ICSI outcome in patients of 40 years age and over: a retrospective analysis

Objective: To report and analyse our experience with ICSI treatment in infe rtile women greater than or equal to 40 years of age, with the intention of contributing to current debates on the effect of aging on the reproductive potential. Study design: 107 infertile couples in which the female partner was aged greater than or equal to 40 years and who received ICSI treatment between January 1996 and December 1998. Results: A total of 107 women unde rwent 171 treatment cycles during this period. Of 171 cycles initiated 33 w ere cancelled (cancellation rate = 19.3%). In this way, 17 women did not ha ve embryo transfer at all, while 90 patients had 138 cycles with oocyte ret rieval and successful embryo transfer, with a mean number of embryos per tr ansfer 2.36. Sixteen pregnancies occurred and eight of them ended in sponta neous abortion. The implantation rate was 4.9%, the pregnancy rate per init iated cycle was 9.35% and per transfer cycle 11.59%. The miscarriage rate w as 50%. Moreover, 12 patients had supernumerary embryos, that were cryopres erved and transferred in 17 thawing cycles and resulted in two pregnancies ending in abortion. All pregnancies occurred when three embryos were availa ble, except in two cases with two available embryos. The great majority of the total pregnancies (16 of 18) resulting in women aged between 40 and 42 years. Conclusion: Our data show that women 40 and older with existing ovar ian function may benefit from ICSI treatment, even when the indication for treatment is male factor infertility. Supernumerary embryos, that are cryop reserved and transferred in subsequent cycles can improve the overall pregn ancy rates per oocyte retrieval, although these women should be aware of th e very high risk of miscarriage. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.