Female age in ART: when to stop?

Area of Science:

• Reproductive Medicine
• Infertility Treatment
• Geriatric Gynecology

Background:

• Assisted reproduction technology (ART) success rates significantly decrease with advancing maternal age.
• The increasing costs per live birth in ART necessitate a discussion on age-related treatment limits.
• Current ART eligibility often relies solely on female age, potentially excluding suitable candidates.

Purpose of the Study:

• To evaluate the age-related efficacy and cost-effectiveness of ART treatments.
• To explore the potential for establishing age limits in ART applications.
• To identify predictive factors that could refine patient selection for ART.

Main Methods:

• Literature review of existing ART success rates and cost-benefit analyses.
• Analysis of ongoing research data on pregnancy outcomes across different age groups.
• Investigation of predictive markers for ART success, such as antral follicle count.

Main Results:

• ART costs per child born increase substantially after age 40 for both intrauterine insemination and in vitro fertilization.
• Pregnancy prognosis approaches zero for women aged 44 and above.
• Antral follicle count can identify women over 40 with favorable ART prospects.

Conclusions:

• Age limits for ART should be considered, balancing treatment costs and success probabilities.
• Predictive factors like antral follicle count can personalize ART eligibility, potentially reducing costs and improving access for selected older women.
• Individualized assessment using predictive markers may offer a more equitable approach than strict age-based exclusions in ART.