Pregnancy in the sixth decade of life: obstetric outcomes in women of advanced reproductive age.
BACKGROUND
As a result of oocyte donation, women in their sixth decade of life are now able to conceive and carry pregnancies to term. However, little is known about pregnancy outcomes in this population.


OBJECTIVE
To describe pregnancy outcomes in women aged 50 years or older who conceived after in vitro fertilization with donor oocytes.


METHODS
Retrospective analysis of cycles conducted at a US university assisted reproduction program during calendar years 1991-2001.


METHODS
Seventy-seven postmenopausal women with no chronic medical conditions (mean [SD] age, 52.8 [2.9] years; range, 50-63 years) who underwent 121 embryo transfer procedures (89 fresh and 32 frozen). Pregnancy outcomes were ascertained by chart review and telephone follow-up.


METHODS
Maternal and neonatal outcomes.


RESULTS
There were 55 clinical pregnancies for a total pregnancy rate of 45.5%. The live birth rate was 37.2%. Of the 45 live births, 31 were singletons, 12 were twins, and 2 were triplets, for which the mean (SD) gestational ages at delivery were 38.4 (2.1) weeks, 35.8 (2.8) weeks, and 32.2 weeks, respectively. Mean (SD) birth weights were 3039 g (703 g), 2254 g (581 g), and 1913 g, respectively. Apgar scores at 1 and 5 minutes were 8.2 (0.9) and 9.1 (0.5), respectively. Of singletons, 68% were delivered by cesarean, and all multiples were delivered by cesarean. Mild preeclampsia was noted in 25% of patients and severe preeclampsia in 10%. Gestational diabetes required diet modification in 17.5%, and 2.5% required insulin.


CONCLUSIONS
Appropriately screened women aged 50 years or older can successfully conceive via oocyte donation and experience similar pregnancy rates, multiple gestation rates, and spontaneous abortion rates as younger recipients. During pregnancy, they appear at increased risk of preeclampsia and gestational diabetes. A majority can expect to deliver via cesarean. However, there does not appear to be any definitive medical reason for excluding these women from attempting pregnancy on the basis of age alone.
Paulson
Richard J
RJ
Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Keck School of Medicine,University of Southern California, Women's and Children's Hospital, 1240 N Mission Rd, Los Angeles, 90033, USA. rpaulson@usc.edu
Boostanfar
Robert
R
Saadat
Peyman
P
Mor
Eliran
E
Tourgeman
David E
DE
Slater
Cristin C
CC
Francis
Mary M
MM
Jain
John K
JK
D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D007231:Infant, Newborn; D008875:Middle Aged; D018587:Oocyte Donation; D017698:Postmenopause; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies