ACHIEVING MULTIPLE-ORDER EMBRYO-TRANSFER IDENTIFIES WOMEN OVER 40 YEARS OF AGE WITH IMPROVED IN-VITRO FERTILIZATION OUTCOME

Objective: To define factors in patients greater than or equal to 40 y ears that may improve outcome and provide prognosis for success in IVF -ET. Design: Retrospective. Setting: University infertility center. Pa tients: Patients (n = 501) undergoing IVF-ET from 1987 to 1994. Interv entions: IVF-ET (n = 713 cycles) with GnRH-analogue suppression and hM G stimulation. Main Outcome Measures: We evaluated data including age, diagnosis, prestimulation (day 3) FSH and E(2), hMG ampules used, day s of monitoring, follicle number and size, maximum E(2), ova retrieved , cancellation rate, clinical pregnancy, nidation, and miscarriage rat es. Results: Overall, patients greater than or equal to 40 years had s ignificantly 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) wer e not significantly different from younger women (47.7% per ET). The m ajority (77.8%) of pregnancies in women greater than or equal to 40 ye ars occurred when four or more embryos were transferred. Conclusion: A subset (49%) of women greater than or equal to 40 years undergoing IV F-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 a ttempt at IVF-ET before recommending oocyte donation.