National trends and outcomes of autologous in vitro fertilization cycles among women ages 40 years and older

  • Heather Hipp
  • Sara Crawford
  • Jennifer F. Kawwass
  • Sheree L. Boulet
  • David A. Grainger
  • Dmitry M. Kissin
  • Denise Jamieson
Assisted Reproduction Technologies
First Online:
Received:
Accepted:

Abstract

Purpose

The purpose of the study was to describe trends in and investigate variables associated with clinical pregnancy and live birth in autologous in vitro fertilization (IVF) cycles among women ≥40 years.

Methods

We used autologous IVF cycle data from the National ART Surveillance System (NASS) for women ≥40 years at cycle start. We assessed trends in fresh and frozen cycles (n = 371,536) from 1996 to 2013. We reported perinatal outcomes and determined variables associated with clinical pregnancy and live birth in fresh cycles between 2007 and 2013.

Results

From 1996 to 2013, the total number of cycles in women ≥40 years increased from 8672 to 28,883 (p < 0.0001), with frozen cycles almost tripling in the last 8 years. Cycles in women ≥40 years accounted for 16.0% of all cycles in 1996 and 21.0% in 2013 (p < 0.0001). For fresh cycles from 2007 to 2013 (n = 157,890), the cancelation rate was 17.1%. Among cycles resulting in transfer (n = 112,414), the live birth rate was 16.1%. The following were associated with higher live birth rates: multiparity, fewer prior ART cycles, use of standard agonist or antagonist stimulation, lower gonadotropin dose, ovarian hyperstimulation syndrome, more oocytes retrieved, use of pre-implantation genetic screening/diagnosis, transferring more and/or blastocyst stage embryos, and cryopreserving more supernumerary embryos. Of the singleton infants born (n = 14,992), 86.9% were full term and 88.3% normal birth weight.

Conclusions

The NASS allows for a comprehensive description of IVF cycles in women ≥40 years in the USA. Although live birth rate is less than 20%, identifying factors associated with IVF success can facilitate treatment option counseling.

Keywords

In vitro fertilization (IVF) Infertility Older women 40 years and over 
This is a preview of subscription content, log in to check access.

Notes

Compliance with ethical standards

The study was approved by the Institutional Review Board of the Centers for Disease Control and Prevention.

Funding

None.

Conflict of interest

Dr. Grainger receives speaking fees from Abbvie, Inc. and Shionogi, Inc. on topics unrelated to the study question.

Disclaimer

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

References

  1. 1.
    Mills M, Rindfuss RR, McDonald P, te Velde E, Reproduction E, Society Task F. Why do people postpone parenthood? Reasons and social policy incentives. Hum Reprod Update. 2011;17(6):848–60. doi: 10.1093/humupd/dmr026.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Martin JA, Hamilton BE, Osterman MJ, Curtin SC, Matthews TJ. Births: final data for 2013. Natl Vital Stat Rep. 2015;64(1):1–65.Google Scholar
  3. 3.
    Eijkemans MJ, van Poppel F, Habbema DF, Smith KR, Leridon H, te Velde ER. Too old to have children? Lessons from natural fertility populations. Hum Reprod. 2014;29(6):1304–12. doi: 10.1093/humrep/deu056.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Klipstein S, Regan M, Ryley DA, Goldman MB, Alper MM, Reindollar RH. One last chance for pregnancy: a review of 2,705 in vitro fertilization cycles initiated in women age 40 years and above. Fertil Steril. 2005;84(2):435–45. doi: 10.1016/j.fertnstert.2005.02.020.CrossRefPubMedGoogle Scholar
  5. 5.
    Tsafrir A, Simon A, Revel A, Reubinoff B, Lewin A, Laufer N. Retrospective analysis of 1217 IVF cycles in women aged 40 years and older. Reprod BioMed Online. 2007;14(3):348–55.CrossRefPubMedGoogle Scholar
  6. 6.
    Gleicher N, Vega MV, Darmon SK, Weghofer A, Wu YG, Wang Q, et al. Live-birth rates in very poor prognosis patients, who are defined as poor responders under the Bologna criteria, with nonelective single embryo, two-embryo, and three or more embryos transferred. Fertil Steril. 2015;104(6):1435–41. doi: 10.1016/j.fertnstert.2015.08.023.CrossRefPubMedGoogle Scholar
  7. 7.
    Patrizio P, Sakkas D. From oocyte to baby: a clinical evaluation of the biological efficiency of in vitro fertilization. Fertil Steril. 2009;91(4):1061–6. doi: 10.1016/j.fertnstert.2008.01.003.CrossRefPubMedGoogle Scholar
  8. 8.
    Serour G, Mansour R, Serour A, Aboulghar M, Amin Y, Kamal O, et al. Analysis of 2,386 consecutive cycles of in vitro fertilization or intracytoplasmic sperm injection using autologous oocytes in women aged 40 years and above. Fertil Steril. 2010;94(5):1707–12. doi: 10.1016/j.fertnstert.2009.09.044.CrossRefPubMedGoogle Scholar
  9. 9.
    Orvieto R, Bar-Hava I, Yoeli R, Ashkenazi J, Rabinerson D, Bar J, et al. Results of in vitro fertilization cycles in women aged 43-45 years. Gynecol Endocrinol. 2004;18(2):75–8.CrossRefPubMedGoogle Scholar
  10. 10.
    Maheshwari A, Scotland G, Bell J, McTavish A, Hamilton M, Bhattacharya S. Direct health services costs of providing assisted reproduction services in older women. Fertil Steril. 2010;93(2):527–36. doi: 10.1016/j.fertnstert.2009.01.115.CrossRefPubMedGoogle Scholar
  11. 11.
    Caplan AL, Patrizio P. Are you ever too old to have a baby? The ethical challenges of older women using infertility services. Semin Reprod Med. 2010;28(4):281–6. doi: 10.1055/s-0030-1255175.CrossRefPubMedGoogle Scholar
  12. 12.
    Salem Yaniv S, Levy A, Wiznitzer A, Holcberg G, Mazor M, Sheiner E. A significant linear association exists between advanced maternal age and adverse perinatal outcome. Arch Gynecol Obstet. 2011;283(4):755–9. doi: 10.1007/s00404-010-1459-4.CrossRefPubMedGoogle Scholar
  13. 13.
    Wennberg AL, Opdahl S, Bergh C, Aaris Henningsen AK, Gissler M, Romundstad LB, et al. Effect of maternal age on maternal and neonatal outcomes after assisted reproductive technology. Fertil Steril. 2016;106(5):1142–1149 e14. doi: 10.1016/j.fertnstert.2016.06.021.CrossRefPubMedGoogle Scholar
  14. 14.
    Centers for Disease Control and Prevention, American Society for Reproductive Medicine, Society for Assisted Reproductive Technology. 2013 assisted reproductive technology fertility clinic success rates report. Atlanta: US Dept of Health and Human Services; 2015.Google Scholar
  15. 15.
    Kissin DM, Crawford S, Boulet SL. The status of public reporting of clinical outcomes in assisted reproductive technology. Fertil Steril. 2013;100(3):e16–7. doi: 10.1016/j.fertnstert.2013.07.199.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Kushnir VA, Barad DH, Albertini DF, Darmon SK, Gleicher N. Effect of embryo banking on U.S. National Assisted Reproductive Technology Live Birth Rates. PLoS One. 2016;11(5):e0154620. doi: 10.1371/journal.pone.0154620.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Toner JP, Coddington CC, Doody K, Van Voorhis B, Seifer DB, Ball GD, et al. Society for Assisted Reproductive Technology and assisted reproductive technology in the United States: a 2016 update. Fertil Steril. 2016;106(3):541–6. doi: 10.1016/j.fertnstert.2016.05.026.CrossRefPubMedGoogle Scholar
  18. 18.
    Sunderam S, Kissin DM, Crawford SB, Folger SG, Jamieson DJ, Warner L, et al. Assisted Reproductive Technology Surveillance—United States, 2013. MMWR Surveill Summ. 2015;64(11):1–25. doi: 10.15585/mmwr.ss6411a1.CrossRefGoogle Scholar
  19. 19.
    Kenny LC, Lavender T, McNamee R, O’Neill SM, Mills T, Khashan AS. Advanced maternal age and adverse pregnancy outcome: evidence from a large contemporary cohort. PLoS One. 2013;8(2):e56583. doi: 10.1371/journal.pone.0056583.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Spandorfer SD, Bendikson K, Dragisic K, Schattman G, Davis OK, Rosenwaks Z. Outcome of in vitro fertilization in women 45 years and older who use autologous oocytes. Fertil Steril. 2007;87(1):74–6. doi: 10.1016/j.fertnstert.2006.05.081.CrossRefPubMedGoogle Scholar
  21. 21.
    Gunnala V, Reichman DE, Meyer L, Davis OK, Rosenwaks Z. Beyond the American Society for Reproductive Medicine transfer guidelines: how many cleavage-stage embryos are safe to transfer in women ≥43 years old? Fertil Steril. 2014;102(6):1626–1632 e1. doi: 10.1016/j.fertnstert.2014.09.015.CrossRefPubMedGoogle Scholar
  22. 22.
    Hill MJ, Richter KS, Heitmann RJ, Lewis TD, DeCherney AH, Graham JR, et al. Number of supernumerary vitrified blastocysts is positively correlated with implantation and live birth in single-blastocyst embryo transfers. Fertil Steril. 2013;99(6):1631–6. doi: 10.1016/j.fertnstert.2013.01.130.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Baker VL, Brown MB, Luke B, Smith GW, Ireland JJ. Gonadotropin dose is negatively correlated with live birth rate: analysis of more than 650,000 assisted reproductive technology cycles. Fertil Steril. 2015;104(5):1145–1152 e1-5. doi: 10.1016/j.fertnstert.2015.07.1151.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Steiner AZ, Jukic AM. Impact of female age and nulligravidity on fecundity in an older reproductive age cohort. Fertil Steril. 2016;105(6):1584–1588 e1. doi: 10.1016/j.fertnstert.2016.02.028.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Malacova E, Kemp A, Hart R, Jama-Alol K, Preen DB. Effectiveness of in vitro fertilization in women with previous tubal sterilization. Contraception. 2015;91(3):240–4. doi: 10.1016/j.contraception.2014.12.001.CrossRefPubMedGoogle Scholar
  26. 26.
    Kalra SK, Ratcliffe SJ, Dokras A. Is the fertile window extended in women with polycystic ovary syndrome? Utilizing the Society for Assisted Reproductive Technology registry to assess the impact of reproductive aging on live-birth rate. Fertil Steril. 2013;100(1):208–13. doi: 10.1016/j.fertnstert.2013.02.055.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  1. 1.Division of Reproductive Endocrinology and Infertility, Emory University School of MedicineEmory UniversityAtlantaUSA
  2. 2.Division of Reproductive HealthUS Centers for Disease Control and PreventionAtlantaUSA
  3. 3.The Center for Reproductive MedicineWichitaUSA

Personalised recommendations