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Assisted reproduction counseling in women aged 40 and above: a cohort study

  • Assisted Reproduction Technologies
  • Published:
Journal of Assisted Reproduction and Genetics Aims and scope Submit manuscript

Abstract

Purpose

Fertility treatment in women aged ≥40 year old remains difficult and controversial. All available studies in older women report results of one specific method of ART, i.e. IUI, IVF/ICSI or oocyte donation, and success rates are always published per attempt but never per patient. Randomized studies are not available because of the obvious heterogeneity in patient populations and treatment options.

This prospective observational study aimed at analyzing the outcome in a consecutive cohort of patients above 40 undergoing various methods of ART.

Methods

A total number of 909 women older than 40 attended our fertility centre during a 3 years period. A flowchart showing the consecutive ART treatments with their respective outcome was constructed. Any delivery after 22 weeks gestation (or 500 g.) was taken as primary endpoint. Crude cumulative delivery rates (CDRs) and binomial exact 95 % confidence limits (95 % CLs) were calculated for each group of interest.

Results

ART treatment could be proposed to 737 patients (81 %) and eventually 585 patients (64 %) started ART treatment: 111 patients started IUI, 439 patients started IVF/ICSI and 35 patients started oocyte donation as a primary approach ART. Ten patients got pregnant spontaneously and delivered before starting any treatment. In the 909 patients consulting for infertility, 111 deliveries were achieved after ART, i.e. a crude CDR of 12.2 % (95 % CL 10.1 % to 14.5 %).

Conclusion

Only 10 % of patients aged 40 and above could achieve delivery of their genetically-own child, while 1 % conceived spontaneously. More than one third of patients consulting never started any treatment for different reasons, i.e. anticipated poor prognosis, financial restrictions, illness or spontaneous pregnancy.

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Acknowledgments

The authors thank Dr Stoop of the Centre for Reproductive Medicine for his literature advice concerning egg donation and results of this technique.

Author information

Author notes

  1. John Collins

    Present address: , 400 Mader’s Cove Road, RR 1, Mahone Bay, Canada, NS B0J 2E0

Authors and Affiliations

  1. Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium

    Michaël De Brucker, Herman Tournaye, Greta Verheyen & Michel Camus

  2. Centre for Outcomes Research and Laboratory for Experimental Surgery, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium

    Patrick Haentjens

  3. McMaster University, 1280 Main Street West, Hamilton, ON, Canada, L8S 4L8

    John Collins

  4. Dalhousie University, Halifax, Canada, B3H3J5

    John Collins

Authors
  1. Michaël De Brucker
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  2. Herman Tournaye
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  3. Patrick Haentjens
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  4. Greta Verheyen
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  5. John Collins
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  6. Michel Camus
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Corresponding author

Correspondence to Michaël De Brucker.

Additional information

Capsule

In women aged 40 and above only 10% achieved delivery of their genetically -own child, while 1% conceived spontaneously.

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De Brucker, M., Tournaye, H., Haentjens, P. et al. Assisted reproduction counseling in women aged 40 and above: a cohort study. J Assist Reprod Genet 30, 1431–1438 (2013). https://doi.org/10.1007/s10815-013-0085-z

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  • DOI: https://doi.org/10.1007/s10815-013-0085-z

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