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Effect of age and cycle responsiveness in patients undergoing intracytoplasmic sperm injection
1Department of Obstetrics and Gynecology, Michigan State University, College of Medicine, USA.
Objective:
To evaluate the effects of age and number of embryos available for transfer on pregnancy rate (PR) in couples undergoing intracytoplasmic sperm injection (ICSI).
Design:
Retrospective study of patients undergoing ICSI for male factor infertility.
Setting:
Tertiary care academic center.
Patient(S):
One hundred twelve patients < 37 years of age and 57 patients > or = 37 years of age who underwent ICSI with uterine ET or tubal ET.
Intervention:
Compare cycles in which three embryos or fewer were available for transfer with those with four or more available embryos.
Main Outcome Measure(S):
Implantation, embryo availability, and pregnancy and miscarriage rates.
Result(S):
Younger patients did significantly better with regard to PR (47% versus 26%), implantation rate (11.4% versus 6.6%), and ongoing PR (40% versus 19%). Patients in whom more than four embryos were transferred also did better than patients in whom three or fewer embryos were available for transfer, with an implantation rate of 14.2% versus 4.2%. In women < 37 years of age, 85% of cycles produced more than three embryos, versus 61% in women > or = 37 years of age. When cycles yielding three embryos or fewer were excluded, the younger group tended to do better, with an ongoing PR of 48% versus 33% for the older group, but the differences were not statistically significant. Both groups had similar number of embryos transferred per cycle.
Conclusion(S):
Age affects cycle responsiveness, and the number of embryos available for transfer affects fertility in patients undergoing ICSI. Older women with good ovarian response, producing more than three embryos suitable for transfer, have a PR similar to younger patients. Cycles yielding three embryos or fewer have a poor prognosis.