Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, Yale Fertility Center 200 West Campus Drive Orange, Orange, CT, USA.
Reprod Biol Endocrinol. 2023 Oct 23;21(1):94. doi: 10.1186/s12958-023-01144-z.
To disaggregate the Society for Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS) age category of " > 42" and compare age-stratified cumulative live birth rates (CLBR) > 42 years old.
Retrospective cohort study of autologous linked ART cycles.
United States (US) National ART Database.
PATIENT(S): Women > 42 years old without a history of prior ART cycles who underwent ART between 2014-2020 as reported to the SART CORS database.
INTERVENTION(S): Disaggregate the SART CORS age category of " > 42" into age-stratified cumulative live birth rates (CLBR).
MAIN OUTCOME MEASURE(S): Age-stratified cumulative live birth rates (CLBR) for women ≥ 43 years old.
Between 2014-2020, 24,650 women > 42 years old without history of prior ART underwent 58,132 cycles, resulting in 1,982 live births. Women ages 43, 44, 45, 46, 47, 48, 49, ≥ 50 achieved maximal CLBR of 9.7%, 8.6%, 5.0%, 3.6%, 2.5%, 1.5%, 2.7%, 1.3%, respectively. CLBR for women between 43-45 were significantly higher compared to those 46 and older (p < 0.05). Among women 46 and older, CLBR were not significantly different. Women ages 43 and 44 did not exhibit a significant increase in CLBR beyond the 5th cycle. Age 45 and 46 reached CLBR plateau by the 3rd cycle. Age ≥ 47 CLBR plateaued after the first cycle. After adjusting for age, race/ethnicity, BMI, nulliparity, etiology of infertility, number of oocytes retrieved, embryos transferred, blastocyst transfer, use of ICSI, PGT, and ART treatment cycle number, there was no association between markers of ovarian reserve (day 3 FSH and random AMH levels) and live birth for women > 42.
While CLBR of autologous cycles from women 42 or younger generally plateau by cycle number 5, age-stratified cycles from women > 42 plateau after fewer cycles to maximize CLBR. Patient and physician expectations for maximum CLBR beyond 42 may be practically based on fewer planned cycles before reaching an age-specific CLBR plateau than may have been previously expected.
对辅助生殖技术协会临床结局报告系统（SART CORS）的年龄类别“>42”进行细分，并比较年龄分层的累积活产率（CLBR）>42 岁。
自体相关 ART 周期的回顾性队列研究。
美国（US）国家 ART 数据库。
无既往 ART 周期史且年龄>42 岁的女性，于 2014-2020 年期间在 SART CORS 数据库报告的接受 ART。
对 SART CORS 的“>42”年龄类别进行细分，按年龄分层的累积活产率（CLBR）。
≥43 岁女性的年龄分层累积活产率（CLBR）。
在 2014-2020 年间，24650 名年龄>42 岁且无既往 ART 周期史的女性接受了 58132 个周期的治疗，产生了 1982 例活产。年龄在 43、44、45、46、47、48、49、≥50 岁的女性获得的最大 CLBR 分别为 9.7%、8.6%、5.0%、3.6%、2.5%、1.5%、2.7%、1.3%。43-45 岁女性的 CLBR 显著高于 46 岁及以上的女性（p<0.05）。46 岁及以上女性的 CLBR 无显著差异。43 和 44 岁的女性在第 5 个周期后，CLBR 没有显著增加。45 和 46 岁的女性在第 3 个周期达到 CLBR 平台期。47 岁及以上的女性在第一个周期后 CLBR 平台期。调整年龄、种族/民族、BMI、不孕病因、获卵数、移植胚胎数、囊胚移植、ICSI 使用、PGT 和 ART 治疗周期数后，卵巢储备标志物（第 3 天 FSH 和随机 AMH 水平）与>42 岁女性的活产率之间无关联。
虽然 42 岁及以下女性自体周期的 CLBR 通常在第 5 个周期达到平台期，但>42 岁女性的年龄分层周期在达到最大 CLBR 之前需要较少的周期。患者和医生对 42 岁以上最大 CLBR 的期望可能基于在达到特定年龄的 CLBR 平台期之前需要比之前预期更少的计划周期来实现，而不是基于实际情况。
