Advertisement

A decision tree analysis applied to women aged 43–45: who should be referred for ovum donation?

Published:October 07, 2021DOI:https://doi.org/10.1016/j.rbmo.2021.09.025

      Abstract

      Research question

      In women at the advanced age of 43–45 years undergoing repeated IVF cycles with autologous oocytes, who has the highest chance for birth and who should be referred early to receive donor oocytes?

      Design

      A retrospective cohort study was conducted at a university hospital reproductive centre. The computerized database of 394 women aged 43–45 years undergoing 1528 non-donor IVF or intracytoplasmic sperm injection cycles between 2010 and 2019 was analysed. A decision tree was developed, enabling a comprehensive study of a set of clinical parameters and the expected outcomes.

      Results

      The cumulative clinical pregnancy rate was 15.0% (59/394) and the cumulative live birth rate was 8.4% (33/394). The decision tree developed to predict women who should be offered egg donation included age, poor ovarian response to stimulation, the number of top-quality embryos, dominant follicles, previous pregnancy or live birth, fertilized oocytes and body mass index. The model showed that a good ovarian response in the first cycle was the best predictor for live birth (13.3% gave birth). However, among women with poor responses, 7.1% of those who were younger than 43.5 years gave birth, and none of the women who were older than 43.5 years did.

      Conclusions

      Women over 43.5 years old with fewer than four oocytes collected in their first IVF cycle should be offered ovum donation, since their live birth rate in subsequent cycles is negligible.

      Keywords

      To read this article in full you will need to make a payment

      References

        • American College of Obstetricians and Gynecologists Committee on Gynecologic Practice and The Practice Committee of the American Society for Reproductive Medicine, Committee Opinion No. 589
        Female age-related fertility decline.
        Fertil. Steril. 2014; 101: 633-634https://doi.org/10.1016/j.fertnstert.2013.12.032
        • Balasch J.
        • Gratacós E.
        Delayed childbearing: effects on fertility and the outcome of pregnancy.
        Curr. Opin. Obs. Gynecol. 2012; 24: 187-193https://doi.org/10.1097/GCO.0b013e3283517908
        • Biljan M.M.
        • Buckett W.M.
        • Dean N.
        • Phillips S.J.
        • Tan S.L.
        The outcome of IVF–embryo transfer treatment in patients who develop three follicles or less.
        Hum. Reprod. 2000; 15: 2140-2144
        • Birenbaum-Carmeli D.
        Thirty-five years of assisted reproductive technologies in Israel.
        Reprod. Biomed. Soc. Online. 2016; 2: 16-23https://doi.org/10.1016/j.rbms.2016.05.004
        • Cetinkaya M.B.
        • Siano L.J.
        • Benadiva C.
        • Sakkas D.
        • Patrizio P.
        Reproductive outcome of women 43 years and beyond undergoing ART treatment with their own oocytes in two Connecticut university programs.
        J. Assist. Reprod. Genet. 2013; 30: 673-678https://doi.org/10.1007/s10815-013-9981-5
        • Cohen Y.
        • Tannus S.
        • Alzawawi N.
        • Son W.Y.
        • Dahan M.
        • Buckett W.
        Poor ovarian response as a predictor for live birth in older women undergoing IVF.
        Reprod. Biomed. Online. 2018; 36: 435-441https://doi.org/10.1016/j.rbmo.2018.01.008
        • de Mouzon J.
        • Chambers G.M.
        • Zegers-Hochschild F.
        • Mansour R.
        • Ishihara O.
        • Banker M.
        • Dyer S.
        • Kupka M.
        • Adamson G.D.
        International Committee for Monitoring Assisted Reproductive Technologies world report: assisted reproductive technology 2012†.
        Hum. Reprod. 2020; 35: 1900-1913https://doi.org/10.1093/humrep/deaa090
        • Fernandez A.M.
        • Drakopoulos P.
        • Rosetti J.
        • Uvin V.
        • Mackens S.
        • Bardhi E.
        • De Vos M.
        • Camus M.
        • Tournaye H.
        • De Brucker M.
        IVF in women aged 43 years and older: a 20-year experience.
        Reprod. Biomed. Online. 2021; 42: 768-773
        • Ferraretti A.P.
        • La Marca A.
        • Fauser B.C.
        • Tarlatzis B.
        • Nargund G.
        • Gianaroli L.
        • Definition E.
        • working group on P.O.R.
        ESHRE consensus on the definition of “poor response” to ovarian stimulation for in vitro fertilization: the Bologna criteria.
        Hum. Reprod. 2011; 26: 1616-1624https://doi.org/10.1093/humrep/der092
        • Fridström M.
        • Akerlöf E.
        • Sjöblom P.
        • Hillensjö T.
        Serum levels of luteinizing and follicle-stimulating hormones in normal and poor-responding patients undergoing ovarian stimulation with urofollitropin after pituitary downregulation.
        Gynecol. Endocrinol. 1997; 11: 25-28https://doi.org/10.3109/09513599709152313
        • Gardner D.K.
        In-vitro culture of human blastocyst.
        Towar. Reprod. Certain. Infertil. Genet. beyond. 1999; (1999): 378-388
        • Gunnala V.
        • Irani M.
        • Melnick A.
        • Rosenwaks Z.
        • Spandorfer S.
        One thousand seventy-eight autologous IVF cycles in women 45 years and older: the largest single-center cohort to date.
        J. Assist. Reprod. Genet. 2018; 35: 435-440https://doi.org/10.1007/s10815-017-1088-y
        • Hamilton B.E.
        • Martin J.A.
        • Osterman M.J.K.
        • Driscoll A.K.
        • Births L.M.R.
        Provisional data for 2017.
        Hyattsv. Natl. Cent. Heal. Stat. 2018;
        • Magnus M.C.
        • Wilcox A.J.
        • Morken N.H.
        • Weinberg C.R.
        • Håberg S.E.
        Role of maternal age and pregnancy history in risk of miscarriage: prospective register based study.
        BMJ. 2019; 364: l869https://doi.org/10.1136/bmj.l869
        • Orvieto R.
        • Bar-Hava I.
        • Yoeli R.
        • Ashkenazi J.
        • Rabinerson D.
        • Bar J.
        • Fisch B.
        Results of in vitro fertilization cycles in women aged 43–45 years.
        Gynecol. Endocrinol. 2004; 18: 75-78
        • Raz N.
        • Shalev A.
        • Horowitz E.
        • Weissman A.
        • Mizrachi Y.
        • Ganer Herman H.
        • Raziel A.
        Cumulative pregnancy and live birth rates through assisted reproduction in women 44-45 years of age: is there any hope?.
        J. Assist. Reprod. Genet. 2018; 35: 441-447https://doi.org/10.1007/s10815-017-1094-0
      1. SART;https://www.sartcorsonline.com/rptCSR_PublicMultYear.aspx; accessed June 21, 2021

        • Serour G.
        • Mansour R.
        • Serour A.
        • Aboulghar M.
        • Amin Y.
        • Kamal O.
        • Al-Inany H.
        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: 1707-1712https://doi.org/10.1016/j.fertnstert.2009.09.044
        • Steiner A.Z.
        • Jukic A.M.
        Impact of female age and nulligravidity on fecundity in an older reproductive age cohort.
        Fertil. Steril. 2016; 105 (e1): 1584-1588https://doi.org/10.1016/j.fertnstert.2016.02.028
        • Sunderam S.
        • Kissin D.M.
        • Zhang Y.
        • Jewett A.
        • Boulet S.L.
        • Warner L.
        • Kroelinger C.D.
        • Barfield W.D.
        Assisted Reproductive Technology Surveillance - United States, 2017.
        MMWR Surveill. Summ. 2020; 69: 1-20https://doi.org/10.15585/mmwr.ss6909a1
        • Sunkara S.K.
        • Rittenberg V.
        • Raine-Fenning N.
        • Bhattacharya S.
        • Zamora J.
        • Coomarasamy A.
        Association between the number of eggs and live birth in IVF treatment: an analysis of 400 135 treatment cycles.
        Hum. Reprod. 2011; 26: 1768-1774https://doi.org/10.1093/humrep/der106
        • 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: 348-355https://doi.org/10.1016/s1472-6483(10)60878-4

      Biography

      Or Bercovich received his MD from Tel Aviv University, Israel. He did his internship year at Sheba Medical Center, Ramat Gan, and Tel Aviv Sourasky Medical Center, Israel.
      Key message
      Women over 43.5 years old who respond poorly to ovarian stimulation with fewer than four oocytes collected in their first IVF cycle should be offered ovum donation, since their live birth rate in subsequent cycles is negligible.