Journal of Assisted Reproduction and Genetics, Vol. 9, No. 5, 1992
SHORT COMMUNICATIONS
RICHMOND,
VICTORIA,
ovulation (5), an increase in abortion rates (1), an increase in oocyte chromosomal abnormalities (6), and associated pelvic disease. Success of in vitro fertilization has also been reported to be adversely affected by increasing age, success rates decreasing from 19.8% per attempt below the age of 25 years to 9.1% per attempt at 40 years or more (7). The effect was due to a reduction in oocyte production and to a reduced implantation rate per embryo. We present results demonstrating the effect of age on success rates for both in vitro fertilization (IVF) and gamete intrafallopian transfer (GIFT) procedures in 841 treatment cycles carried out in 663 women.
AUSTRALIA
A g e a n d Fertility: R e s u l t s o f A s s i s t e d R e p r o d u c t i v e T e c h n o l o g y in W o m e n o v e r 40 Y e a r s
Submitted: June 5, 1992 Accepted: July 20, 1992
INTRODUCTION MATERIALS AND METHODS
Fertility declines with age in all populations (1). Births per 1000 women from five populations declined from a range of 250-560 in the most fertile age group, 20-24 years, to 70-200 in the age group 40-44 years. The decline in fertility is gradual over the reproductive age span, the decline being a factor of 3-4 by the age of 40-44 years (Fig. 1) (1). This decline consists of a reduction in conception rate and an increase in spontaneous abortion rate (1). The abortion rate increases from 12% in the age group 20-24 years to 26% in the group over 40 years. The two major factors determining birth rate, conception and abortion rates, change differently with increasing age; conception rates decline approximately fourfold, while abortion rates approximately double by the age of 40-44 years. Young couples having regular coitus after stopping mechanical contraceptives conceive in five cycles, 20% per cycle (2,3). Based upon Gray's data the expectation for the 40- to 44-year age group to conceive is about 20 cycles, 5% per cycle. There is a rapid further decline in fertility between 40 and 44 years, to negligible levels between 45 and 49 years of age, when only 2-5% of women have babies (1). The decline in fertility with increasing age is due to the reduction in coital frequency (4), a reduction in 1058-0468/92/1000-0482506.50/0 © 1992 Plenum Publishing Corporation
Patients were treated during 1988-1990. The average age of the patients was 33.7 years, the range being 21--46 years. Age distribution was similar for IVF and GIFT procedures up to the age of 40 years; 41 of 59 treatments in women over the age of 40 years were GIFT procedures. Causal factors for infertility were tubal (35.5%); unexplained (20.9%); male factor (17.6%); endometriosis (10.7%); cervical (5.1%); and endocrine, failed donor insemination, and combined factors (10.2%). Tubal disease and male factor were treated in most cases by IVF (47% of all cases), while GIFT was used mainly for unexplained infertility, endometriosis, unilateral tubal disease, mild male factor, and cervical hostility (53% of all cases). Stimulation protocols were either combined gonadotropin releasing hormone (GnRH) agonist and pergonal or metrodin (short protocol) or downregulation with GnRH agonist followed by stimulation with Pergonal or metrodin. The GnRH agonist was either buserelin by nasal spray or lucrin by daily subcutaneous injection (8). Vaginal ultrasound-guided egg retrieval was done under neurolept anesthesia and embryos were transferred at the two- to eight-cell stage 48 hr later. 482
483
SHORT COMMUNICATIONS
HUT'[ERITE (Marna$e~ 1921-30) NORMANDY (Marriages 1642-1742)
~
600
Table I. Effect of Age on Discharge Rate Before Egg Pickup and Number of Eggs Retrieved Discharged before transfer
PUNJAB
........
(Marna$¢s 1900-14)
................ S W E D E N
[ M a r n a s ¢ l lS,t 1-19001 CHINA
500
IMarnages approx. 1 9 ~ - 3 0 )
"~
400
E
. . . . . . . . . . .... . ,
\\
.........................
3~ ..,
'".. "..
.......i',,
Total
~.,
I _'10- .~4
I .~5 _"9
t 30-34
SHORT COMMUNICATIONS
RICHMOND,
VICTORIA,
ovulation (5), an increase in abortion rates (1), an increase in oocyte chromosomal abnormalities (6), and associated pelvic disease. Success of in vitro fertilization has also been reported to be adversely affected by increasing age, success rates decreasing from 19.8% per attempt below the age of 25 years to 9.1% per attempt at 40 years or more (7). The effect was due to a reduction in oocyte production and to a reduced implantation rate per embryo. We present results demonstrating the effect of age on success rates for both in vitro fertilization (IVF) and gamete intrafallopian transfer (GIFT) procedures in 841 treatment cycles carried out in 663 women.
AUSTRALIA
A g e a n d Fertility: R e s u l t s o f A s s i s t e d R e p r o d u c t i v e T e c h n o l o g y in W o m e n o v e r 40 Y e a r s
Submitted: June 5, 1992 Accepted: July 20, 1992
INTRODUCTION MATERIALS AND METHODS
Fertility declines with age in all populations (1). Births per 1000 women from five populations declined from a range of 250-560 in the most fertile age group, 20-24 years, to 70-200 in the age group 40-44 years. The decline in fertility is gradual over the reproductive age span, the decline being a factor of 3-4 by the age of 40-44 years (Fig. 1) (1). This decline consists of a reduction in conception rate and an increase in spontaneous abortion rate (1). The abortion rate increases from 12% in the age group 20-24 years to 26% in the group over 40 years. The two major factors determining birth rate, conception and abortion rates, change differently with increasing age; conception rates decline approximately fourfold, while abortion rates approximately double by the age of 40-44 years. Young couples having regular coitus after stopping mechanical contraceptives conceive in five cycles, 20% per cycle (2,3). Based upon Gray's data the expectation for the 40- to 44-year age group to conceive is about 20 cycles, 5% per cycle. There is a rapid further decline in fertility between 40 and 44 years, to negligible levels between 45 and 49 years of age, when only 2-5% of women have babies (1). The decline in fertility with increasing age is due to the reduction in coital frequency (4), a reduction in 1058-0468/92/1000-0482506.50/0 © 1992 Plenum Publishing Corporation
Patients were treated during 1988-1990. The average age of the patients was 33.7 years, the range being 21--46 years. Age distribution was similar for IVF and GIFT procedures up to the age of 40 years; 41 of 59 treatments in women over the age of 40 years were GIFT procedures. Causal factors for infertility were tubal (35.5%); unexplained (20.9%); male factor (17.6%); endometriosis (10.7%); cervical (5.1%); and endocrine, failed donor insemination, and combined factors (10.2%). Tubal disease and male factor were treated in most cases by IVF (47% of all cases), while GIFT was used mainly for unexplained infertility, endometriosis, unilateral tubal disease, mild male factor, and cervical hostility (53% of all cases). Stimulation protocols were either combined gonadotropin releasing hormone (GnRH) agonist and pergonal or metrodin (short protocol) or downregulation with GnRH agonist followed by stimulation with Pergonal or metrodin. The GnRH agonist was either buserelin by nasal spray or lucrin by daily subcutaneous injection (8). Vaginal ultrasound-guided egg retrieval was done under neurolept anesthesia and embryos were transferred at the two- to eight-cell stage 48 hr later. 482
483
SHORT COMMUNICATIONS
HUT'[ERITE (Marna$e~ 1921-30) NORMANDY (Marriages 1642-1742)
~
600
Table I. Effect of Age on Discharge Rate Before Egg Pickup and Number of Eggs Retrieved Discharged before transfer
PUNJAB
........
(Marna$¢s 1900-14)
................ S W E D E N
[ M a r n a s ¢ l lS,t 1-19001 CHINA
500
IMarnages approx. 1 9 ~ - 3 0 )
"~
400
E
. . . . . . . . . . .... . ,
\\
.........................
3~ ..,
'".. "..
.......i',,
Total
~.,
I _'10- .~4
I .~5 _"9
t 30-34
