Objective: To define factors in patients > or = 40 years that may improve outcome and provide prognosis for success in IVF-ET.
Design: Retrospective.
Setting: University infertility center.
Patients: Patients (n = 501) undergoing IVF-ET from 1987 to 1994.
Interventions: IVF-ET (n = 713 cycles) with GnRH-analogue suppression and hMG stimulation.
Main Outcome Measures: We evaluated data including age, diagnosis, prestimulation (day 3) FSH and E2, hMG ampules used, days of monitoring, follicle number and size, maximum E2, ova retrieved, cancellation rate, clinical pregnancy, nidation, and miscarriage rates.
Results: Overall, patients > or = 40 years had significantly decreased pregnancy rates (PRs), response to stimulation, and increased miscarriage rates. However, if these patients had four or more embryos transferred, their response and PRs (34.4% per ET) were not significantly different from younger women (47.7% per ET). The majority (77.8%) of pregnancies in women > or = 40 years occurred when four or more embryos were transferred.
Conclusion: A subset (49%) of women > or = 40 years undergoing IVF-ET will respond to ovarian stimulation well enough to result in four or more embryos available for transfer with a resultant PR similar to that observed in younger patients. We recommend consideration of an attempt at IVF-ET before recommending oocyte donation.
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