%)341 (77.3%)235 (76.1%)32 (78.1%)0.95ClinicalPregnancy, n (%)716 (66.3%)187 (64.7%)295 (66. 9%)206 (66.7%)28 (68.3%)0.70Ongoing pregnancy, n (%)636 (58.9%)167 (57.8%)270 (61.2%)179 (57.9%)20 (48.8%)0.39First trimester miscarriage, n (%)95 (8.8%)22 (7.6%)29 (6.6%)36 (11.7%)8 (19.5%)<0.01*Live Birth, n (%)608 (56.3%)156 (54.0%)264 (59.9%)169 (54.7%)19 (46.3%)0.18 Open table in a new tab Success rates of IVF remained excellent in older patients who utilized donated oocytes. However, these patients, particularly those aged 50 years and older, may have an increased risk of first trimester miscarriage.