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Merviel P, Menard M, Cabry R, Scheffler F, Lourdel E, Le Martelot MT, Roche S, Chabaud JJ, Copin H, Drapier H, Benkhalifa M, Beauvillard D. Can Ratios Between Prognostic Factors Predict the Clinical Pregnancy Rate in an IVF/ICSI Program with a GnRH Agonist-FSH/hMG Protocol? An Assessment of 2421 Embryo Transfers, and a Review of the Literature. Reprod Sci 2020; 28:495-509. [PMID: 32886340 DOI: 10.1007/s43032-020-00307-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 08/25/2020] [Indexed: 11/30/2022]
Abstract
None of the models developed in in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) is sufficiently good predictors of pregnancy. The aim of this study was to determine whether ratios between prognostic factors could predict the clinical pregnancy rate in IVF/ICSI. We analyzed IVF/ICSI cycles (based on long GnRH agonist-FSH protocols) at two ART centers (the second to validate externally the data). The ratios studied were (i) the total FSH dose divided by the serum estradiol level on the hCG trigger day, (ii) the total FSH dose divided by the number of mature oocytes, (iii) the serum estradiol level on the trigger day divided by the number of mature oocytes, (iv) the serum estradiol level on the trigger day divided by the endometrial thickness on the trigger day, (v) the serum estradiol level on the trigger day divided by the number of mature oocytes and then by the number of grade 1 or 2 embryos obtained, and (vi) the serum estradiol level on the trigger day divided by the endometrial thickness on the trigger day and then by the number of grade 1 or 2 embryos obtained. The analysis covered 2421 IVF/ICSI cycles with an embryo transfer, leading to 753 clinical pregnancies (31.1% per transfer). Four ratios were significantly predictive in both centers; their discriminant power remained moderate (area under the receiver operating characteristic curve between 0.574 and 0.610). In contrast, the models' calibration was excellent (coefficients: 0.943-0.978; p < 0.001). Our ratios were no better than existing models in IVF/ICSI programs. In fact, a strongly discriminant predictive model will be probably never be obtained, given the many factors that influence the occurrence of a pregnancy.
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Affiliation(s)
- Philippe Merviel
- ART Center, Brest University Hospital, 2 avenue Foch, 29200, Brest, France. .,Department of Gynecology, Obstetrics and Reproductive Medicine, Brest University Hospital, 2 avenue Foch, F-29200, Brest, France.
| | - Michel Menard
- ART Center, Brest University Hospital, 2 avenue Foch, 29200, Brest, France
| | - Rosalie Cabry
- ART Center, Amiens University Hospital, 1 rond-point du professeur Christian Cabrol, 80054, Amiens, France
| | - Florence Scheffler
- ART Center, Amiens University Hospital, 1 rond-point du professeur Christian Cabrol, 80054, Amiens, France
| | - Emmanuelle Lourdel
- ART Center, Amiens University Hospital, 1 rond-point du professeur Christian Cabrol, 80054, Amiens, France
| | | | - Sylvie Roche
- ART Center, Brest University Hospital, 2 avenue Foch, 29200, Brest, France
| | | | - Henri Copin
- ART Center, Amiens University Hospital, 1 rond-point du professeur Christian Cabrol, 80054, Amiens, France
| | - Hortense Drapier
- ART Center, Brest University Hospital, 2 avenue Foch, 29200, Brest, France
| | - Moncef Benkhalifa
- ART Center, Amiens University Hospital, 1 rond-point du professeur Christian Cabrol, 80054, Amiens, France
| | - Damien Beauvillard
- ART Center, Brest University Hospital, 2 avenue Foch, 29200, Brest, France
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Tan TY, Lau SK, Loh SF, Tan HH. Female ageing and reproductive outcome in assisted reproduction cycles. Singapore Med J 2015; 55:305-9. [PMID: 25017405 DOI: 10.11622/smedj.2014081] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Fertility in women declines with increasing age. With the deferment of marriage and childbearing, couples are turning to assisted reproductive technology to counteract this decline. We aimed to evaluate the results of in vitrofertilisation (IVF)/intracytoplasmic sperm injection (ICSI) in women of different age groups, and highlight the cost-effectiveness of IVF treatment in these groups while assessing its implications on the national healthcare provision model. METHODS Retrospective analysis of 3,412 stimulated IVF/ICSI cycles in a hospital-based IVF centre was performed from January 2008 to December 2010. Patients were stratified into seven age groups: < 30 years; 30-35 years; 36-37 years; 38 years; 39 years; 40-44 years; and ≥ 45 years. RESULTS Age had a significant effect on the number of cycles leading to embryo transfer (p < 0.001). The number of oocytes retrieved decreased across the various age groups (p < 0.001) and was the highest among women aged < 30 (mean 18.5 ± 10.3) years. With increasing age, there was a trend toward a lower fertilisation rate. Age also had a significant effect on the rates of clinical pregnancy, live birth and multiple pregnancies (p < 0.001). CONCLUSION Patients aged < 30 years had the best IVF outcomes, reflecting optimal reproductive capacity. Age-related decline in fertility starts after 30 years. Women opting for IVF should be counselled about age-specific success rates while taking into account individual risk factors.
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Affiliation(s)
| | - S K Lau
- Department of Reproductive Medicine, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899.
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Controlled ovarian hyperstimulation interventions in infertile women aged 40 years or older undergoing in vitro fertilization. Int J Gynaecol Obstet 2009; 106:193-7. [PMID: 19464684 DOI: 10.1016/j.ijgo.2009.03.055] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2009] [Revised: 02/24/2009] [Accepted: 03/31/2009] [Indexed: 11/20/2022]
Abstract
BACKGROUND The success of in vitro fertilization (IVF) treatment depends on adequate follicle recruitment following controlled ovarian hyperstimulation (COH). Women aged 40 years or older have a reduced ovarian reserve and various treatment protocols have been proposed that aim to increase their ovarian response. OBJECTIVES To compare the effectiveness of different COH treatment interventions in women undergoing IVF aged 40 years or older. SEARCH STRATEGY MEDLINE, the Cochrane Library, and the Chinese Biomedical database were searched for randomized controlled trials (RCTs). SELECTION CRITERIA Only RCTs comparing one type of COH intervention with another in women undergoing IVF aged 40 years or older were included. DATA COLLECTION AND ANALYSIS Two authors independently searched the abstracts, identified relevant papers, assessed inclusion and trial quality, and extracted the relevant data. MAIN RESULTS Four trials involving 4 different comparison groups were included in the review and enrolled a total of 611 randomized subjects. CONCLUSION There was insufficient evidence to support the routine use of any particular COH intervention to manage infertile women aged 40 years or older undergoing IVF. More robust data from good quality RCTs with relevant outcomes are needed.
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Aboulghar M, Mansour R, Al-Inany H, Abou-Setta AM, Aboulghar M, Mourad L, Serour G. Paternal age and outcome of intracytoplasmic sperm injection. Reprod Biomed Online 2007; 14:588-92. [PMID: 17509198 DOI: 10.1016/s1472-6483(10)61050-4] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In a retrospective study, the outcome of intracytoplasmic sperm injection (ICSI) in two age groups of men was studied. Couples with male partners aged 50 years and over (group A) (n = 227) with mean age of 53 +/- 5 years were compared with couples with younger age-group male partners (group B) (n = 227) with a mean age of 38.4 +/- 5.8 years. The control group of younger men was selected so that the women's age matched between the two groups. There was no significant difference in pregnancy rate between the two groups (37.9 versus 36.6%; OR = 1.06, 95% CI = 0.72-1.55). There was also no significant difference in the pregnancy rate between men aged 60 years and over as compared with men aged 50 to 59 years (OR = 1.00, 95% CI 0.74-1.37). However, the long-term outcome of these pregnancies needs further investigation. Semen analysis showed significantly lower motility in group A (37.4 +/- 20.4) versus group B (46.4 +/- 15.5; P < 0.0001). There was a significantly higher fertilization rate in younger men (P < 0.0001; OR = 1.36, 95% CI = 1.19-1.55), but this did not affect the pregnancy rate. In conclusion, it appears that paternal age has no effect on the pregnancy rate after ICSI.
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Affiliation(s)
- Mohamed Aboulghar
- The Egyptian IVF- ET Centre, No. 3, St. 181, Hadaek El Maadi, Maadi, Egypt.
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El-Toukhy T, Khalaf Y, Braude P. IVF results: optimize not maximize. Am J Obstet Gynecol 2006; 194:322-31. [PMID: 16458624 DOI: 10.1016/j.ajog.2005.05.018] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2004] [Revised: 03/25/2005] [Accepted: 04/25/2005] [Indexed: 11/19/2022]
Abstract
The desire to improve in vitro fertilization (IVF) results has led clinicians to replace more than 1 embryo in the uterus. As a result, multiple births have increased over the last 2 decades to epidemic proportions, exposing the field of assisted conception to justified criticism. This review aims to ensure that physicians involved in the field of fertility treatment are aware of the risks and complications related to multiple pregnancies, and to explore possible strategies such as blastocyst culture, preimplantation genetic screening, and embryo cryopreservation, which can help to control and reverse the tide of multiple pregnancies without reducing the good success rate that modern IVF treatment enjoys. A brief overview of the respective UK legislative system is also presented.
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Affiliation(s)
- Tarek El-Toukhy
- Assisted Conception Unit, Guy's and St. Thomas' Hospital, NHS Trust, London, United Kingdom.
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Kupka MS, Dorn C, Montag M, Felberbaum RE, van der Ven H, Kulczycki A, Friese K. Previous miscarriages influence IVF and intracytoplasmatic sperm injection pregnancy outcome. Reprod Biomed Online 2004; 8:349-57. [PMID: 15038904 DOI: 10.1016/s1472-6483(10)60916-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Previous conceptions are one predictor for the outcome of assisted reproductive technology procedures. Approximately 18-34% of clinical pregnancies following assisted reproduction procedures result in spontaneous abortion. The risk of such pregnancy loss is believed to increase with women's age, previous miscarriages and use of frozen-thawed embryos. This study analyses German IVF Registry data to examine the impact of previous miscarriages on the outcome of assisted reproduction procedures. The data set consists of a total of 174,909 assisted reproduction procedures performed between January 1998 and December 2000. Multiple logistic regression is used to assess the correlation between women's age, spousal/partner change, and infertility diagnosis. It is demonstrated that any previous miscarriage will increase the treatment-dependent miscarriage rate in assisted reproduction procedures. A significantly higher impact is shown for one previous miscarriage achieved by assisted reproduction procedures compared with spontaneous conception. Partner change is shown to have no specific impact on the treatment dependent miscarriage rate, whereas a statistically significant increase in miscarriages in all assisted reproduction procedures was found among women older than 34 years of age. Overall, the highest rate of treatment-dependent miscarriages was seen in assisted reproduction procedures with cryopreserved embryo transfer.
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Affiliation(s)
- M S Kupka
- University Medical Centre of Obstetrics and Gynaecology, University of Munich, Maistr. 11, D-80337 Munich, Germany.
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Kupka MS, Dorn C, Richter O, Schmutzler A, van der Ven H, Kulczycki A. Stress relief after infertility treatment--spontaneous conception, adoption and psychological counselling. Eur J Obstet Gynecol Reprod Biol 2003; 110:190-5. [PMID: 12969582 DOI: 10.1016/s0301-2115(03)00280-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE In this study, we sought to evaluate characteristics of couples with spontaneous conceptions after treatment with assisted reproductive technologies (ART). STUDY DESIGN Data from 254 couples who underwent 1127 therapy cycles between November 1987 and February 1997, were analyzed. Chi-Square (chi(2)) test and Student's t-test were used. P<0.05 was considered significant. RESULTS Spontaneous pregnancies occurred in 14% of all treated couples. Psychological counselling only was performed in 21% but was observed significantly more frequently among patients without later spontaneous conception. Ten percent of all treated couples applied for adoption. The miscarriage rate was significantly higher in the group of treatment dependent pregnancies compared to the group of patients with later spontaneous conception (27% versus 9%). The spontaneous conception rate differed significantly depending on women's age and normal semen analysis. CONCLUSION Appearance of spontaneous conception after ART-procedures should be taken into account in the first patient's interview. Depending on women's age and andrological parameters, treatment-success will differ. The positive impact of psychological counselling for stress relief during and after therapy should also be noted, even though a statistically significant impact could not be demonstrated in the present study. Adoption should be discussed as an alternative to overcome infertility.
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Affiliation(s)
- Markus S Kupka
- Fertility Workgroup--Reproduction Medicine & Endocrinology, Munich University Hospital--City Centre, Ludwig-Maximilian-University, Maistrasse 11, D-80337, Muenchen, Germany.
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Kupka MS, Dorn C, Richter O, Felberbaum R, van der Ven H. Impact of reproductive history on in vitro fertilization and intracytoplasmic sperm injection outcome: evidence from the German IVF Registry. Fertil Steril 2003; 80:508-16. [PMID: 12969690 DOI: 10.1016/s0015-0282(03)00760-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate the effect of reproductive history on the outcome of different procedures in assisted reproductive technologies (ART) comparing IVF, ICSI, and cryopreserved embryo transfer (CPE). DESIGN Prospective registration of ART cycles and their outcomes. SETTING One hundred three reproductive programs in Germany. PATIENT(S) Women undergoing 174,909 ART procedures from January 1998 through December 2000. INTERVENTION(S) Data analysis of reproductive history collected by the German IVF Registry; multiple logistic regression modeling of success rates. MAIN OUTCOME MEASURE(S) Effect of type of conception and outcome of previous pregnancies, duration of infertility, female's age, and type of ART on clinical pregnancy rate per retrieval. Odds ratios with 95% CIs are reported. RESULT(S) More than one previous pregnancy was negatively correlated with outcome of IVF, ICSI, or CPE. This association disappeared when female age was restricted to a maximum of 35 years. A previous pregnancy achieved by spontaneous conception had less impact on outcome of IVF, ICSI or CPE outcome than did a previous assisted conception. Previous live births and miscarriages demonstrated a statistically significant increase compared with ectopic pregnancies and induced abortions. CONCLUSION(S) Reproductive history must be considered when counseling subfertile couples. Female age, method of conception, and previous pregnancy outcome have a significant effect on IVF, ICSI, and CPE outcome.
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Affiliation(s)
- Markus S Kupka
- Department of Epidemiology and International Health, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA.
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Spontaneous Abortion Among Pregnancies Conceived Using Assisted Reproductive Technology in the United States. Obstet Gynecol 2003. [DOI: 10.1097/00006250-200305000-00024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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10
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Schramm RD, Paprocki AM, Bavister BD. Features associated with reproductive ageing in female rhesus monkeys. Hum Reprod 2002; 17:1597-603. [PMID: 12042284 DOI: 10.1093/humrep/17.6.1597] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The specific aims were to determine the effects of maternal age on the meiotic and developmental competence of oocytes and incidence of chromosomal anomalies in oocytes from a population of fertile rhesus monkeys. METHODS Monkeys were divided into two age groups (4-15 and 16-26 years of age) and underwent ovarian stimulation for collection of oocytes. RESULTS In the older, compared with younger, monkeys, serum basal concentrations of FSH were elevated (P < 0.05), peak concentrations of estradiol during a stimulation cycle were diminished (P < 0.05), and mean numbers of oocytes retrieved following ovarian stimulation were markedly (P < 0.05) reduced. There were no significant maternal age-related impairments in oocyte maturation, fertilization or blastocyst development. Both abnormal numbers of whole chromosomes, as well as free chromatids, were detected in a limited number of rhesus oocytes. CONCLUSIONS Similarities between female rhesus monkeys and women in several features associated with reproductive ageing, in conjunction with our ability to perform IVF and other assisted reproductive techniques in monkeys, demonstrate the suitability of these animals for studies on human reproductive ageing and maternal age-related infertility. Although maternal age-related impairments in oocytes were not evident prior to implantation, further studies may reveal more subtle impairments, manifested during post-implantation development.
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Affiliation(s)
- R Dee Schramm
- Wisconsin Regional Primate Research Center, Madison, WI 53715, USA.
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Ziebe S, Loft A, Petersen JH, Andersen AG, Lindenberg S, Petersen K, Andersen AN. Embryo quality and developmental potential is compromised by age. Acta Obstet Gynecol Scand 2001; 80:169-74. [PMID: 11167214 DOI: 10.1034/j.1600-0412.2001.080002169.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The aim of this retrospective study was to assess whether and how the age of the woman affects the quality and developmental potential of the oocytes and embryos in an ART program. METHOD AND MATERIAL A total of 878 IVF cycles was included as a consecutive series of single transfers (n=292), dual transfers (n=366) and triple transfers (n=220), where all the transferred embryos in each cycle were of identical quality score and identical cleavage stage. RESULTS We found a highly significant decrease in oocyte recovery with increasing age with about one oocyte per 2.3 years (95% CI 1.8 years to 3.1 years, p<0.0001). Further, we found that the number of oocytes that cleaved declined significantly with increasing age with one per 3.7 years (95% CI 2.7 years to 5.5 years, p<0.0001). This decline was mainly due to the decline in number of oocytes retrieved as the ratio of aspirated oocytes that cleaved with increasing age (approx. -0.04/10 year 95% CI: -0.10; +0.009) was not significantly different (p=0.10). The percentage of transfers using fragmented embryos did not increase significantly with increasing age (p=0.08). The odds of fragmentation increased by 3% per year. The average number of embryos transferred decreased significantly (p=0.03) with age from approximately 2.1 at the age of 25 to approximately 1.8 at the age of 40. In a selected subgroup of embryos all consisting of good quality embryos, a significant decrease was found in implantation rate with increasing age (approx. -0.08/10 years, 95% CI: -1.6; +0.00, p=0.05). Of the 357 pregnancies achieved in this study we found a significantly decreased ongoing pregnancy rate and a significantly increased abortion rate with increasing age (p=0.03). The decrease in the rate of ongoing pregnancies was almost linear, decreasing by approximately 1.5% per year. CONCLUSIONS We conclude that age has an impact throughout a woman's reproductive life and that it is important to realize that the age-related decline in fertility may start already in the late twenties and not in the mid-thirties as is generally assumed.
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Affiliation(s)
- S Ziebe
- The Fertility Clinic, The Juliane Marie Center, Rigshospitalet, University of Copenhagen, Denmark
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Lass A, Gerrard A, Abusheikha N, Akagbosu F, Brinsden P. IVF performance of women who have fluctuating early follicular FSH levels. J Assist Reprod Genet 2000; 17:566-73. [PMID: 11209537 PMCID: PMC3455456 DOI: 10.1023/a:1026485830540] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The aim was to evaluate whether women who have early follicular follicle-stimulating hormone (FSH) levels > 12 mIU/ml have reduced response to follicular stimulation for in vitro fertilization (IVF) in a following month, in spite of normal FSH levels. MATERIAL AND METHODS In a 3-year period from January 1996 to December 1998, 303 women aged 38 years and above and/or who had previously responded poorly to superovulation for IVF gave blood samples for FSH, luteinizing hormone (LH), and estradiol (E2) on day 2 of menstruation before commencing treatment. RESULTS In 117 (38.6%) of these women, FSH levels were > 12 mIU/ml (range 12-114 mIU/ml). Sixty-six of these women gave a further 130 blood samples for FSH measurement in the following months. Seventy-eight (60.0%) of the tests showed raised FSH value > 12 mIU/ml. Thirty women whose repeat FSH levels were < 12 mIU/ml underwent 41 IVF cycles (group 1). Sixty-three other women, older than 38 and/or who had a poor response to superovulation previously and whose FSH levels were < 12 mIU/ml, served as the control group (group II). There were no differences in the responses to superovulation and delivery rates between the two groups (14.6% vs. 12.7%). CONCLUSIONS Women whose early follicular phase FSH levels were raised > 12 mIU/ml had an increased risk (> 50%) that in subsequent cycles levels would remain raised, and it was not possible to predict which individuals would have favorable FSH levels. If the cycle day 2 FSH level returns to a "normal" level of < 12 mIU/ml, women aged 40 and above had substantial cycle cancellation rates (43%), but patients who achieved the stage of embryo transfer had a good chance of conceiving, regardless of their age.
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Affiliation(s)
- A Lass
- Bourn Hall Clinic, Bourn, Cambridge CB3 7TR, England
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Ron-El R, Raziel A, Strassburger D, Schachter M, Kasterstein E, Friedler S. Outcome of assisted reproductive technology in women over the age of 41. Fertil Steril 2000; 74:471-5. [PMID: 10973640 DOI: 10.1016/s0015-0282(00)00697-x] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To analyze the results of ongoing pregnancies and deliveries after assisted reproductive technology (ART) in women aged >/=41 years, stratified by year of age. DESIGN Retrospective study. SETTING University hospital, IVF unit. PATIENT(S) A total of 431 IVF and intracytoplasmic sperm injection (ICSI) cycles were initiated in women >/=41 years of age. INTERVENTION(S) Medical files of ART patients and pregnancy outcomes were reviewed. MAIN OUTCOME MEASURE(S) Oocytes retrieved, embryos developed, and clinical pregnancy and delivery rates. RESULT(S) Of the 431 started cycles, 376 (87%) reached the oocyte retrieval stage. The mean number of oocytes aspirated per patient was 5.4 +/- 0.9 and 6.7 +/- 1.2 in the IVF and ICSI cycles, respectively, and the number of embryos obtained was 2.3 +/- 1.3 and 2.8 +/- 1.6 in the IVF and ICSI cycles, respectively. The number of transferable embryos was 2.0 +/- 1.2 and 2.5 +/- 0.8. The pregnancy rate per oocyte pickup (OPU) was 12.4%; however, the delivery rate per OPU was 4.5%. The mean delivery rate per OPU among women aged 41-43 years was 2%-7%. There were no deliveries aged >/=44 years and no pregnancies at the age of 45 years. The pregnancy and delivery rates of the ICSI and IVF patients were similar after stratification by age. CONCLUSION(S) In our studies, ART performed with homologous oocytes, whether by IVF or ICSI, yielded no clinical pregnancies among women aged >/=45 years and no deliveries aged >/=44 years. The mean delivery rate per oocyte retrieval among women aged 41-43 years varied between 2% and 7%.
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Affiliation(s)
- R Ron-El
- In Vitro Fertilization and Infertility Unit, Assaf Harofeh Medical Center, Zerifin, Israel.
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Jones GM, Trounson AO. Blastocyst stage transfer: pitfalls and benefits. The benefits of extended culture. Hum Reprod 1999; 14:1405-8. [PMID: 10357946 DOI: 10.1093/humrep/14.6.1405] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- G M Jones
- Centre for Early Human Development, Institute of Reproduction and Development, Monash University, Level 5, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria, Australia, 3168
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Jones GM, Trounson AO, Lolatgis N, Wood C. Factors affecting the success of human blastocyst development and pregnancy following in vitro fertilization and embryo transfer. Fertil Steril 1998; 70:1022-9. [PMID: 9848289 DOI: 10.1016/s0015-0282(98)00342-2] [Citation(s) in RCA: 131] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To determine the factors affecting blastocyst development and pregnancy after IVF and ET. DESIGN Retrospective analysis of data arising from a clinical trial. SETTING Private in vitro fertilization clinic. PATIENT(S) Fifty-six patients aged < or = 40 years, undergoing IVF procedures for infertility, recruited specifically for blastocyst transfer. INTERVENTION(S) All zygotes were cultured to days 5 or 6 after insemination, and one to four of the most advanced blastocysts were transferred to the patient's uterus. MAIN OUTCOME MEASURE(S) Development of zygotes to blastocysts in vitro and pregnancy and implantation rates after ET. RESULT(S) Fifty-one percent of all zygotes developed to blastocysts. Significant positive correlation between the number of blastocysts formed was observed with the number of oocytes, pronuclear zygotes, and eight-cell embryos formed. There was a negative correlation with male factor infertility. By day 5 or 6, 93% of the patients had at least one blastocysts, and the clinical pregnancy rate per transfer was 43% and the implantation per embryo transferred was 25%. No other clinical factor significantly affected the number of blastocysts formed, pregnancy rate, or implantation rate. CONCLUSION(S) The numbers of oocytes, zygotes, and normally developing embryos in culture significantly affects the production of blastocysts in vitro. Male infertility significantly reduces blastocyst production. The number and the quality of the blastocysts transferred significantly influences clinical pregnancy rate.
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Affiliation(s)
- G M Jones
- Centre for Early Human Development, Monash University, Institute of Reproduction and Development, Clayton, Victoria, Australia.
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Lass A, Croucher C, Duffy S, Dawson K, Margara R, Winston RM. One thousand initiated cycles of in vitro fertilization in women > or = 40 years of age. Fertil Steril 1998; 70:1030-4. [PMID: 9848290 DOI: 10.1016/s0015-0282(98)00353-7] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the results of IVF in women > or = 40 years of age using their own oocytes. DESIGN Retrospective study. SETTING Wolfson and Royal Masonic in vitro fertilization units, London, United Kingdom. PATIENT(S) A total of 1,087 IVF cycles were started in women > or = 40 years of age. INTERVENTION(S) Medical records of patient outcomes were reviewed. MAIN OUTCOME MEASURE(S) Clinical pregnancy, miscarriage, and delivery rates. RESULT(S) Of the 1,087 cycles started in 471 women > or = 40 years of age, 842 reached oocyte retrieval (77.5%) and 702 had embryos transferred (64.6%). The pregnancy rate (PR) was significantly lower in women > or = 40 years of age than in a control group of women <40 years of age (11.3% versus 28.2%). It decreased sharply in women >42 years of age, and no women >45 years of age had a child. Women > or = 40 years of age were more likely to miscarry (27% versus 12.7%). When only one embryo was available for transfer, the PR was 3.3%. When >2 embryos were available for transfer, the PR was similar whether 2 or 3 embryos were replaced. No triplet pregnancy occurred. Women > or = 40 years of age achieved a cumulative PR of 30% after three cycles with a cumulative "take home baby" rate of 21%. CONCLUSION(S) In vitro fertilization is a reasonable treatment for women <45 years of age using their own gametes. Those with a "good response" in their first attempt may be encouraged to complete three cycles with an acceptable chance of conception.
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Affiliation(s)
- A Lass
- Institute of Obstetrics and Gynecology, Royal Postgraduate Medical School, Hammersmith Hospital, London, United Kingdom.
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Sauer MV. Infertility and early pregnancy loss is largely due to oocyte aging, not uterine senescence, as demonstrated by oocyte donation. Ann N Y Acad Sci 1997; 828:166-74. [PMID: 9329836 DOI: 10.1111/j.1749-6632.1997.tb48536.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- M V Sauer
- Division of Reproductive Endocrinology, Columbia-Presbyterian Medical Center, College of Physicians & Surgeons of Columbia University, New York, New York, USA
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Roest J, van Heusden AM, Mous H, Zeilmaker GH, Verhoeff A. The ovarian response as a predictor for successful in vitro fertilization treatment after the age of 40 years. Fertil Steril 1996; 66:969-73. [PMID: 8941063 DOI: 10.1016/s0015-0282(16)58691-9] [Citation(s) in RCA: 54] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine whether age or response to controlled ovarian hyperstimulation (COH) is a better predictor of IVF outcome in women > or = 40 years. DESIGN Retrospective analysis. SETTING A transport IVF program. PATIENT(S) For patients undergoing IVF treatment the correlation between treatment outcome and age and response to COH was analyzed using the data of 2,588 consecutive cycles. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Pregnancy. RESULT(S) The incidence of poor ovarian response rises significantly with increasing age. Analysis of all cycles showed a significant decrease in clinical and ongoing pregnancy rate for women > or = 40 years. Analysis of cycles with a good ovarian response showed no statistically significant differences for these parameters between women > or = 40 years and those younger. A logistic regression analysis on pregnancy showed that ovarian response contributes more to the prediction of pregnancy than age. CONCLUSION(S) Patients aged > or = 40 years with a good response to COH have a good prognosis for IVF treatment. The age limit for acceptance of patients should not be set at 40 years. Instead, the response to COH can be used to predict candidates likely to have a successful IVF outcome.
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Affiliation(s)
- J Roest
- Department of Obstetrics and Gynaecology, University Hospital Dijkzigt, Rotterdam, The Netherlands
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Qasim SM, Karacan M, Corsan GH, Shelden R, Kemmann E. High-order oocyte transfer in gamete intrafallopian transfer patients 40 or more years of age. Fertil Steril 1995. [DOI: 10.1016/s0015-0282(16)57664-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Alsalili M, Yuzpe AA, Tummon IS, Parker J, Martin JS, Nisker JA, Daniel SA. Confounding variables affecting in vitro fertilization success: a decade of experience. J Assist Reprod Genet 1995; 12:88-92. [PMID: 7670279 DOI: 10.1007/bf02211375] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
PURPOSE To evaluate etiology of infertility, female age, ovarian response and stimulation protocol in affecting in vitro fertilization (IVF) success. METHODS Retrospective analysis was used. Computer records of all 5209 cycles initiated in 2391 couples from February 1, 1984 to December 31, 1993 were analyzed. RESULTS There were 644 intrauterine, 24 solely ectopic and 7 heterotopic pregnancies. Pregnancy rates increased with number of embryos transferred with a significant increase still found between transfer of three or four embryos. Multiple gestations also increased in association with an increasing number of embryos transferred. Pregnancy rates per cycle did not decline with repeated cycles. Reduced pregnancy rates were associated with a primary diagnosis of male infertility. Covariates associated with a better pregnancy rate were younger age of the female partner or higher peak preovulatory serum estradiol. Routine administration of GnRH-agonist was associated with a reduced cycle cancellation rate, an increase in oocytes retrieved and an improved pregnancy rate. CONCLUSIONS Couples with male infertility and increased female age should be counselled regarding the reduced prognosis for success.
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Affiliation(s)
- M Alsalili
- Department of Gynaecology and Reproductive Medicine, University Hospital, London, Ontario, Canada
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Ashkenazi J, Farhi J, Dicker D, Feldberg D, Shalev J, Ben-Rafael Z. Acute pelvic inflammatory disease after oocyte retrieval: adverse effects on the results of implantation. Fertil Steril 1994; 61:526-8. [PMID: 8137978 DOI: 10.1016/s0015-0282(16)56587-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To determine the impact of pelvic inflammation on the results of IVF after oocyte retrieval. DESIGN Retrospective analysis of IVF cycles. SETTING IVF Unit, Golda Medical Center, Petah Tikva, Israel. PATIENTS Twenty-eight women with a diagnosis of pelvic inflammatory disease (PID) during IVF therapy. MAIN OUTCOME MEASURE The pregnancy rate (PR) of IVF cycles complicated by PID after oocyte retrieval was compared with our ongoing IVF results. RESULTS All 28 women with PID during IVF treatment did not conceive, despite the high number of oocytes retrieved, fertilized, and transferred. The PR over the same period was 23% to 31%. CONCLUSIONS Pelvic infection after IVF treatment might have a detrimental effect on the results of treatment. In an effort to maximize the chances for normal implantation, postponement of ET should be considered when pelvic infection or inflammation is diagnosed.
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Affiliation(s)
- J Ashkenazi
- Department of Obstetrics and Gynecology, Sherman Institute of Fertility, Golda Medical Center, (Hasharon Hospital), Petah Tikva, Israel
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Seidman DS, Lotan Y. In vitro fertilization and embryo transfer in Israel: 1990 results from a national survey. J Assist Reprod Genet 1994; 11:1-4. [PMID: 7949828 DOI: 10.1007/bf02213689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
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