Assisted fertilization with own oocytes in women over 40 years of age: indications and results

Abstract

Women postpone motherhood because of their desire for personal and professional
improvement. It is known that the quantity and quality of oocytes per cycle depends
on the patient’s age. Success rates in assisted reproduction treatments decrease
with age, especially after 40 years of age. Higher live birth rates are observed in
younger women, and rates decrease significantly in older women due to decreased
fertility and increased miscarriages. Therefore, age is crucial when assessing the
possibility of a successful pregnancy through assisted reproductive treatments
(ART). The indications to perform in vitro fertilization (IVF) with own ovules in women
older than 40 years include starting as soon as possible highly complex procedures,
good evaluation of ovarian reserve with antimüllerian hormone analysis (AMH) and
antral follicle count (AFC) for genetic counseling, proposing IVF-intracytoplasmatic
sperm injection (ICSI) before the age of 44 years, generating realistic expectations
and informed consent, with own statistics. At REDLARA, of all IVF-ICSI procedures,
34% of patients are over 40 years old; preference is given to transfer blastocysts
with preimplantation genetic testing for aneuploidy (PGT-A) to select euploid
embryos. Success rates are low, even when they are pregnancy rates per embryo
transfer in the group of women ≥ 40 years (18.2% without PGT, 42.7% with PGT in
IMRCRP). It is recommended to bank ovules or embryos by performing multiple
ovarian stimulations. A single embryo transfer should be chosen to avoid obstetric
complications with multiple pregnancies in patients ≥40 years, because of the high
risk due to age.