The influence of ovarian response on gamete intra-Fallopian transfer outcome in older women

Fecundity declines with increasing age in women. The pregnancy rate is lower in in-vitro fertilization/embryo transfer (IVF/ET) in women aged ≥40 years. We analysed 349 consecutive gamete intra-Fallopian transfer (GUT) cycles in women aged ≥40 years to identify factors which affected the outcome. A...

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Published in:Human reproduction (Oxford) 1992-09, Vol.7 (8), p.1106-1110
Main Authors: Al-Shawaf, Talha, Nolan, Aonghus, Guirgis, Rifky, Harper, Joyce, Santis, Meryl, Craft, Ian
Format: Article
Language:English
Subjects:
Adult
Aging - physiology
Biological and medical sciences
Buserelin - therapeutic use
Chorionic Gonadotropin - blood
Chorionic Gonadotropin, beta Subunit, Human
Clomiphene - therapeutic use
Female
Follicle Stimulating Hormone - therapeutic use
gamete intra-Fallopian transfer
Gamete Intrafallopian Transfer
Gynecology. Andrology. Obstetrics
Humans
Medical sciences
Menotropins - therapeutic use
older aged women
Oocytes - physiology
ovarian response
Ovary - physiology
Peptide Fragments - blood
Pregnancy
Pregnancy Outcome
pregnancy rate
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Summary:Fecundity declines with increasing age in women. The pregnancy rate is lower in in-vitro fertilization/embryo transfer (IVF/ET) in women aged ≥40 years. We analysed 349 consecutive gamete intra-Fallopian transfer (GUT) cycles in women aged ≥40 years to identify factors which affected the outcome. A maximum of four oocytes were transferred in GIFT as recommended by the Interim Licensing Authority; 61 women (17.5%) had a positive serum β-human chorionic gonadotrophin, 35 (10%) had a miscarriage and 26 (7.5%) delivered live infants. The pregnancy rate was lower than with younger women while the conception loss was higher. Pregnancy and delivery rates increased as the number of oocytes retrieved increased but declined again if > 10 oocytes were retrieved. If 1—3 oocytes were retrieved, the pregnancy rate was 9.7% and the delivery rate was 3.9%; if 4–10 oocytes were retrieved, the pregnancy rate was 22.1% and the delivery rate was 10.1%, and when >10 oocytes were retrieved, the rates were 17.6 and 5.9% respectively. The highest pregnancy rate was when four oocytes were transferred in GIFT (22.4%) and the delivery rate was 10.0%. An adequate response to long down-regulation with gonado-trophin-releasing hormone agonist was also a factor associated with high delivery rates (13.5%). We conclude that the delivery rate after GIFT in women aged ≥40 years is low, but there is a subgroup who have an acceptable delivery rate because of a good ovarian response. In this group, pituitary down-regulation improves the outcome of treatment.
ISSN:0268-1161
1460-2350
DOI:10.1093/oxfordjournals.humrep.a137802