title: Outcome of assisted reproductive technology in women aged 40 years and older.
abstract: BACKGROUND
  Human fertility has been declined all over the world. Advanced women's age is one of the most important factors in determining the success of reproduction and ageing has negative impact on ART outcome and advanced female age decreases the chance of live birth rates achieved using ART, especially after 40 years of age.
  
  
  OBJECTIVE
  To evaluate ART outcomes regarding to pregnancy, abortion, cycle cancellation and live birth rates in women 40 years and older.
  
  
  METHODS
  A retrospective study was performed on three hundred-thirteen women undergoing ART cycles in the Madar Hospital in Yazd. Women with age ≥ 40 years who indicated for ART enrolled the study regardless of the infertility type or etiology. In this study, we used data from IVF or ICSI cycles using fresh embryo transfer. Follow up was performed in regard to pregnancy, abortion, cycle cancellation and live birth rates.
  
  
  RESULTS
  The mean age of women was 41.87±1.97 years. Chemical pregnancy rate was 8.6% (27/313) per cycle. Clinical pregnancy rate was 3.8% (12/313) per cycle. Spontaneous abortion was observed in 63% (17/27) of patients with positive pregnancy test. The overall cancellation rate was 23.3% per oocytes retrieval. The overall live birth rate per cycle for all women who initiated an ART cycle at age ≥40 years was 3.2% (10/313) that eight of those women were under 42 years old.
  
  
  CONCLUSIONS
  Based on our results, we suggest that women with age 42 years and above should be advised to use other options, including oocyte donation or adoption.
authors.affiliation: Department of Obstetrics and Gynecology, Research and Clinical Center for Infertility, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
authors.forename: Abbas
authors.initials: A
authors.lastname: Aflatoonian
authors.affiliation: Department of Obstetrics and Gynecology, Research and Clinical Center for Infertility, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
authors.forename: Maryam
authors.initials: M
authors.lastname: Eftekhar
authors.affiliation: Department of Obstetrics and Gynecology, Zanjan University of Medical Sciences, Zanjan, Iran.
authors.forename: Farnaz
authors.initials: F
authors.lastname: Mohammadian
authors.affiliation: Department of Obstetrics and Gynecology, Research and Clinical Center for Infertility, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
authors.forename: Fariba
authors.initials: F
authors.lastname: Yousefnejad
keywords: Advanced age; Assisted reproductive technology; Live birth; Pregnancy rate