title: Assisted reproduction counseling in women aged 40 and above: a cohort study.
abstract: OBJECTIVE
  Fertility treatment in women aged ≥40 year old remains difficult and controversial. All available studies in older women report results of one specific method of ART, i.e. IUI, IVF/ICSI or oocyte donation, and success rates are always published per attempt but never per patient. Randomized studies are not available because of the obvious heterogeneity in patient populations and treatment options. This prospective observational study aimed at analyzing the outcome in a consecutive cohort of patients above 40 undergoing various methods of ART.
  
  
  METHODS
  A total number of 909 women older than 40 attended our fertility centre during a 3 years period. A flowchart showing the consecutive ART treatments with their respective outcome was constructed. Any delivery after 22 weeks gestation (or 500 g.) was taken as primary endpoint. Crude cumulative delivery rates (CDRs) and binomial exact 95 % confidence limits (95 % CLs) were calculated for each group of interest.
  
  
  RESULTS
  ART treatment could be proposed to 737 patients (81 %) and eventually 585 patients (64 %) started ART treatment: 111 patients started IUI, 439 patients started IVF/ICSI and 35 patients started oocyte donation as a primary approach ART. Ten patients got pregnant spontaneously and delivered before starting any treatment. In the 909 patients consulting for infertility, 111 deliveries were achieved after ART, i.e. a crude CDR of 12.2 % (95 % CL 10.1 % to 14.5 %).
  
  
  CONCLUSIONS
  Only 10 % of patients aged 40 and above could achieve delivery of their genetically-own child, while 1 % conceived spontaneously. More than one third of patients consulting never started any treatment for different reasons, i.e. anticipated poor prognosis, financial restrictions, illness or spontaneous pregnancy.
authors: Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium, mdebruck@vub.ac.be.
authors: Michaël
authors: M
authors: De Brucker
authors: Herman
authors: H
authors: Tournaye
authors: Patrick
authors: P
authors: Haentjens
authors: Greta
authors: G
authors: Verheyen
authors: John
authors: J
authors: Collins
authors: Michel
authors: M
authors: Camus
mesh_terms: D000328:Adult; D003376:Counseling; D005260:Female; D006801:Humans; D007246:Infertility / Q000523:psychology / Q000628:therapy*; D018587:Oocyte Donation; D011247:Pregnancy; D011256:Pregnancy Outcome; D011446:Prospective Studies; D027724:Reproductive Techniques, Assisted / Q000523:psychology*
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