Intracytoplasmic sperm injection and advanced maternal age: Success or treatment failure?

Infertility rate documented in Pakistan is 21.9% with only 25% success rate even after procedures like intracytoplasmic sperm injection (ICSI). This rate is further on the decline with enhancement of female age. We aimed to observe the effect of female age on oocyte parameters and reproductive outcome after ICSI. It was done by retrospective analysis of a quasi- experimental design carried out after approval from "Ethical review board of Islamabad clinic serving infertile couples" from July 2010 to August 2011. The response to ovarian stimulation in (282) females was assessed on the basis of groups, A, B, C and D with age ranges up to 25years; 25.1 to 30years; 30.1 to 35years and >35years, respectively. The outcome was assessed as non-pregnant, preclinical abortion and clinical pregnancy groups on the basis of beta hCG and cardiac activity by trans-vaginal scan. We observed that maximum number of pregnancies 32 (38%) occurred in C group, and least 10 (10%) in group A. There was a statistical reduction in the number of mature and fertilized oocytes as the age advanced from group C to D (p<0.05).This shows that reduction in maturity and fertilization of oocytes with advancement of age recommends early referral of couples to assisted reproductive clinics.