The pattern of infertility diagnoses in women of advanced reproductive age

OBJECTIVE: Our intention was to determine whether there is a unique pattern of infertility diagnoses in older infertile couples. STUDY DESIGN: The design of this study was a retrospective chart review stu dy. It was performed in a tertiary referral reproductive medicine unit. The re were 2 groups of patients-couples: group 1, female partner aged 20-29 (n = 105) at presentation; group 2, female partner aged 40-45 (n = 112) at pr esentation. All women underwent infertility evaluations between 1989 and 19 94. There were no interventions. The prevalence of standard infertility dia gnoses was the main outcome measure. RESULTS: The prevalence of 8 major infertility diagnoses in the younger and older groups (each couple could have greater than or equal to 1 diagnosis) was as follows. (1) ovulatory factor-younger group, 56%; older group, 30%; (2) tubal factor-younger group, 34%; older group, 29%; (3) endometriosis-y ounger group, 13%; older group, 17%; (4) uterine factor-younger group, 1%; older group, 5%; (5) cervical factor-younger group, 4%; older group, 1%; (6 ) luteal deficiency-younger group, 4%; older group, 10%; (7) male factor-yo unger group, 32%; older group, 45%; (8) unexplained-younger group, 5%; olde r group, 10%. The only significant difference was an increase in ovulatory factor in the younger group. CONCLUSIONS: There is no unique pattern of infertility diagnoses in women o f advanced reproductive age as seen at a tertiary referral center. We specu late that a high false-positive rate associated with standard infertility t ests and a different referral pattern for older couples obscures any real d ifferences in the etiology of infertility in older couples.