Outcome of Assisted Reproductive Technology in Women over the Age of 44: Does Changing Our Policy was Justified?

Introduction: In Israel, In vitro fertilization treatments are permitted until age 45 yrs. Based on our published data, our policy was to set the upper age limit at the age of 44 yrs. We recently changed our policy and treated patients until their 45th birthday.
Aim: To evaluate the outcome of IVF treatment in women at ages 44-45.

Methods & Materials: A retrospective analysis of 8 cycles in women aged 44-45 years old who attended our unit from March 2017 to January 2018. Only cases with homologous oocytes were included. We treated patients with regular menstruation and a cycle day 3 FSH level of ≤15 IU/L. Five patients had controlled ovarian stimulation with recombinant FSH or menotropins followed by gonadotropin-releasing hormone (GnRH) antagonist. In one patient, a long protocol ovarian stimulation with GnRH agonist followed by menotropins was administered, and one patient had an in vitro maturation cycle. We recorded the infertility history as well as the demographic cycle characteristics.

Result: After our change in age limit policy, 7 patients aged 44-45 (44.1-44.11) had 8 IVF cycle. The mean day 3 FSH level was 9.7 (5.7-14.5), the mean dosage of gonadotropin was 3197±1899 units. All patients reached the oocyte retrieval stage, the mean number of oocytes aspirated per patient was 7.6±3.4 and fertilization rate (%) was 66±36. One cycle ended without embryo to transfer, the mean number of embryos transferred was 2.1±1.3. Out of 7 cycles with embryo transfer we had just one ongoing pregnancy (pregnancy rate 12.5%).

Conclusions: Futile treatment defined as treatment with live birth rate less than 1%. Although we report a small cycle number, we reckon that our changed age limit policy is justified.