HIGH-ORDER OOCYTE TRANSFER IN GAMETE INTRAFALLOPIAN TRANSFER PATIENTS40 OR MORE YEARS OF AGE

Objective: To analyze whether a policy of high-order oocyte transfer w ould be effective in women greater than or equal to 40 years of age wh o are undergoing GIFT, and further, whether a specific subgroup of the se patients could be identified where clinical pregnancy was more like ly to occur. Design: Prospective descriptive study. Setting: Patients in a university-based reproductive endocrinology and infertility pract ice. Patients: Infertile women greater than or equal to 40 years of ag e who underwent GIFT cycles between January, 1990 and December, 1993 a fter not having achieved pregnancy with at least three previous cycles of superovulation and intrauterine insemination. Interventions: Gamet e intrafallopian transfer was performed after controlled ovarian hyper stimulation with hMGs. High-order oocyte transfer was employed. Main O utcome Measures: Clinical pregnancy rates (PRs). Results: The overall clinical PR was 24.5% per retrieval (12/49) and 25.5% per transfer (12 /47). A significantly higher number of oocytes were retrieved in patie nts who became pregnant than those who did not. Patient age, cycle day 3 FSH level, E(2) level on the day of hCG administration, number of o ocytes transferred, and total number of motile sperm transferred did n ot differ significantly between the two groups. The clinical PR per tr ansfer was significantly higher in patients with more than five oocyte s transferred (10/27, 37%) versus those with five or less oocytes tran sferred (2/20, 10%). No multiple gestations were obtained. Conclusion: The number of oocytes retrieved in women greater than or equal to 40 years of age undergoing GIFT is the main determinant predicting clinic al pregnancy. High-order oocyte transfer seems to lead to a favorable PR while the risk of multiple gestation is limited.