Clinical and Experimental Reproductive Medicine

The Korean Society for Reproductive Medicine (대한생식의학회)
권호 표지

Outcome of in vitro Fertilization in Women $\geq$40 Years of Age

40세 이상의 여성에서 연령에 따른 체외수정시술 결과 분석

  • Kwon, Cheo-Jin (Infertility Center, Seoul Women's Hospital) ;
  • Lee, Sang-Hee (Department of Obstetrics & Gynecology, Seoul Women's Hospital) ;
  • Kang, Eun-Hee (Department of Obstetrics & Gynecology, Seoul Women's Hospital) ;
  • Kim, Jong-Sik (Infertility Center, Seoul Women's Hospital) ;
  • Jung, Byeong-Jun (Department of Obstetrics & Gynecology, Seoul Women's Hospital)
  • 권처진 (인천 서울여성병원 불임센터) ;
  • 이상희 (인천 서울여성병원 산부인과) ;
  • 강은희 (인천 서울여성병원 산부인과) ;
  • 김종식 (인천 서울여성병원 불임센터) ;
  • 정병준 (인천 서울여성병원 산부인과)
  • Published : 2007.12.31
Download PDF
⟨ Previous Next ⟩

Abstract

Objective: To evaluate the outcomes of in vitro fertilization and embryo transfer (IVF-ET) in women over 40 years of age. Methods: A total of 170 patients (271 cycles) over 40 years of age who underwent IVF-ET at Seoul Women's Hospital (Incheon, Korea) were analyzed in this study retrospectively. The patients were grouped into the women <44 years old group and the women $\geq$44 years old group. Statistical analysis was performed using Student's t-test and Fisher's exact test as appropriate. Results: An overall clinical pregnancy rate per retrieval was 11% (30/271). Of these, clinical miscarriage rate were 33% (10/30) and the overall delivery rate was 7.4% (20/271) per retrieval, respectively. The women $\geq$44 years old group had significantly higher cancellation rate (13% vs. 25%), lower number of retrieved oocytes (6.17$\times$4.62 vs. 4.13$\times$4.07), decreased number of 2PN (4.83$\times$3.61 vs. 3.46$\times$3.12), and reduced embryos for transfer (3.52$\times$1.72 vs. 2.81$\times$1.83) than the women <44 years old group. We found significantly lower clinical pregnancy rate (13.0% vs. 2.1%) and live birth rate (9.0% vs. 0.0%) in the women $\geq$44 years old group than the women <44 years old group. Conclusion: The present study has shown that IVF outcome is seriously impaired in the women $\geq$44 years old.

목 적: 자신의 난자를 사용하여 체외수정시술을 시행한 40세 이상의 여성 환자에서 시술 결과를 분석하여 체외수정시술의 유용성을 평가하였다. 연구방법: 본원에 내원하여 체외수정-배아이식 시술을 받은 환자 중 40세 이상의 여성 환자 170명 271주기를 대상으로 하여 시술 결과를 분석하였다. 이들 환자 중 44세 미만 군과 44세 이상 군으로 나누어 시술 결과를 비교하였다. 통계학적 분석은 student t-test 및 Fishers exact test를 이용하였다. 결 과:총 임상적 임신율이 11% (30/271), 임상적 임신이 확인된 후 유산된 경우가 33% (10/30), 총 분만율이 7.4% (20/271)이었다. 44세 미만 군과 44세 이상 군의 비교에서는 주기취소율이 13%와 23%로 44세 이상군에서 높았고, 평균 회수된 난자 수, 수정된 배아 수, 이식한 배아 수는 각각 6.17$\pm$4.62와 4.13$\pm$4.07, 4.83$\pm$3.61와 3.46$\pm$3.12, 3.52$\pm$1.72와 2.81$\pm$1.83로 44세 이상 군에서 통계적으로 유의하게 낮았다. 임상적 임신율과 분만율도 각각 13.0%와 2.1%, 9.0%와 0.0%로 44세 이상 군에서 유의하게 낮았다. 결 론: 본 연구 결과에 의하면 자신의 난자를 사용한 체외수정-배아이식 시술이 44세 미만의 여성불임 환자에게는 유용한 시술이지만, 44세 이상의 환자에서는 시술을 통한 성공적인 임신과 분만에 어려움이 많았다.

Keywords

References

  1. Rosenwaks Z, Davis OK, Damario MA. The role of maternal age in assisted reproduction. Hum Reprod 1995; 10: 165-73 https://doi.org/10.1093/humrep/10.1.165
  2. Abdelmassih R, Sollia S, Moretto M. Female age is an important parameter to predict treatment outcome in intracytoplasmic sperm injection. Fertil Steril 1996; 65: 573-7 https://doi.org/10.1016/S0015-0282(16)58156-4
  3. BarHava I, Orvieto R, Ferber A. Standard in vitro fertilization or intracytoplasimic sperm injection in advanced female age-what may be expected? Gynecol Endocrinol 1999; 13: 93 -7 https://doi.org/10.3109/09513599909167539
  4. Tietze C. Reproductive span and rate of reproduction among Hutterite women. Fertil Steril 1957; 8: 89-97 https://doi.org/10.1016/S0015-0282(16)32587-0
  5. Federation CECOS, Schwartz D, Mayaux JM. Female fecundity as a function of age: results of artificial insemination in 2193 nulliparous women with azoospermic husbands. N Engl J Med 1982; 306: 404-6 https://doi.org/10.1056/NEJM198202183060706
  6. Devroey P, Godoy H, Smitz J, Camus M, Toumaye H, Derde MP, et al. Female age predicts embryonic implantation after ICSI: a case-controlled study. Hum Reprod 1996; 11: 1324-7 https://doi.org/10.1093/oxfordjournals.humrep.a019380
  7. Van Kooij RJ, Looman CW, Habbema JDF, Dorland M, te Velde ER. Age dependent decrease in embryo implantation rate after in vitro fertilization. Fertil Steril 1996; 66: 769-75 https://doi.org/10.1016/S0015-0282(16)58634-8
  8. Liu HC, Rosenwaks Z. Early pregnancy wastage in IVF patients. J In Vitro Fert Embryo Transf 1991; 8: 65-72 https://doi.org/10.1007/BF01138657
  9. Coulam CB, Opsahl MS, Sherins RJ, Thorsell LP, Dorfman A, Krysa L, et al. Comparisons of pregnancy loss patterns after intracytoplasmic sperm injection and other assisted reproductive technologies. Fertil Steril 1996; 65: 1157-62 https://doi.org/10.1016/S0015-0282(16)58331-9
  10. Spandorfer SD, Davis OK, Barmat LI, Chung P, Rosenwaks Z. Relationship between maternal age and aneuploidy in vitro fertilization pregnancy loss. Fertil Steril 2004; 81: 1265-9 https://doi.org/10.1016/j.fertnstert.2003.09.057
  11. Richardson SJ, Senikas V, Nelson JF. Follicular depletion during the menopausal transition: evidence for accelerated loss and ultimate exhaustion. J Clin Endocrinol Metab 1987; 65: 1765-8
  12. Wallach EE. Pitfalls in evaluating ovarian reserve. Fertil Steril 1995; 63: 12-4 https://doi.org/10.1016/S0015-0282(16)57288-4
  13. Abdalla HI, Baber R, Kirkland A, Leonard T, Power M, Studd JW. A report on 100 cycles of oocyte donation: factors affecting the outcome. Hum Reprod 1990; 5: 1018-22 https://doi.org/10.1093/oxfordjournals.humrep.a137209
  14. Munne S, Alikani M, Tomkin G, Grifo J, Cohen J. Embryo morphology, developmental rates, and maternal age are correlated with chromosome abnormalities. Fertil Steril 1995; 64: 382-91 https://doi.org/10.1016/S0015-0282(16)57739-5
  15. Lass A, Croucher C, Duffy S, Dawson K, Margara R, Winston R. One thousand initiated cycles of in vitro fertilization in women $\geq 40$ years of age. Fertil Steril 1998; 70: 1030-4 https://doi.org/10.1016/S0015-0282(98)00353-7
  16. Ron-El R, Raziel A, Strassburger D, Schachter M, Kasterstein E, Friedler S. Outcome of assisted reproductive technology in women over the age of 41. Fertil Steril 2000; 74: 471-5 https://doi.org/10.1016/S0015-0282(00)00697-X
  17. SART, ASRM. Assisted reproduction technology in the United States: 1999 results generated from the American Society for Reproductive Medicine/Society for Assisted Reproductive Technology Registry. Fertil Steril 2002; 78: 918-31 https://doi.org/10.1016/S0015-0282(02)04198-5
  18. Templeton A, Morris JK, Parslow W. Factors that affect outcome of in-vitro fertilization treatment. Lancet 1996; 348: 1402-6 https://doi.org/10.1016/S0140-6736(96)05291-9
  19. Steven DS, Kristin B, Kate K, Glenn S, Owen KD, Zev R. Outcome of in vitro fertilization in women 45 years and older who use autologous oocytes. Fertil Steril 2006; 87: 74-6 https://doi.org/10.1016/j.fertnstert.2006.05.081
  20. Stolwijk AM, Zielhuis GA, Sauer MY, Hamilton CJCM, Paulson RJ. The impact of the woman's age on the success of standard and donor in vitro fertilization. Fertil Steril 1997; 67: 702-10 https://doi.org/10.1016/S0015-0282(97)81370-2
  21. Hull MGR, Flemming CF, Hughes AO, McDermott A. The age-related decline in female fecundity: a quantitative controlled study of implanting capacity and survival of individual embryos after in vitro fertilization. Fertil Steril 1996; 65: 783 -90 https://doi.org/10.1016/S0015-0282(16)58214-4
  22. Soren Z, Anne L, Jorgen HP, Anne-Grethe A, Svend L, Karsten P, et al. Embryo quality and developmental potential is compromised by age. Acta Obstet Gynecol Scand 2001; 80: 169-74 https://doi.org/10.1034/j.1600-0412.2001.080002169.x
  23. Gianaroli L. Preimplantation diagnosis for aneuploidies in patients undergoing in vitro fertilization with a poor prognosis: identification of the categories for which it should be proposed. Fertil Steril 1999; 72: 837-44 https://doi.org/10.1016/S0015-0282(99)00377-5
  24. Cristina M, Luca G, Anna PF, Michela L, Alessandra R, Valeria F. Embryo morphology and development are dependent on the chromosomal complenent. Fertil Steril 2007; 87: 534-40 https://doi.org/10.1016/j.fertnstert.2006.07.1512
  25. Jonathan Van B, Michael A, Robin S. The developmental potential of the human oocyte is related to the dissolved oxygen content of follicular fluid: association with vascular endothelial growth factor levels and perifollicular blood flow characteristics. Hum Reprod 1997; 12: 1047-55 https://doi.org/10.1093/humrep/12.5.1047