Achieving multiple-order embryo transfer identifies women over 40 years of age with improved in vitro fertilization outcome

Objective: To define factors in patients greater than or equal to 40 years that may improve outcome and provide prognosis for success in IVF-ET. Design: Retrospective. Setting: University infertility center. Patients: Patients (n = 501) undergoing IVF-ET from 1987 to 1994. Interventions: IVF-ET (n = 713 cycles) with GnRH-analogue suppression and hMG stimulation. Main Outcome Measures: We evaluated data including age, diagnosis, prestimulation (day 3) FSH and E(2), hMG ampules used, days of monitoring, follicle number and size, maximum E(2), ova retrieved, cancellation rate, clinical pregnancy, nidation, and miscarriage rates. Results: Overall, patients greater than or equal to 40 years had significantly decreased pregnancy rates (PRs), response to stimulation, and increased miscarriage rates. However, if these patients had four or more embryos transferred, their response and PRs (34.4% per ET) were not significantly different from younger women (47.7% per ET). The majority (77.8%) of pregnancies in women greater than or equal to 40 years occurred when four or more embryos were transferred. Conclusion: A subset (49%) of women greater than or equal to 40 years undergoing IVF-ET will respond to ovarian stimulation well enough to result in four or more embryos available for transfer with a resultant PR similar to that observed in younger patients. We recommend consideration of an attempt at IVF-ET before recommending oocyte donation.