Very advanced maternal age - chance of pregnancy after ICSI

Background:Postponing procreation becomes an increasing problem in developed countries. Maternal aging contributes to intensive development of assisted reproduction techniques (ART). The aim of the study was to analyze the results of in vitro fertilization in women of very advanced maternal age (AMA, ≥42Y) using autologous oocytes (AO) or donor oocytes (DO) compared to women ≤35Y.Material and methods:This was a retrospective study of AMA women who underwent intracytoplasmic sperm injection (ICSI) using AO or DO. The control group consisted of young patients with age ≤35Y.Results:In group of AMA patients, the AMH level was significantly lower (0.56 ng/ml) than in young patients (3.6 ng/ml), which corresponded to obtaining a significantly lower number of oocytes (1.6±0.4 vs 12±4 oocytes/cycle), (p < 0.001). In older patients with AO only 0.4±0.1 blastocysts/cycle were obtained compared to 1.9±0.7 when DO were used and 3.8±1.1 from young women. Euploidy rate of blastocysts obtained after fertilization of AO of AMA patients was 26% in compare to 57% in a group of young women and 54% in the group of older patients with DO. The implantation rate was significantly lower in the group of older patients with AO (28%) compared to the other groups (50%, 59%), (p < 0.001).Conclusions:AMA patients must be aware that IVF procedure does not guarantee pregnancy and the birth of a healthy child and they should be offered pre-implantation PGT-A diagnostics due to the high risk of chromosomal defects. These patients should also be informed about the much higher effectiveness of IVF using DO.