title: Redefining advanced maternal age as an indication for preimplantation genetic screening.
abstract: In this retrospective study, the utility of preimplantation genetic screening (PGS) in patients with advanced maternal age is evaluated. The patient population consisted of women aged 38-44years and included in a regular IVF programme with or without PGS analysis. Transfer rate, ongoing implantation rate and ongoing pregnancy rate were the main outcome parameters measured. A trend of better ongoing pregnancy rate per oocyte retrieval was observed in patients aged 38 and 39years in the non-PGS group when compared with PGS groups, but better ongoing pregnancy rate per oocyte retrieval was observed in patients 41-44years old in the PGS group. When patients with a low ovarian response accumulated oocytes in several stimulation cycles, clinical outcomes were comparable to those of normal-responder patients. These results show that, although PGS does not benefit patients less than 40years of age, reproductive success increases more than two-fold in patients over 40years, especially in patients with more than six metaphase II oocytes, as a result of a good ovarian response or gamete accumulation, suggesting a redefinition of advanced maternal age as indication for PGS. In this retrospective study, the utility of preimplantation genetic screening (PGS) in patients with advanced maternal age is evaluated. Patient population consisted of women aged 38-44 years and included in a regular IVF programme with or without PGS analysis. Transfer rate, ongoing implantation rate and ongoing pregnancy rate were the main outcome parameters measured. A trend of better ongoing pregnancy rate per ovarian stimulation cycle was observed in patients aged 38-39 years in the non-PGS group when compared with PGS groups, but better ongoing implantation rate was observed in patients aged 41-44 years old in the PGS group. When patients with a low ovarian response (low number of oocytes available for the IVF cycle) accumulated oocytes in several stimulation cycles, their reproductive possibilities were comparable to those of normal-responder patients. These results show that, although PGS does not benefit patients less than 40 years of age, reproductive success increases more than 2-fold in patients over 40 years, especially in patients with more than six metaphase II oocytes, as a result of a good ovarian response or gamete accumulation, suggesting a redefinition of advanced maternal age as indication for PGS.
authors.affiliation: Instituto Universitario-IVI, Plaza Policía Local, No. 3, 46015-Valencia, Spain. mmilan@ivi.es
authors.forename: Miguel
authors.initials: M
authors.lastname: Milán
authors.forename: Ana Cristina
authors.initials: AC
authors.lastname: Cobo
authors.forename: Lorena
authors.initials: L
authors.lastname: Rodrigo
authors.forename: Emilia
authors.initials: E
authors.lastname: Mateu
authors.forename: Amparo
authors.initials: A
authors.lastname: Mercader
authors.forename: Pilar
authors.initials: P
authors.lastname: Buendía
authors.forename: Vanessa
authors.initials: V
authors.lastname: Peinado
authors.forename: Arantzazu
authors.initials: A
authors.lastname: Delgado
authors.forename: Pere
authors.initials: P
authors.lastname: Mir
authors.forename: Carlos
authors.initials: C
authors.lastname: Simón
authors.forename: José
authors.initials: J
authors.lastname: Remohí
authors.forename: Antonio
authors.initials: A
authors.lastname: Pellicer
authors.forename: Carmen
authors.initials: C
authors.lastname: Rubio
mesh_terms: D000328:Adult; D010064:Embryo Implantation; D004624:Embryo Transfer; D005260:Female; D005307:Fertilization in Vitro; D005820:Genetic Testing; D006801:Humans; D008423:Maternal Age; D054315:Oocyte Retrieval; D011247:Pregnancy; D018873:Pregnancy Rate; D019836:Preimplantation Diagnosis; D012189:Retrospective Studies