Female patients over 40 in fresh non-donor art cycles: a chance for success?
DOI:
https://doi.org/10.37800/RM.3.2022.24-33Keywords:
advanced reproductive age, advanced maternal age, assisted reproductive technologies, infertility, aneuploidies, pregnancy outcomesAbstract
Relevance: The number of women of advanced maternal age (>40) who chooses to use assisted reproductive technologies (ART) has increased dramatically over the past decades. Several factors can naturally decrease female fertility: a decrease in the number of oocytes, a decrease in the quality of oocytes/embryos, an increase in the number of chromosomal aneuploidies, and the rate of early pregnancy losses.
The study aimed to analyze the results and efficiency of “fresh” non-donor ART cycles of females over 40.
Methods: The study involved clinical and laboratory analysis of 435 non-donor IVF/ICSI cycles performed in female patients aged <40 years in 2016-2018 at the Institute of Reproductive Medicine (Almaty, Kazakhstan).
Results: High rate (57.5%) of cycle cancellation due to various reasons was observed in female patients of advanced maternal age with non-donor oocytes. The largest portion of embryo transfer (ET) cancellations occurred at the embryological stage (40%). The second-largest cause of ET cancellations was based on the results of PGT-A/aCGH (34%). The blastulation rate was significantly higher (p≤0.05) in women aged 40-42 vs. those aged 43-46 years – 48 vs. 38%, respectively. Comparative analysis showed a significant decrease in the clinical pregnancy rate (p<0.01) with age: 8.7% in women aged 43-46 vs. 32.3% in women aged 40-42 years. The proportion of cycles with cryopreservation of blastocysts also significantly decreased with an increase in the female age – 4.3% at 43-46 years vs. 33.3% at 40-42 years (p<0.001). Implantation rate at 7 and 12 weeks of gestation was significantly higher in patients aged 40-42 years compared to females aged 43-46 years and amounted to 21.3 and 14% versus 5.7 and 2.8% (p<0.01 and p<0.001). The live birth rate in “fresh” IVF/ICSI cycles with non-donor oocytes was also significantly higher in patients aged 40-42 – 22.6 vs. 4.3% in patients aged 43-46.
Conclusion: There is a clear correlation between an increase in the female reproductive age in ART programs with non-donor oocytes and a decrease in the reproductive potential in patients over 40 years.
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