title: Ovulation induction in women age 40 and older: the importance of basal follicle-stimulating hormone level and chronological age.
abstract: OBJECTIVE
  To determine pregnancy and livebirth rates for women age 40 and older undergoing ovulation induction and to assess the impact of basal follicle-stimulating hormone (FSH) on outcome in these patients.
  
  
  METHODS
  Prospective, observational.
  
  
  METHODS
  Fertility service of university medical center.
  
  
  METHODS
  Infertile couples in whom the female partner was age 40 or older referred for ovulation induction therapy.
  
  
  METHODS
  Assessment of basal hormonal status; ovulation induction.
  
  
  METHODS
  Clinical pregnancy rate (PR), livebirth rate.
  
  
  RESULTS
  Analysis of 402 cycles in 85 women age 40 and older demonstrated a clinical PR of 3.5% per cycle (95% confidence interval [CI] 1.7% to 5.3%). The livebirth rate was 1.2% per cycle (95% CI 0.1% to 2.3%). Women with a basal FSH < 25 IU/L and age < 44 years had a clinical PR of 5.2% per cycle (95% CI 2.5% to 7.9%) compared with 0.0% per cycle (95% CI 0.0% to 2.1%) in cases in which either basal FSH was > or = 25 IU/L or age was > or = 44 (P < 0.005). The prognostic importance of basal FSH and chronological age was confirmed by multivariate logistic regression analysis. The predictive value of the resulting regression equation was high (R2 = 0.94; P < 0.01).
  
  
  CONCLUSIONS
  Pregnancy and livebirth rates are generally low during ovulation induction in women age 40 and older. In combination, basal FSH and chronological age are accurate predictors of PR, in these couples and can define a subset of patients with a more favorable prognosis. The spontaneous abortion rate in women who do conceive is high, substantially lowering the livebirth rate.
authors.affiliation: Department of Obstetrics and Gynecology, University of California, School of Medicine, Los Angeles 90024-1740.
authors.forename: A C
authors.initials: AC
authors.lastname: Pearlstone
authors.forename: N
authors.initials: N
authors.lastname: Fournet
authors.forename: J C
authors.initials: JC
authors.lastname: Gambone
authors.forename: S C
authors.initials: SC
authors.lastname: Pang
authors.forename: R P
authors.initials: RP
authors.lastname: Buyalos
mesh_terms: D000328:Adult; D000367:Age Factors; D001723:Birth Rate; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood*; D006801:Humans; D007247:Infertility, Female / Q000209:etiology / Q000628:therapy; D008423:Maternal Age; D015999:Multivariate Analysis; D010062:Ovulation Induction; D011247:Pregnancy / Q000706:statistics & numerical data*; D018566:Pregnancy, High-Risk; D011446:Prospective Studies
chemical_list: D005640:Follicle Stimulating Hormone