HIGH-ORDER OOCYTE TRANSFER IN GAMETE INTRAFALLOPIAN TRANSFER PATIENTS 40 OR MORE YEARS OF AGE

Objective: To analyze whether a policy of high-order oocyte transfer would be effective in women greater than or equal to 40 years of age who are undergoing GIFT, and further, whether a specific subgroup of these patients could be identified where clinical pregnancy was more likely to occur. Design: Prospective descriptive study. Setting: Patients in a university-based reproductive endocrinology and infertility practice. Patients: Infertile women greater than or equal to 40 years of age who underwent GIFT cycles between January, 1990 and December, 1993 after not having achieved pregnancy with at least three previous cycles of superovulation and intrauterine insemination. Interventions: Gamete intrafallopian transfer was performed after controlled ovarian hyperstimulation with hMGs. High-order oocyte transfer was employed. Main Outcome Measures: Clinical pregnancy rates (PRs). Results: The overall clinical PR was 24.5% per retrieval (12/49) and 25.5% per transfer (12/47). A significantly higher number of oocytes were retrieved in patients who became pregnant than those who did not. Patient age, cycle day 3 FSH level, E(2) level on the day of hCG administration, number of oocytes transferred, and total number of motile sperm transferred did not differ significantly between the two groups. The clinical PR per transfer was significantly higher in patients with more than five oocytes transferred (10/27, 37%) versus those with five or less oocytes transferred (2/20, 10%). No multiple gestations were obtained. Conclusion: The number of oocytes retrieved in women greater than or equal to 40 years of age undergoing GIFT is the main determinant predicting clinical pregnancy. High-order oocyte transfer seems to lead to a favorable PR while the risk of multiple gestation is limited.