IVF and pregnancy outcomes for women 45+

Researchers in a 2018 study report on IVF and pregnancy outcomes for women 45 to 48.

Fertility decreases with age which is believed to be due to increases in aneuploidy, with declines beginning around age 37. Despite this, many women in their 40s still wish to have a child.

Previous studies have found live birth rates of 1% and 0.6% for women >43 and have concluded that transfer of autologous embryos is futile (Serour et al. 2010, Tsafrir et al. 2007). Another study by Machado Fernandez et al. (2021) (reviewed here) examined women above 43, but included mostly those aged 43 and 44, with only 61 cycles from women 45 and above. In their study they found no live births for women aged 45, and only 1 live birth for women >45.

So overall, the IVF success rates for women who are 45 and above is lacking. Gunnala et al. (2018), reviewed here, wanted to expand on this and compared IVF and pregnancy outcomes for women 45 to 49 at a single IVF center between 1995 and 2015. Note that due to the very small sample size, the data for age 49 is not shown here.

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In terms of IVF outcomes, they found no differences in the number of eggs retrieved, the number mature, or the number of fertilized (2PN) eggs.

For pregnancy outcomes, they looked at “per transfer” and “per cycle” data. Women in the “per transfer” group actually had embryos to transfer, while the “per cycle” group didn’t necessarily have a transfer. In fact, there were a number of cycles that didn’t reach embryo transfer (for age 45: 32.8% of cycles didn’t have an ET; for age 46: 32.8%; for age 47: 45.1%; for age 48: 63.2%).

All the transfers reported were fresh day 3 embryo transfers and an average of 3.4 embryos were transferred.

For the “per transfer” analysis there were 626 transfers between 479 women (with 350 women aged 45, 100 women aged 46, 21 women aged 47, 7 women aged 48, and 1 woman aged 49), with an overall clinical pregnancy rate of 9.6% and live birth rate of 3.4%. They found no differences between the age groups and clinical pregnancies, live births, or pregnancy loss (including biochemicals and miscarriages). Keep in mind that although there appear to be differences below, due to the smaller sample sizes these weren’t statistically significant.

IVF pregnancy outcomes per transfer for women aged 45-47 — Note that age 48 is not included here because there were no clinical pregnancies

For the “per cycle” analysis there were 952 cycles between 658 women (with 469 women aged 45, 135 women aged 38 women aged 47, 13 women aged 48, and 3 women aged 49). In terms of pregnancy outcomes there were no differences between the age groups and clinical pregnancies, live births, or pregnancy loss (including biochemicals and miscarriages).

IVF pregnancy outcomes per cycle for women aged 45-47 — Note that age 48 is not included here because there were no clinical pregnancies

Finally, they compared women who had a positive beta-hCG to those who didn’t and found that on average women who did not get pregnant had 6.7 eggs retrieved (vs. 9.4 eggs in women with a positive pregnancy), 5.3 mature eggs (vs. 7.8), 3.6 fertilized eggs (vs. 5.7) and 3.2 embryos transferred (vs 4.3). No patients had a delivery with an AMH of less than 0.4 pg/mL or fewer than 4 oocytes retrieved.

For women >45, this study found an overall per transfer clinical pregnancy rate of 9.6% and live birth rate of 3.4%. In terms of individual ages, this study didn’t find a difference between women aged 45-49, although the smaller sample sizes for groups above 45 may have caused this. The live birth rate for women aged 45 was 4.4% (20 births per 456 transfers), while only 0.8% for women aged 46 (1 birth per 133 transfers), and there were no live births for women aged 47, 48 and 49 (based on 28, 7 and 2 cycles respectively).

This study is limited in that it compares transfers between 1995 and 2015, and the older data may not represent what we would see today with modern culturing techniques. The SART National Summary for 2019 (the most recent data accessed at this time) shows a cumulative live birth rate per egg retrieval of 4.3% for women >42 (9645 egg retrievals), however this includes blastocyst transfers and PGT-A which the current study does not.

Reference

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 Mar;35(3):435-440. doi: 10.1007/s10815-017-1088-y. Epub 2017 Nov 16. PMID: 29143944; PMCID: PMC5904061.

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About Embryoman

Embryoman (Sean Lauber) is a former embryologist and the founder of Remembryo, an IVF research and fertility education website. After working in an IVF lab in the US, he returned to Canada and now focuses on making fertility research more accessible. He holds a Master’s in Immunology and launched Remembryo in 2018 to help patients and professionals make sense of IVF research. Sean shares weekly study updates on Facebook, Instagram, and Reddit regularly. He also answers questions on Reddit or in his private Facebook group.

Reference

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