title: Embryo apoptosis may be a significant contributing factor in addition to aneuploidy inhibiting live deliveries once a woman reaches age 45.
abstract: OBJECTIVE
  To determine the relative role of aneuploidy vs embryo apoptosis as the etiologic factor of poor pregnancy rates with advancing age.
  
  
  METHODS
  A retrospective review of chemical vs clinical vs live delivery pregnancy rates in women aged 40-42, 43-45, and > or = 45 years is reported. The data were further stratified according to oocyte reserve based on day 3 serum follicle-stimulating hormone (FSH) < or = 11 mIU/ml vs >12 mIU/ml.
  
  
  RESULTS
  For women aged 40-42 years there were no differences in live delivery pregnancy rates in women with normal vs decreased egg reserve (DOR). There were no differences in live delivery pregnancy rates in women aged 40-42 years vs 43-44 years with normal oocyte reserve; however despite no differences in clinical pregnancy rates in women aged 43-44 years with normal vs DOR, the live delivery pregnancy rates were markedly lower in the group with DOR. In contrast, there were very low chemical pregnancy rates in women aged > or = 45 years.
  
  
  CONCLUSIONS
  As seen in younger women, there does not appear to be any increased risk of meiosis errors in women aged 40-42 years with DOR compared to women of the same age with normal reserve. Low pregnancy rates in women aged 43-44 years with DOR is related to meiosis errors. In contrast the very low chemical pregnancy rates found in women aged > or = 45 years despite embryo transfer (ET) suggest embryo apoptosis is mostly responsible for poor pregnancy rates in this very advanced reproductive age group.
authors.affiliation: Cooper Medical School of Rowan University, Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology & Infertility, Camden, New Jersey, USA. laurie@ccivf.com
authors.forename: J H
authors.initials: JH
authors.lastname: Check
authors.forename: S
authors.initials: S
authors.lastname: Burgos
authors.forename: B
authors.initials: B
authors.lastname: Slovis
authors.forename: C
authors.initials: C
authors.lastname: Wilson
mesh_terms: D000328:Adult; D000367:Age Factors; D000375:Aging / Q000502:physiology*; D000782:Aneuploidy; D017209:Apoptosis; D004622:Embryo, Mammalian / Q000502:physiology*; D005260:Female; D006801:Humans; D007247:Infertility, Female / Q000503:physiopathology*; D008875:Middle Aged; D011247:Pregnancy; D018873:Pregnancy Rate; D012189:Retrospective Studies