[Assisted reproductive techniques in women aged 38 years or more].
OBJECTIVE
More and more young women are delaying childbearing until the fourth decade of life: thus, Assisted Reproductive Techniques centres receive more and more requests from ageing women. The aim of the study is to analyse the purpose of these requests, the biological and clinical features of these patients and the results in our infertility centre.


METHODS
A retrospective study was carried out at the CHU of Saint-Etienne from 01.01.01 to 31.12.04. We analysed the social, clinical and biological features of 84 couples when the woman's age was equal or superior to 38 years, representing 218 cycles. A questionnaire was used to collect social data.


RESULTS
Several factors can explain the increasing number of ageing women consulting for infertility: extend university time and professional career, professional stability, contraception and late meeting of the partner, false reassuring information concerning progress in ART, second child desire after a late first pregnancy, but also second marital unions and child desire in the redefined couple. In our study, above 40 years old, the pregnancy (19.4 versus 10.5%) and delivery rates (16.7 versus 5.8%) clearly decreased in IUI. Thus, most of the clinicians propose, in first choice, an IVF cycle to a 40 year-old woman. The ultrasound measurement of antral follicle count can accurately evaluate the prognosis in terms of pregnancy (P<0.01) and delivery rate (P=0.03). For patients with unfavourable prognosis, oocyte donation, embryo donation, or adoption can be considered.


CONCLUSIONS
ART cannot compensate for the natural decrease in pregnancy rates and the increase in early miscarriages in ageing women. Therefore, it is essential to inform young women of the negative effects of age on their potential fertility.
Lamarche
C
C
Laboratoire de biologie de la reproduction, CHU de Saint-Etienne, Hôpital Nord, Saint-Etienne, France.
Lévy
R
R
Felloni
B
B
de Mouzon
J
J
Denis-Belicard
E
E
Huss
M
M
Maubon
I
I
Aknin
I
I
Seffert
P
P
D000022:Abortion, Spontaneous / Q000453:epidemiology; D000328:Adult; D000367:Age Factors; D000375:Aging / Q000502:physiology*; D005260:Female; D006801:Humans; D007247:Infertility, Female / Q000628:therapy*; D008423:Maternal Age; D008875:Middle Aged; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology; D018873:Pregnancy Rate; D018566:Pregnancy, High-Risk; D027724:Reproductive Techniques, Assisted; D012189:Retrospective Studies