Analysis of 2,386 consecutive cycles of in vitro fertilization or intracytoplasmic sperm injection using autologous oocytes in women aged 40 years and above

Objective: To estimate the live-birth and miscarriage rates in 1-year age increments for women aged >= 40 years undergoing in vitro fertilization or intracytoplasmic sperm injection (ICSI-IVF) with autologous oocytes. Design: Retrospective database and chart analysis. Setting: Egyptian IVF and embryo transfer center. Patient(s): One thousand six hundred forty-five women aged >= 40 years undergoing 2004 fresh nondonor IVF-ICSI cycles. Intervention(s): ICSI-IVF using ejaculate or surgically retrieved sperm. Main Outcome Measure(s): Pregnancy and live-birth rates per initiated cycle based on 1-year age increments. Result(s): The overall live-birth rate per initiated cycle was 6.7% (range: 10% to 0.5%). The pregnancy loss rate was 44.8% (range: 39.0% to 75.0%). The cutoff age was 43 years, when the pregnancy rate became statistically significantly lower. The live-birth rate per initiated cycle was statistically significantly higher for women <43 years old, 132 out of 1766 (7.4%) compared with women >= 43 years old, 7 out of 620 (1.1%). The miscarriage rate was 127 out of 295 (43.1%) compared with 15 out of 23 (65.2%) for the two age groups, respectively. Conclusion(s): The success rate of ICSI-IVF as measured by live-birth rate per initiated cycle was statistically significantly higher for women aged <43 years as compared with women aged >= 43 years. Once women have attained age 43 years, alternative methods such as oocyte donation cycles or previously cryopreserved embryos are likely to be more effective. (Fertil Steril (R) 2010;94:1707-12. (C) 2010 by American Society for Reproductive Medicine.)