title: Minimal ovarian stimulation combined with elective single embryo transfer policy: age-specific results of a large, single-centre, Japanese cohort.
abstract: BACKGROUND
  The two main complications associated with the use of assisted reproduction techniques, ovarian hyperstimulation syndrome and multiple pregnancies, could be eliminated by milder ovarian stimulation protocols and the increased use of a single embryo transfer (SET) policy. A retrospective, cohort study was performed in private infertility centre to evaluate the embryological and clinical results of a large exclusively SET program according to patient age (lower or equal 29, 30-34, 35-39, 40-44 and equal or higher 45 years).
  
  
  METHODS
  A total of 7,244 infertile patients have undergone 20,244 cycles with a clomiphene-based minimal stimulation or natural cycle IVF protocol during 2008. Following oocyte retrieval, fertilization and embryo culture a total of 10,401 fresh or frozen single embryo transfer procedures were performed involving cleavage-stage embryos or blastocysts.
  
  
  RESULTS
  Successful oocyte retrieval rate (78.0 %) showed no age-dependent decrease until 45 years. Fertilization (80.3 %) and cleavage (91.1 %) rates were not significantly different between age groups. Blastocyst formation (70.1 % to 22.8 %) and overall live birth rates (35.9 % to 2 %) showed an age-dependent decrease. Frozen-thawed blastocyst transfer cycles gave the highest chance of live birth per embryo transfer (41.3 % to 6.1 %).
  
  
  CONCLUSIONS
  High fertilization and cleavage rates were obtained regardless of age whereas blastocyst formation and live birth rates showed an age-dependent decrease. An elective single embryo transfer program based on a minimal ovarian stimulation protocol yields acceptable live birth rates per embryo transfer in infertile patients up until their mid-forties. However in very advanced age patients (equal or higher 45 years old) success rates fall below 1 %.
authors.affiliation: Kato Ladies Clinic, 7-20-3, Nishishinjuku, Shinjuku, Tokyo, 160-0023, Japan. k-kato@towako.net
authors.forename: Keiichi
authors.initials: K
authors.lastname: Kato
authors.forename: Yuji
authors.initials: Y
authors.lastname: Takehara
authors.forename: Tomoya
authors.initials: T
authors.lastname: Segawa
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kawachiya
authors.forename: Takashi
authors.initials: T
authors.lastname: Okuno
authors.forename: Tamotsu
authors.initials: T
authors.lastname: Kobayashi
authors.forename: Daniel
authors.initials: D
authors.lastname: Bodri
authors.forename: Osamu
authors.initials: O
authors.lastname: Kato
mesh_terms: D000328:Adult; D000367:Age Factors; D002996:Clomiphene / Q000627:therapeutic use; D015331:Cohort Studies; D015925:Cryopreservation; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods; D006801:Humans; D050498:Live Birth; D008875:Middle Aged; D010062:Ovulation Induction / Q000379:methods*; D011247:Pregnancy; D018873:Pregnancy Rate; D012189:Retrospective Studies; D056826:Single Embryo Transfer
chemical_list: D002996:Clomiphene