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Wu TW, Tsai HD, Huang HC, Yang HH, Chen YJ, Wu HH, Wu CH. Rare live birth to a 48-year-old woman after embryo transfer with autologous oocyte: A case report. Taiwan J Obstet Gynecol 2022; 61:551-554. [PMID: 35595457 DOI: 10.1016/j.tjog.2022.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Advanced maternal age and decreased ovarian reserve have been challenges for assisted reproductive technology (ART). Few cases, using autologous oocytes more than 46-years-old, have previously been reported. We seek to show how the age at which autologous oocytes may successfully be employed may be increasing. CASE REPORT We report a 47-year-old woman with an anti-Müllerian hormone (AMH) level of 0.24 ng/mL, conceived through in vitro fertilization (IVF) using autologous oocytes. Patient was given an antagonist protocol for ovarian stimulation and one frozen-thawed embryo was transferred. The patient became pregnant. The course of her pregnancy was uneventful and she gave birth to a 3330 gm male baby by cesarean section. CONCLUSION Technological advances permit women, who previously would have been considered too old to employ an autologous oocyte, to have a successful pregnancy with a live birth.
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Affiliation(s)
- Te-Wei Wu
- Changhua Christian Hospital Reproductive Medicine Center, Taiwan
| | - Horng-Der Tsai
- Changhua Christian Hospital Reproductive Medicine Center, Taiwan.
| | - Hsiao-Chin Huang
- Changhua Christian Hospital Reproductive Medicine Center, Taiwan
| | - Hsaio-Hsuan Yang
- Changhua Christian Hospital Reproductive Medicine Center, Taiwan
| | - Yu-Jing Chen
- Changhua Christian Hospital Reproductive Medicine Center, Taiwan
| | - Hsin-Hung Wu
- Changhua Christian Hospital Reproductive Medicine Center, Taiwan
| | - Chen-Hsuan Wu
- Changhua Christian Hospital Reproductive Medicine Center, Taiwan
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Sahin G, Acet F, Tavmergen Goker EN, Tavmergen E. Live Birth Rates After Assisted Reproductive Techniques of Women Aged 42 and Over. JOURNAL OF CLINICAL AND EXPERIMENTAL INVESTIGATIONS 2021. [DOI: 10.29333/jcei/11214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Fujishiro E, Yoneyama K, Kakinuma T, Kagawa A, Tanaka R, Kaijima H. Retrospective outcome in women aged 45 years and older undergoing natural cycle IVF treatment. Reprod Biomed Online 2021; 43:66-72. [PMID: 33931370 DOI: 10.1016/j.rbmo.2021.03.020] [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: 12/06/2020] [Revised: 03/18/2021] [Accepted: 03/27/2021] [Indexed: 10/21/2022]
Abstract
RESEARCH QUESTION Is natural cycle IVF treatment beneficial to middle-aged women with poor ovarian response? DESIGN Retrospective investigation of outcomes in women aged 45 years and older, who underwent natural cycle IVF treatment between 2009 and 2018 in a single assisted reproduction clinic with the aim of reporting several successful outcomes. RESULTS In total, 2408 IVF retrievals in women aged 45 years and older were included in this study. Mean serum FSH level on day 3 was 21.4 ± 12.5 (range: 0.3-93.7) IU/ml. One fresh cleavage-stage embryo was transferred in 37.4% (900/2408) of the initiated cycles. The overall clinical pregnancy rate and live birth rate per fresh embryo transfer were 2.8% (25/900) and 0.8% (7/900), respectively. Natural cycle IVF treatment led to seven successful deliveries during the period. All seven women who successfully delivered were poor ovarian responders who met the diagnostic Bologna criteria and, among them, three had elevated serum FSH levels on day 3 (range: 39.0-47.1 mIU/ml). All seven had full-term delivery, and no congenital abnormalities were observed in their infants. No significant difference was found in serum FSH level on day 3 between those with and without positive beta-HCG test results. CONCLUSIONS These findings suggest that natural cycle IVF treatment could be an option for older poor responders in countries that do not permit egg donation. Careful counselling is required, however, because of the low probability of live births after IVF in middle-aged women.
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Affiliation(s)
- Emi Fujishiro
- Minatomirai Yume Clinic, 3-6-3 Minatomirai, Nishi-ku, Yokohama Kanagawa 220-0012, Japan.
| | - Koichi Yoneyama
- Minatomirai Yume Clinic, 3-6-3 Minatomirai, Nishi-ku, Yokohama Kanagawa 220-0012, Japan
| | - Toshiyuki Kakinuma
- International University of Health and Welfare, 2600-1 Kitakanemaru, Otawara Tochigi 324-8501, Japan
| | - Aiko Kagawa
- Minatomirai Yume Clinic, 3-6-3 Minatomirai, Nishi-ku, Yokohama Kanagawa 220-0012, Japan
| | - Rieko Tanaka
- Minatomirai Yume Clinic, 3-6-3 Minatomirai, Nishi-ku, Yokohama Kanagawa 220-0012, Japan
| | - Hirotsune Kaijima
- Minatomirai Yume Clinic, 3-6-3 Minatomirai, Nishi-ku, Yokohama Kanagawa 220-0012, Japan
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One thousand seventy-eight autologous IVF cycles in women 45 years and older: the largest single-center cohort to date. J Assist Reprod Genet 2017; 35:435-440. [PMID: 29143944 DOI: 10.1007/s10815-017-1088-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 11/08/2017] [Indexed: 10/18/2022] Open
Abstract
PURPOSE The purpose of this study was to determine IVF outcomes in women 45 years and older using autologous oocytes. METHODS This is a retrospective cohort study reviewing all IVF cycles in women ≥ 45 years old from January 1995 to June 2015 that were conducted at one academic medical center. One thousand seventy-eight fresh, autologous IVF cycles met inclusion criteria. PGD/S, natural IVF, and donor egg cycles were excluded. Outcomes were analyzed for the different age groups (age 45, n = 773; age 46, n = 221; age 47, n = 57; age 48, n = 22; age 49, n = 5). Primary outcome measures included IVF cycle characteristics, total pregnancy loss, clinical pregnancy, and live birth rates, and were stratified according to patient age. RESULTS Mean age of patients in the study cohort was 45.4 ± 0.72. 11.7% of patients did not start due to an elevated FSH or cyst and 28.5% of patients were canceled prior to oocyte retrieval. The overall pregnancy rate per transfer was 18.7% (117/626), of which 82.1% ended in a pregnancy loss. The overall clinical pregnancy and live birth rates per transfer were 9.6 and 3.4%, respectively, which did not differ between age groups. Per cycle start women aged 45 had significantly higher positive pregnancy rates compared to women aged 46 and 47 (14.1 vs. 8.6 vs. 5.9%, p = 0.04). For women 45 years old, the live birth rate was 2.9% per cycle start and was 4.4% per embryo transfer. Of the 21 live births, 20 were in women aged 45 and one live birth was in a 46-year-old woman. There were no live births in any patient with ≤ 4 oocytes retrieved. CONCLUSION Autologous IVF in women aged 45 with acceptable ovarian reserve is not futile; however, it does carry very low prognosis. Patients aged 46 and older should be counseled appropriately that a live birth seems highly unlikely.
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Burks HR, Baker M, Quaas AM, Bendikson KA, Chung K, Paulson RJ. The dilemma of counseling patients about poor prognosis: live birth after IVF with autologous oocytes in a 43-year-old woman with FSH levels above 30 mIU/mL. J Assist Reprod Genet 2017; 34:1185-1188. [PMID: 28656538 DOI: 10.1007/s10815-017-0986-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 06/16/2017] [Indexed: 10/19/2022] Open
Abstract
Providing reasonable expectations to patients with diminished ovarian reserve prior to attempting pregnancy through in vitro fertilization (IVF) is one of the most challenging aspects of fertility care. In some instances, advice from the clinician to pursue more effective treatment, such as donor oocytes, may not be acceptable to the patient. In this case report, a patient is presented who represents a poor prognosis candidate for IVF treatment. She was 43 years old with six prior failed IVF cycles and repetitive basal FSH values above 30 mIU/mL. Presented are the challenges in patient counseling and decision making. In her seventh IVF cycle, which she was strongly counseled against pursuing, the patient experienced the desired outcome of live birth. Increasing reports are emerging of live birth using autologous oocytes among women of advanced reproductive age. These instances, as well as the case of our patient, raise issues commonly encountered in patient counseling in poor prognosis patients. This discussion should include an emphasis on patient goals as well as an acknowledgement that no test for ovarian reserve has a 100% positive predictive value.
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Affiliation(s)
- Heather R Burks
- Department of Obstetrics and Gynecology, Section of Reproductive Endocrinology and Infertility, University of Oklahoma Health Sciences Center, PO Box 26901, COMB 2400, Oklahoma City, OK, 73126, USA.
| | - Marsha Baker
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Kaiser Permanente, Los Angeles, CA, USA
| | - Alexander M Quaas
- Department of Obstetrics and Gynecology, Section of Reproductive Endocrinology and Infertility, University of Oklahoma Health Sciences Center, PO Box 26901, COMB 2400, Oklahoma City, OK, 73126, USA.,Universitätsspital Basel Frauenklinik, Spitalstr. 21, 4031, Basel, Switzerland
| | - Kristin A Bendikson
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of Southern California, 2020 Zonal Ave, Room 534, Los Angeles, CA, 90033, USA
| | - Karine Chung
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of Southern California, 2020 Zonal Ave, Room 534, Los Angeles, CA, 90033, USA
| | - Richard J Paulson
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of Southern California, 2020 Zonal Ave, Room 534, Los Angeles, CA, 90033, USA
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Zhang H, Liu YQ, Lu GX, Gong F. Live birth in a 46-year-old woman using microdose GnRH agonist flare-up protocol combined with GnRH antagonist: a case report. Clin Case Rep 2016; 4:1107-1111. [PMID: 27980742 PMCID: PMC5134149 DOI: 10.1002/ccr3.693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 07/18/2016] [Accepted: 08/08/2016] [Indexed: 11/28/2022] Open
Abstract
Few successful pregnancies after age 45 years with low ovarian reserve have been reported. We report a 46‐year‐old woman with basal FSH 20.36 mIU/mL and an antral follicle count of four obtained two embryos and delivered a healthy infant with IVF using a microdose GnRH‐a flare‐up protocol combined with GnRH‐ant.
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Affiliation(s)
- Hong Zhang
- Reproductive and Genetic Hospital of CITIC-Xiangya Changsha China
| | - Ya-Qiong Liu
- Institute of Reproductive and Stem Cell Engineering School of basic medicine Central South University Changsha China; Key Laboratory of Reproductive and Stem Cell Engineering Ministry of Health Changsha China
| | - Guang-Xiu Lu
- Reproductive and Genetic Hospital of CITIC-Xiangya Changsha China; Key Laboratory of Reproductive and Stem Cell Engineering Ministry of Health Changsha China
| | - Fei Gong
- Reproductive and Genetic Hospital of CITIC-Xiangya Changsha China; Institute of Reproductive and Stem Cell Engineering School of basic medicine Central South University Changsha China; Key Laboratory of Reproductive and Stem Cell Engineering Ministry of Health Changsha China
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Nicopoullos JDM, Wren M, Abdalla H. Treatment and preservation at the extremes of reproductive age: a case report outlining the ethical dilemmas. J Assist Reprod Genet 2015; 32:1547-50. [PMID: 26319526 PMCID: PMC4615914 DOI: 10.1007/s10815-015-0551-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 07/24/2015] [Indexed: 10/23/2022] Open
Abstract
PURPOSE The purpose of the study was to report a livebirth from a cryopreserved embryo created from autologous oocytes collected at 47 years and 9 months that outlines the ethical difficulties of decision-making at the extreme of reproductive age. METHODS The method used was IVF and embryo cryopreservation within an assisted conception unit prior to adjuvant cancer treatment in a nulliparous patient diagnosed with breast carcinoma (47 years and 9 months at oocyte collection). RESULTS A 47-year-old nulliparous woman was diagnosed with breast malignancy during work-up for fertility treatment. Ovarian stimulation yielded one embryo from four oocytes that was cryopreserved to allow completion of adjuvant treatment. Subsequent embryo transfer cycle led to a live birth of a healthy baby girl at term, weighing 3.37 kg. CONCLUSION This paper demonstrates the oldest reported age of autologous oocyte collection to have achieved a livebirth. In women where most would consider treatment futile, we highlight the difficulties in decision-making in this group of patients.
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Affiliation(s)
| | - Marie Wren
- Lister Fertility Clinic, Lister Hospital, Chelsea Bridge Rd, London, SW1W 8RH, UK
| | - Hossam Abdalla
- Lister Fertility Clinic, Lister Hospital, Chelsea Bridge Rd, London, SW1W 8RH, UK
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Rani G, Goswami S, Chattopadhyay R, Ghosh S, Chakravarty B, Ganesh A. Live birth in a 50-year-old woman following in vitro fertilization-embryo transfer with autologous oocytes: a rare case report. Fertil Steril 2014; 103:414-6. [PMID: 25516083 DOI: 10.1016/j.fertnstert.2014.11.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 11/04/2014] [Accepted: 11/06/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To report a live birth with in vitro fertilization (IVF) from a 50-year-old woman with homologous oocytes. DESIGN Case report. SETTING Referral center. PATIENT(S) A 50-year-old woman. INTERVENTION(S) IVF with fresh embryo transfer (ET). MAIN OUTCOME MEASURE(S) Live birth after IVF. RESULT(S) A 50-year-old woman conceived with her own oocytes by means of IVF. Three fresh embryos were transferred, resulting in a pregnancy and delivery by cesarean section at 35 weeks of a healthy male baby weighing 2,300 g. CONCLUSION(S) Extensive literature search suggests that this is the first case report of live birth in a 50-year-old woman after IVF-ET with her own oocytes. This is a very rare and unusual case that deviates from the norm and therefore warrants attention. In selected cases, assisted reproductive technology might be reasonable to try for a limited number of times with a woman's own oocytes.
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Affiliation(s)
- Geetha Rani
- Institute of Reproductive Medicine, Kolkata, India
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