Live Birth Rate For Advanced Aged ART Patients, Do The Bologna Criteria Assist In Predicting The Treatment Outcome ?

Introduction:

Growing portions of ART patients are women in their late 30s and older. Many of them present with poor ovarian response (POR). Unveiling the success rate of advanced age patients who have additional features of POR may assist them in making informed decisions.

Aim:

To determine live birth rate (LBR) for advanced aged ART patients and the prognostic impact of the Bologna criteria for POR.

Material & Methods:

This retrospective cohort study included 254 patients older than 38 at ovum pickup undergoing 696 autologous fresh and frozen thawed ART cycles between 2010 and 2016. POR was established according to the Bologna criteria when 2 of the following were present: 1. Advanced age (>40 years), endometriosis, or previous chemotherapy. 2. A previous POR cycle (≤3 oocytes retrieved). 3. Abnormal ovarian reserve test: (FSH > 12). Fifty-eight patients fulfilled these criteria

Results:

Overall, 36 women had a live birth (14.1%). They were younger (40.5 vs 41.4, p=0.004), had more oocytes aspirated (5.9 vs 4.3, p=0.005), more embryos transferred (2.1 vs 1.5 p=0.002) and frozen (1 vs 0.4, p=0.03) than patients who didn`t succeed. POR patients had lower maximal estradiol levels (738 vs 1220pg/ml, p<0.0001), fewer oocytes aspirated (2.3 vs 5.1, p<0.0001), embryos transferred (1.2 vs 1.8, p=0.007) and cryopreserved (0.007 vs 0.7, p=0.014). 6.9% of POR patients delivered as compared to 16.3% non-POR patients (p=0.07).

Conclusions:

Women of advanced maternal age have a poor reproductive outcome. The Bologna criteria are of limited value for this population. Further studies with larger cohort are required to reinforce our conclusions.