Fertility and infertility in aging women

Age is often a dominant factor for women wanting to conceive. The objective of this study tvas to examine the outcome of an in vitro fertilization/int racytoplasmic sperm injection (IVF/ICSI) program in relation to a woman's a ge. Between January 1995 and June 1997 we stimulated 2511 cycles. The mean age of the women was 34 years, with 21.9% under 30, 45.9% between 30 and 35 , 24.5% between 36 and 39, and 7.7% over 39 years. All patients aged greate r than or equal to 40 years had day 3 serum follicle-stimulating hormone (F SH) concentrations <20 IU/l. The stimulation regimen consisted of 150-450 I U of human menopausal gonadotropin (hMG) or FSH combined with either clomip hene citrate (CC) or gonadotropin-releasing hormone agonist (GnRHa) in a sh ort or long protocol. Age had a significantly negative effect on the stimul ation and fertilization failure rates. The clinical pregnancy rate per tran sfer and the embryo implantation rate declined significantly from 29.4% and 18.9% in women <30 years to 19.8% and 14.3% in patients between 30 and 35 years, 17.1% and 9.0% between 36 and 39 years and to 12.8% and 7.4% in thos e aged greater than or equal to 40 years. The spontaneous abortion rate was 14.9%, 16.5%, 22.4% and 33.2%, respectively. The clinical pregnancy rate p er transfer reflected only imperfectly the performance of the older women b ecause the discharge rate during stimulation and spontaneous abortions redu ced the 'take home baby' rate to about 7% per cycle in patients aged greate r than or equal to 40 years. It is very important in fertility practice to recognize the major impact of advancing maternal age.