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Fertility Treatment in the Forty and Older Woman

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Abstract

Purpose: To determine the outcomes and logical progression of fertility treatment in women forty years and older using their own oocytes.

Methods: This was a retrospective study in which 401 completed treatment cycles in 152 women aged forty and older were reviewed.

Results: Assisted reproductive technology (ART) cycles (n = 58) were reviewed, comprising both in vitro fertilization (IVF) and gamete intrafallopian transfer (GIFT). Intrauterine insemination (IUI) cycles (n = 343) were reviewed, consisting of 38 unstimulated natural cycle–IUI (NC-IUI), 194 clomiphene citrate–IUI (CC-IUI), and 111 injectable gonadotropins–IUI (INJ-IUI) cycles.

The live birth rate of 15.5% for ART cycles was significantly higher than the live birth rate of 3.2% seen for all IUI cycles (p = 0.0007). There were no differences among treatment groups in spontaneous abortion, preterm delivery, or ectopic pregnancy rates.

Conclusions: For women ≥40 years of age who wish to use their own eggs, ART offers the best chances for conception and delivery.

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REFERENCES

  1. Menken J, Trussell J, Larsen U: Age and infertility. Science 1986;233:1389-1394. Published erratum appears in Science 1986; 234:413

    Google Scholar 

  2. Navot D, Bergh PA, Williams MA, Garrisi GJ, Guzman I, Sandler B, Grunfeld L: Poor oocyte quality rather than implantation failure as a cause of age-related decline in female fertility [see comments]. Lancet 1991;337:1375-1377

    Google Scholar 

  3. Batista MC, Cartledge TP, Zellmer AW, Merino MJ, Axiotis C, Bremner WJ, Nieman LK: Effects of aging on menstrual cycle hormones and endometrial maturation. Fertil Steril 1995;64:492-499

    Google Scholar 

  4. Rosenwaks Z, Davis OK, Damario MA: The role of maternal age in assisted reproduction. Hum Reprod 1995;10(Suppl 1):165-173

    Google Scholar 

  5. Hull MG, Fleming CF, Hughes AO, McDermott A: The age-related decline in female fecundity: A quantitative controlled study of implanting capacity and survival of individual embryos after in vitro fertilization. Fertil Steril 1996;65:783-790

    Google Scholar 

  6. Agarwal SK, Buyalos RP: Clomiphene citrate with intrauterine insemination: Is it effective therapy in women above the age of 35 years? Fertil Steril 1996;65:759-763

    Google Scholar 

  7. Corsan G, Trias A, Trout S, Kemmann E: Ovulation induction combined with intrauterine insemination in women 40 years of age and older: Is it worthwhile? [see comments]. Hum Reprod 1996;11:1109-1112

    Google Scholar 

  8. Legro RS, Shackleford DP, Moessner JM, Gnatuk CL, Dodson WC: ART in women 40 and over. Is the cost worth it? J Reprod Med 1997;42:76-82

    Google Scholar 

  9. Revised American Fertility Society classification of endometriosis: 1985. Fertil Steril 1985;43:351-352

    Google Scholar 

  10. Hofmann GE, Sosnowski J, Scott RT, Thie J: Efficacy of selection criteria for ovarian reserve screening using the clomiphene citrate challenge test in a tertiary fertility center population. Fertil Steril 1996;66:49-53

    Google Scholar 

  11. Campana A, Sakkas D, Stalberg A, Bianchi PG, Comte I, Pache T, Walker D: Intrauterine insemination: Evaluation of the results according to the woman's age, sperm quality, total sperm count per insemination and life table analysis. Hum Reprod 1996;11:732-736

    Google Scholar 

  12. Brzechffa PR, Daneshmand S, Buyalos RP: Sequential clomiphene citrate and human menopausal gonadotrophin with intrauterine insemination: The effect of patient age on clinical outcome. Hum Reprod 1998;13:2110-2114

    Google Scholar 

  13. Faddy MJ, Gosden RG, Gougeon A, Richardson SJ, Nelson JF: Accelerated disappearance of ovarian follicles in mid-life: Implications for forecasting menopause. Hum Reprod 1992;7:1342-1346

    Google Scholar 

  14. Abdalla HI, Burton G, Kirkland A, Johnson MR, Leonard T, Brooks AA, Studd JW: Age, pregnancy and miscarriage: Uterine versus ovarian factors. Hum Reprod 1993;8:1512-1517

    Google Scholar 

  15. Navot D, Drews MR, Bergh PA, Guzman I, Karstaedt A, Scott RT Jr, Garrisi GJ, Hofmann GE: Age-related decline in female fertility is not due to diminished capacity of the uterus to sustain embryo implantation [see comments]. Fertil Steril 1994;61:97-101

    Google Scholar 

  16. Dodson WC, Haney AF: Controlled ovarian hyperstimulation and intrauterine insemination for treatment of infertility [see comments]. Fertil Steril 1991;55(3):457-467

    Google Scholar 

  17. Pearlstone AC, Fournet N, Gambone JC, Pang SC, Buyalos RP: Ovulation induction in women age 40 and older: The importance of basal follicle-stimulating hormone level and chronological age. Fertil Steril 1992;58:674-679

    Google Scholar 

  18. Brzechffa PR, Buyalos RP: Female and male partner age and menotropin requirements influence pregnancy rates with human menopausal gonadotrophin therapy in combination with intrauterine insemination. Hum Reprod 1997;12:29-33

    Google Scholar 

  19. Guzick DS, Carson SA, Coutifaris C, Overstreet JW, Factor-Litvak P, Steinkampf MP, Hill JA, Mastroianni L, Buster JE, Nakajima ST, Vogel DL, Canfield RE: Efficacy of superovulation and intrauterine insemination in the treatment of infertility. National Cooperative Reproductive Medicine Network. N Engl J Med 1999;340:177-183

    Google Scholar 

  20. Guzick DS, Sullivan MW, Adamson GD, Cedars MI, Falk RJ, Peterson EP, Steinkampf MP: Efficacy of treatment for unexplained infertility. Fertil Steril 1998;70:207-213

    Google Scholar 

  21. Serhal PF, Katz M, Little V, Woronowski H: Unexplained infertility-the value of Pergonal superovulation combined with intrauterine insemination. Fertil Steril 1988;49:602-606

    Google Scholar 

  22. Nulsen JC, Walsh S, Dumez S, Metzger DA: Arandomized and longitudinal study of human menopausal gonadotropin with intrauterine insemination in the treatment of infertility. Obstet Gynecol 1993;82:780-786

    Google Scholar 

  23. Lass A, Croucher C, Duffy S, Dawson K, Margara R, Winston RM: One thousand initiated cycles of in vitro fertilization in women 40 years of age. Fertil Steril 1998;70:1030-1034

    Google Scholar 

  24. Society for Assisted Reproductive Technology, The American Society for Reproductive Medicine: Assisted reproductive technology in the United States: 1996 results generated from the American Society for Reproductive Medicine/Society for Assisted Reproductive Technology Registry. Fertil Steril 1999;71:798-807

    Google Scholar 

  25. US Department of Health and Human Services, Centers for Disease Control and Prevention: 1998 Assisted Reproductive Technology Success Rates. Dec 2000

  26. Scott RT, Toner JP, Muasher SJ, Oehninger S, Robinson S, Rosenwaks Z: Follicle-stimulating hormone levels on cycle day 3 are predictive of in vitro fertilization outcome. Fertil Steril 1989;51(4):651-654

    Google Scholar 

  27. Scott RT Jr, Hofmann GE, Oehninger S, Muasher SJ: Intercycle variability of day 3 follicle-stimulating hormone levels and its effect on stimulation quality in in vitro fertilization. Fertil Steril 1990;54(2):297-302

    Google Scholar 

  28. Martin JS, Nisker JA, Tummon IS, Daniel SA, Auckland JL, Feyles V: Future in vitro fertilization pregnancy potential of women with variably elevated day 3 follicle-stimulating hormone levels. Fertil Steril 1996;65(6):1238-1240

    Google Scholar 

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Authors and Affiliations

  1. Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri

    Anthony Auyeung, Molly E. Klein, Valerie S. Ratts, Randall R. Odem & Daniel B. Williams

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  1. Anthony Auyeung
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  2. Molly E. Klein
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  3. Valerie S. Ratts
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  4. Randall R. Odem
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  5. Daniel B. Williams
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Auyeung, A., Klein, M.E., Ratts, V.S. et al. Fertility Treatment in the Forty and Older Woman. J Assist Reprod Genet 18, 638–643 (2001). https://doi.org/10.1023/A:1013159116180

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  • DOI: https://doi.org/10.1023/A:1013159116180

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