title: Intracytoplasmic sperm injection outcome of women over 39: an analysis of 668 cycles.
abstract: OBJECTIVE
  To evaluate intracytoplasmic sperm injection (ICSI) outcome of women over age 39 and to determine when to discourage such couples to undergo IVF using their own oocytes.
  
  
  METHODS
  Four hundred ninety-five consecutive women (n=668 cycles) over age 39 were evaluated by year-by-year age increments to discriminate the independent prognostic factors for the achievement of pregnancy.
  
  
  RESULTS
  Although the ovarian hyperstimulation performance (COH) and embryological data were not too diverse, the clinical pregnancy rates per embryo transfer decreased from 26 to 13% from age 40 to 44. According to logistic regression, the female age seems to be the only variable in order to predict an ongoing pregnancy. The miscarriage rate increased with advancing female age. It was 33% at age 40 but increased to 100% by age 45.
  
  
  CONCLUSIONS
  The performance of COH and embryological data is not discouraging among women over 39 years in ICSI cycles. However, increased miscarriages as well as decreased implantation rate are mainly responsible for the poor performance of patients with advanced female age. Irrespective of the ovarian reserve testing, ICSI may be refused at age 45 and thereafter.
authors.affiliation: Department of Obstetrics and Gynecology, School of Medicine, Hacettepe University, Ankara, Turkey. hyarali@hacettepe.edu.tr
authors.forename: Hakan
authors.initials: H
authors.lastname: Yarali
authors.forename: Gurkan
authors.initials: G
authors.lastname: Bozdag
authors.forename: Mehtap
authors.initials: M
authors.lastname: Polat
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Esinler
authors.forename: Bulent
authors.initials: B
authors.lastname: Tiras
mesh_terms: D000328:Adult; D010064:Embryo Implantation; D004624:Embryo Transfer; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007248:Infertility, Male / Q000628:therapy*; D008297:Male; D008423:Maternal Age; D015999:Multivariate Analysis; D011247:Pregnancy; D020554:Sperm Injections, Intracytoplasmic / Q000592:standards*