title: One last chance for pregnancy: a review of 2,705 in vitro fertilization cycles initiated in women age 40 years and above.
abstract: OBJECTIVE
  To describe live birth rates and predictors of success in 1-year age increments for women > or =40 years when initiating assisted reproductive technologies (ART).
  
  
  METHODS
  Retrospective database analysis.
  
  
  METHODS
  A large university-affiliated infertility center.
  
  
  METHODS
  One thousand two hundred sixty-three women undergoing 2,705 ART cycles at age 40 or above.
  
  
  METHODS
  Couples undergoing ART.
  
  
  METHODS
  Pregnancy and live birth rates per cycle start were determined based on 1-year increments in women aged > or =40. Predictors of success, including number of embryos transferred, number of fetal heartbeats, availability of embryos for cryopreservation, and cycle day 3 FSH levels, were analyzed.
  
  
  RESULTS
  The overall live birth rate per cycle start was 9.7%. Cumulative live birth rates in women ranged from 28.4% if starting ART at age 40 to 0 by age 46. The overall spontaneous abortion rate was 32.6% (range, 23.9%-66.7%). Higher pregnancy rates were predicted by the greater number of embryos available for transfer, by the availability of excess embryos for cryopreservation, and by the presence of two fetal heartbeats on ultrasound. The outcome of the first IVF cycle did not predict the outcome of subsequent cycles.
  
  
  CONCLUSIONS
  Assisted reproductive technology has a reasonable chance for success (>5%) up until the end of the forty-third year. Twins on initial ultrasound, large numbers of embryos available for transfer, and the presence of excess embryos for cryopreservation predict higher live birth rates.
authors.affiliation: Boston IVF, Waltham, Massachusetts, USA. sklipstein@karandeivf.com
authors.forename: Sigal
authors.initials: S
authors.lastname: Klipstein
authors.forename: Meredith
authors.initials: M
authors.lastname: Regan
authors.forename: David A
authors.initials: DA
authors.lastname: Ryley
authors.forename: Marlene B
authors.initials: MB
authors.lastname: Goldman
authors.forename: Michael M
authors.initials: MM
authors.lastname: Alper
authors.forename: Richard H
authors.initials: RH
authors.lastname: Reindollar
mesh_terms: D000328:Adult; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D050498:Live Birth / Q000453:epidemiology*; D016015:Logistic Models; D008423:Maternal Age; D008875:Middle Aged; D011247:Pregnancy; D018873:Pregnancy Rate; D012189:Retrospective Studies