Journal of Endocrinology and Reproduction

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Female Fertility Clock Closes to Tick around the Age of 43


Affiliations
1 Department of Assisted Reproduction, Institute of Reproductive Medicine, HB-36/A/3, Sector -III, Salt Lake City, Kolkata − 700064, West Bengal, India
2 Division of Molecular Medicines, Bose Institute (Centenary Building), P 1/12, C. I. T. Road, Scheme-VIIM, Kolkata − 700054, West Bengal, India
     

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Objective: To investigate if attempting In Vitro Fertilization (IVF) in women over 40 is of worth. Materials & Methods: Two hundred and thirty nine women over 40 years of age undergoing IVF were enrolled. Long protocol was used for downregulation followed by stimulation and IVF-ET. The primary outcome measure was live-birth rate. Secondary outcomes included rates of miscarriage, cycle cancellation, obstetrical complications, and maternal and fetal adverse events. Results: Clinical pregnancy rates per cycle were 42.85 %, 39.34 %, 34.09 %, 27.27 % and 16.66 % for 40, 41, 42, 43 and 44 years old, respectively. Absolute difference in live birth rate in age 40 - 44 vs control, -15 percentage points; 95 % Confidence Interval (CI) -45 to 15.1, -18.77 percentage points; 95 % CI,(-56.31 to 18.79), -23.77 percentage points; 95 % CI,(-71.31 to 23.81), -25.82 percentage points; 95 % CI, (-77.48 to 25.84) and, - 27.72 percentage points; 95 % CI, (-83.16 to 27.76), respectively. Intra-uterine growth restriction and preterm delivery occurred significantly more frequently in the age group of 42 and above. Only one IVF cycle in patients aged 44 resulted in delivery. Conclusion: It appears that IVF treatment should be limited to patients not older than 43 years, with adequate ovarian response.

Keywords

Age, Live Birth Rate, Ovarian Function.
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  • Mills M, Rindfuss RR, McDonald P, te Velde E. (On behalf of the ESHRE Reproduction and Society Task Force). Why do people postpone parenthood? Reasons and social policy incentives. Hum Reprod Update. 2011; 17:848-860. https://doi.org/10.1093/humupd/dmr026.

  • Martin JA, Hamilton BE, Ventura SJ, Osterman MJK, Wilson EC, Mathews TJ. Births: final data for 2010. National Vital Statistics Reports. 2012; 61:1-71. Hyattsville, MD: National Center for Health Statistics 2012.

  • Menken J, Trussell J, Larsen U. Age and fertility. Science. 1986; 233(4771):1389-1394. https://doi.org/10.1126/science.3755843.

  • O’Connor KA, Holman DJ, Wood JW. Declining fecundity and ovarian ageing in natural fertility populations. Maturitas 1998; 30:127-136. https://doi.org/10.1016/ S0378-5122(98)00068-1.

  • Sauer MV. Treating women of advanced reproductive age. In: Sauer MV ed. Principles of Oocyte and Embryo Donation. New York, US: Springer; 1998. p. 271-292. https://doi.org/10.1007/978-1-4612-1640-7_17.

  • McCrary J, Royer H. The Effect of Female Education on Fertility and Infant Health: Evidence from School Entry Policies Using Exact Date of Birth. Am Econ Rev. 2011; 101:158-95. https://doi.org/10.1257/aer.101.1.158.

  • Dunson DB, Colombo B, Baird DD. Changes with age in the level and duration of fertility in the menstrual cycle. Hum Reprod. 2002; 17: 1399-1403. https://doi.org/10.1093/humrep/17.5.1399.

  • Liu K, Case A, Cheung AP et al. Advanced Reproductive Age and Fertility. Int J Gyne & Obs. 2012; 117:95-102. https://doi.org/10.1016/j.ijgo.2011.11.002.

  • Chibber R. Problems of older maternal age and pregnancy outcome. Bah Med Bull. 2004; 26:1-9.

  • Bornstein MH, Cote LR, Haynes OM, Hahn CS, Park Y. Parenting knowledge: experiential and sociodemographic factors in European American mothers of young children. Dev Psychol. 2010; 46:1677-1693. https://doi.org/10.1037/a0020677.

  • Jolly M, Sebire N., Harris J, Robinson S., Regan L. The risks associated with pregnancy in women aged 35 years or older. Hum Reprod. 2000; 15:2433-2437. https://doi.org/10.1093/humrep/15.11.2433.

  • Spandorfer SD, Bendikson K, Dragisic K, et al. Outcome of in vitro fertilization in women 45 years and older who use autologous oocytes. Fertil Steril. 2007; 87:74-76. https://doi.org/10.1016/j.fertnstert.2006.05.081.

  • Hourvitz A., Machtinger R., Maman E., Baum M, Dor J, Levron J. Assisted reproduction in women over 40 years of age: How old is too old? RBM Online. 2009; 19:599-603. https://doi.org/10.1016/j.rbmo.2009.04.002.

  • Yan J, Wu K, Tang R, Ding L, Chen ZJ. Effect of maternal age on the outcomes of in vitro fertilization and embryo transfer (IVF-ET). Sci. China. Life Sci. 2012; 55:694-698. https://doi.org/10.1007/s11427-012-4357-0.

  • ESHRE Capri workshop group. Fertility and ageing. Hum Rep Update. 2005; 11:268-276. https://doi.org/10.1093/humupd/dmi006.

  • Navot D., Bergh R.A., Williams M.A., et al. Poor oocyte quality rather than implantation failure as a cause of age-related decline in female fertility. Lancet. 1991; 337:1375-1377. https://doi.org/10.1016/0140-6736(91)93060-M.

  • Psychoyos A. Uterine receptivity for nidation. Ann N Y Acad Sci. 1986; 476:36-42. https://doi. org/10.1111/j.1749-6632.1986.tb20920.x.

  • Jirge PR. Ovarian reserve test. Hum Reprod Sci. 2011; 4:108-113. https://doi.org/10.4103/0974-1208.92283.

  • Dhont M., Neubourg F De, Elst van der J. Perinatal outcome of pregnancies after assisted reproduction: A case-control study. JARG. 1997; 14:575-580. https://doi.org/10.1023/A:1022576500894.

  • Serour G, Mansour R, Serour A, et al. Analysis of 2,386 consecutive cycles of in vitro fertilization or intracytoplasmic sperm injection using autologous oocytes in women aged 40 years and above. Fertil Steril. 2010; 94:1707-12. https://doi.org/10.1016/j.fertnstert.2009.09.044.

  • Tsafrir A, Simon A, Revel A, et al. Retrospective analysis of 1217 IVF cycles in women aged 40 years and older. Reprod Biomed Online. 2007; 14:348-355. https://doi.org/10.1016/S1472-6483(10)60878-4.

  • Institute of Medicine (US) CoPtGEoCD. Epidemiology of cardiovascular disease. In: Fuster V, Kelly BB, eds. Promoting Cardiovascular Health in the Developing World: A Critical Challenge to Achieve Global Health. Washington, DC: National Academic Press; 2010.

  • Li Y, Townend J, Rowe R, et al. The effect of maternal age and planned place of birth on intrapartum outcomes in healthy women with straightforward pregnancies: Secondary analysis of the birthplace national prospective cohort study. BMJ. 2014; 4:e004026. https://doi.org/10.1136/ bmjopen-2013-004026.


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  • Female Fertility Clock Closes to Tick around the Age of 43

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Authors

Baidyanath Chakravarty
Department of Assisted Reproduction, Institute of Reproductive Medicine, HB-36/A/3, Sector -III, Salt Lake City, Kolkata − 700064, West Bengal, India
Ratna Chattopadhyay
Department of Assisted Reproduction, Institute of Reproductive Medicine, HB-36/A/3, Sector -III, Salt Lake City, Kolkata − 700064, West Bengal, India
Kuladip Jana
Division of Molecular Medicines, Bose Institute (Centenary Building), P 1/12, C. I. T. Road, Scheme-VIIM, Kolkata − 700054, West Bengal, India
Pratip Chakraborty
Department of Assisted Reproduction, Institute of Reproductive Medicine, HB-36/A/3, Sector -III, Salt Lake City, Kolkata − 700064, West Bengal, India

Abstract


Objective: To investigate if attempting In Vitro Fertilization (IVF) in women over 40 is of worth. Materials & Methods: Two hundred and thirty nine women over 40 years of age undergoing IVF were enrolled. Long protocol was used for downregulation followed by stimulation and IVF-ET. The primary outcome measure was live-birth rate. Secondary outcomes included rates of miscarriage, cycle cancellation, obstetrical complications, and maternal and fetal adverse events. Results: Clinical pregnancy rates per cycle were 42.85 %, 39.34 %, 34.09 %, 27.27 % and 16.66 % for 40, 41, 42, 43 and 44 years old, respectively. Absolute difference in live birth rate in age 40 - 44 vs control, -15 percentage points; 95 % Confidence Interval (CI) -45 to 15.1, -18.77 percentage points; 95 % CI,(-56.31 to 18.79), -23.77 percentage points; 95 % CI,(-71.31 to 23.81), -25.82 percentage points; 95 % CI, (-77.48 to 25.84) and, - 27.72 percentage points; 95 % CI, (-83.16 to 27.76), respectively. Intra-uterine growth restriction and preterm delivery occurred significantly more frequently in the age group of 42 and above. Only one IVF cycle in patients aged 44 resulted in delivery. Conclusion: It appears that IVF treatment should be limited to patients not older than 43 years, with adequate ovarian response.

Keywords


Age, Live Birth Rate, Ovarian Function.

References





DOI: https://doi.org/10.18311/jer%2F2021%2F27816