Bradford L. Bopp

Success rates with gamete intrafallopian transfer and in vitro fertilization in women of advanced maternal age

OBJECTIVE To evaluate the effect of maternal age on outcomes for IVF and GIFT in women 40 to 45 years of age. DESIGN Retrospective. SETTING Boston IVF, a free-standing university-affiliated IVF and GIFT unit. PATIENTS A total of 2,931 cycles of IVF and 1,826 cycles of GIFT were analyzed in women undergoing assisted reproductive technologies (IVF or GIFT) using autologous eggs. INTERVENTIONS Medical records of patient outcomes were reviewed. RESULTS For patients undergoing IVF, the cancellation rate for initiated cycles showed significant differences in women aged 25 to 39 (38.3%), women aged 40 to 43 (49.5%), and women aged 44 to 45 years (69.5%). A significantly lower delivery rate per stimulation and delivery rate per retrieval was found in women aged 40 to 43 years when compared with women aged 25 to 39 years. No deliveries occurred in 59 cycles in women aged 44 to 45 years, thereby representing a significant difference when compared with both women aged 25 to 39 years and women aged 40 to 43 years. For patients undergoing GIFT, the cancellation rate for initiated cycles was significantly higher in women aged 40 to 43 (25.0%) and 44 to 45 years (31.0%) when compared with women aged 25 to 39 years (15.1%). A significantly lower delivery rate per stimulation and delivery rate per retrieval was found in women aged 40 to 43 and 44 to 45 years when compared with women aged 25 to 39 years. CONCLUSIONS Success rates for IVF and GIFT decline significantly in women > 40 years old. Women aged > or = 44 years are unlikely to benefit from the use of IVF and GIFT.

In Vitro Fertilization in the Office Setting

Since the birth of the first child conceived using the process of in vitro fertilization (IVF) in 1978, many thousands of children have been born worldwide through this fascinating procedure. In the early days of IVF, only a few highly specialized centers around the world were prepared to perform the dramatic surgical procedure involving the recovery of oocytes. At the same time, behind the scenes a highly skilled team of biologists waited patiently to receive and prepare the oocytes for in vitro insemination. Although the emotional intensity involved with each IVF procedure performed remains constant, over time the process itself has been greatly simplified. In fact, over the past 20 years, IVF has become increasingly successful, all the while becoming less expensive and less invasive.