title: Embryo quality and developmental potential is compromised by age.
abstract: OBJECTIVE
  The aim of this retrospective study was to assess whether and how the age of the woman affects the quality and developmental potential of the oocytes and embryos in an ART program.
  
  
  METHODS
  A total of 878 IVF cycles was included as a consecutive series of single transfers (n=292), dual transfers (n=366) and triple transfers (n=220), where all the transferred embryos in each cycle were of identical quality score and identical cleavage stage.
  
  
  RESULTS
  We found a highly significant decrease in oocyte recovery with increasing age with about one oocyte per 2.3 years (95% CI 1.8 years to 3.1 years, p<0.0001). Further, we found that the number of oocytes that cleaved declined significantly with increasing age with one per 3.7 years (95% CI 2.7 years to 5.5 years, p<0.0001). This decline was mainly due to the decline in number of oocytes retrieved as the ratio of aspirated oocytes that cleaved with increasing age (approx. -0.04/10 year 95% CI: -0.10; +0.009) was not significantly different (p=0.10). The percentage of transfers using fragmented embryos did not increase significantly with increasing age (p=0.08). The odds of fragmentation increased by 3% per year. The average number of embryos transferred decreased significantly (p=0.03) with age from approximately 2.1 at the age of 25 to approximately 1.8 at the age of 40. In a selected subgroup of embryos all consisting of good quality embryos, a significant decrease was found in implantation rate with increasing age (approx. -0.08/10 years, 95% CI: -1.6; +0.00, p=0.05). Of the 357 pregnancies achieved in this study we found a significantly decreased ongoing pregnancy rate and a significantly increased abortion rate with increasing age (p=0.03). The decrease in the rate of ongoing pregnancies was almost linear, decreasing by approximately 1.5% per year.
  
  
  CONCLUSIONS
  We conclude that age has an impact throughout a woman's reproductive life and that it is important to realize that the age-related decline in fertility may start already in the late twenties and not in the mid-thirties as is generally assumed.
authors.affiliation: The Fertility Clinic, The Juliane Marie Center, Rigshospitalet, University of Copenhagen, Denmark.
authors.forename: S
authors.initials: S
authors.lastname: Ziebe
authors.forename: A
authors.initials: A
authors.lastname: Loft
authors.forename: J H
authors.initials: JH
authors.lastname: Petersen
authors.forename: A G
authors.initials: AG
authors.lastname: Andersen
authors.forename: S
authors.initials: S
authors.lastname: Lindenberg
authors.forename: K
authors.initials: K
authors.lastname: Petersen
authors.forename: A N
authors.initials: AN
authors.lastname: Andersen
mesh_terms: D000328:Adult; D002970:Cleavage Stage, Ovum / Q000502:physiology; D010064:Embryo Implantation / Q000502:physiology; D004624:Embryo Transfer; D004622:Embryo, Mammalian / Q000502:physiology*; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D008423:Maternal Age; D008875:Middle Aged; D009865:Oocytes / Q000254:growth & development*; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies