Zdravniški Vestnik (Dec 2003)
OVARIAN AGING AND INFERTILITY TREATMENT
Abstract
Background. Due to changes in the socio-economic environment the first pregnancy is being more often postponed to advanced age; an increasing number of women seek medical help for infertility in their late thirties. Degenerative processes in the ovary start as early as after 35 years of age. When the woman is over 38, the signs of hormonal changes occur (FSH, inhibin), the menstrual cycle changes, and fertility is being increasingly reduced. Infertility treatment by assisted reproduction technology (ART) has proved less efficient in older than in younger women.Material and methods. In a retrospective analysis we evaluated the success rates achieved with homologous intrauterine insemination (IUI), in vitro fertilization and embryo-transfer (IVF-ET), intracytoplasmic sperm injection (ICSI), and compared them in regard to the women > 38 years vs. < 38 years.Results. After IUI the pregnancy rate in the women over 38 was 3.7% per patient (1.5% per cycle) and 28.0% (9.9%) in the women younger than 38 years. After IVF-ET the pregnancy rate in the over 38-year group was 16% per patient (14% per cycle), and 28% per patient (25% per cycle) in the less than 38-year group. After ICSI, the pregnancy rate in the group over 38 years was 11% per patient (9% per cycle), and 25% per patient (22% per cycle) in the less than 38-year group. In the analysed population, the spontaneous abortion rate was 26.0% in the group of women aged over 38 years, and 14.0% in the group of women aged less than 38 years.Conclusions. Before introduction of an ART procedure the woman with advanced age should be properly counselled and well informed about poor success of their infertility treatment and high spontaneous abortion rate.
