One thousand initiated cycles of in vitro fertilization in women > or = 40 years of age

Abstract

Objective: To evaluate the results of IVF in women > or = 40 years of age using their own oocytes.

Design: Retrospective study.

Setting: Wolfson and Royal Masonic in vitro fertilization units, London, United Kingdom.

Patient(s): A total of 1,087 IVF cycles were started in women > or = 40 years of age.

Intervention(s): Medical records of patient outcomes were reviewed.

Main outcome measure(s): Clinical pregnancy, miscarriage, and delivery rates.

Result(s): Of the 1,087 cycles started in 471 women > or = 40 years of age, 842 reached oocyte retrieval (77.5%) and 702 had embryos transferred (64.6%). The pregnancy rate (PR) was significantly lower in women > or = 40 years of age than in a control group of women <40 years of age (11.3% versus 28.2%). It decreased sharply in women >42 years of age, and no women >45 years of age had a child. Women > or = 40 years of age were more likely to miscarry (27% versus 12.7%). When only one embryo was available for transfer, the PR was 3.3%. When >2 embryos were available for transfer, the PR was similar whether 2 or 3 embryos were replaced. No triplet pregnancy occurred. Women > or = 40 years of age achieved a cumulative PR of 30% after three cycles with a cumulative "take home baby" rate of 21%.

Conclusion(s): In vitro fertilization is a reasonable treatment for women <45 years of age using their own gametes. Those with a "good response" in their first attempt may be encouraged to complete three cycles with an acceptable chance of conception.