IVF in women aged 43 years and older: a 20-year experience

RESEARCH QUESTION

What are the reproductive outcomes of women aged 43 years and older undergoing IVF and intracytoplasmic sperm injection (ICSI) treatment using their own eggs.

DESIGN

Retrospective study of 833 woman aged 43 years or older undergoing their first IVF and ICSI cycle using autologous oocytes at a tertiary referral hospital between January 1995 and December 2019. Live birth rate (LBR) after 24 weeks' gestation was the primary outcome.

RESULTS

Ninety-five out of 833 (11.4%) had a positive HCG, whereas 59 (62.1% per positive HCG) had a miscarriage before 12 weeks' gestation and 36 (4.3%) live births were achieved. Analysis by age showed that the number of cumulus-oocyte complexes retrieved was significantly different between the four age groups: 43 years (5 [3-9]); 44 years (5 [2-7]); 45 years (3 [2-8)]); ≥45 years (2.5 [2-6]); P < 0.01; the number of metaphase II oocytes, however, was similar. Positive HCG rates remained low: 43 years (78/580 [13.4%]); 44 years (14/192 [7.3%]); 45 years (1/39 [2.6%]; and ≥46 years (2/22 [9.1%]); P = 0.03, as did LBR: 43 years (28 [4.8%]); 44 (7 [3.6%]); 45 years (0 [0%]); and ≥46 years (1 [4.5%]); P = 0.5. Multivariate regression analysis revealed that only number of metaphase II was significantly associated with LBR, when age was considered as a continuous (OR 1.08, 96% CI 1.004 to 1.16) or categorical variable (OR 1.08, 95% CI 1.005 to 1.16).

CONCLUSION

The chances of achieving a live birth in patients aged 43 years and older undergoing IVF/ICSI with their own gametes are low, even in cases of patients with a relatively 'normal' ovarian reserve for their age.

Reduction of hospital stay at maternity unit: an evaluation of the impact on maternal and neonatal readmission

In June 2015, the Belgian federal minister of public health imposed a reduction of 1 day in hospital stay at the maternity unit. This retrospective cohort study evaluated data of all patients who delivered between January 01 2010 and November 30 2015. Neonatal readmissions during the first 28 days postpartum and maternal readmissions during the first 6 weeks postpartum were studied. In total, 6009 births were included. The neonatal readmissions significantly increased (4.8% versus 6.9%, p value = .04) after June 2015. There was no significant difference in maternal readmissions between groups. In conclusion, hospital stay reduction at the maternity unit was linked with an increase of neonatal readmissions in the first 28 days postpartum, but did not have an effect on the maternal readmissions.Impact StatementWhat is already known on this subject? Many studies have evaluated the impact of early discharge on maternal and neonatal morbidity since 1950. Nevertheless, there are still concerns regarding the advantages and inconveniences of this policy. This retrospective cohort study took place in a tertiary referral centre in Belgium (CHU Tivoli) and evaluated data of all patients who delivered between January 01 2010 and November 30 2015.What the results of this study add? The readmissions for icterus increased significantly after the introduction of the reduced stay. There was no significant difference in maternal readmissions between groups.What the implications are of these findings for clinical practice and/or further research? A shorter hospital may be linked with an increase of neonatal readmissions in the first 28 days postpartum, but does not seem to have an effect on the maternal readmissions. Further prospective studies are needed in order to validate this hypothesis and also elucidate the reasons leading to a higher neonatal readmission rate.

Digital optical computing with magneto-optic spatial light modulators: a new and efficient multiplication algorithm

Digital optical computing executed on arrays of binary data can offer parallel processing and multivalued output, which permits more flexibility in algorithm development. The hardware used consists of two computer-controlled magneto-optic spatial-light-modulator arrays in conjunction with a CCD detector array as the computational hardware. Algorithms for binary-processing tasks are presented. We used magneto-optic spatial light modulators for parallel processing in a way that exploits multivalued output. Also, in carrying this evaluation out, we developed a new and efficient multiplication algorithm. Multiplication is an important operation in many digital systems, and the design of fast multipliers is of great interest to computer scientists and engineers. The speed of this computing system is evaluated.