Abstract
Purpose: The purpose was to determine the effect of basaluterine perfusion on the pregnancy rates of in vitro fertilizationand embryo transfer (IVF-ET) in women aged 40 and above.
Methods: A total of 47 patient aged 40 and over underwentIVF-ET. The conception cycles and the nonconception cycleswere compared.
Results: Of the 47 patients, 4 patients were pregnant (8.5%).The mean age, basal follicle stimulating hormone (FSH),basal estradiol (E2) level, antral follicle count (AFC), numberof ampoules of gonadotropin used, E2 levels and endometrial thickness on the day of human chorionic gonadotropin(hCG) administration, number of retrieved and fertilizedoocytes, and number of transferred embryos were not statisticallysignificant between the conception and nonconceptioncycles. However, the basal uterine artery pulsatility index(UA PI) was significantly lower in the conception cycles(P < 0.001). The receiver operating characteristics (ROC)curve analysis for basal FSH, AFC, and basal UA PI inpredicting the pregnancy rate of IVF in patients aged ≥ 40were demonstrated. The best prediction rate was achievedby a pulsatility index cutoff of < 2.0 for a receptive uterus.
Conclusions: Increased uterine perfusion in the early follicularphase enhanced the pregnancy rate of IVF in womenaged 40 and above. It is therefore essential that patientsaged ≥ 40 with poor basal uterine perfusion should beidentified early in the early follicular phase of the menstrualcycle to apply appropriate intervention to improve the uterinecirculation for the subsequent chance of pregnancy.
Keywords: Basal uterine perfusion; color Doppler ultrasound; IVF-ET, pregnancy rate; women aged 40 and above
Full Text
The Full Text of this article is available as a PDF (58.7 KB).
REFERENCES
- 1.Reuss ML, Kline J, Santos R, Levin B, Timor-Tritsh I. Age and the ovarian follicle pool assessed with transvaginal ultra sounography. Am J Obstet Gynecol. 1996;174:624–627. doi: 10.1016/s0002-9378(96)70439-8. [DOI] [PubMed] [Google Scholar]
- 2.Bongain A, Castillon JM, Isnard V, Benoit B, Donzeau M, Gillet JY. In vitro fertilization in women over 40 years of age. A study on retrospective data for eight years. Eur J Obstet Gynecol Reprod Biol. 1998;76:225–231. doi: 10.1016/s0301-2115(97)00210-8. [DOI] [PubMed] [Google Scholar]
- 3.Lass A, Croucher C, Duffy S, Dawson K, Margara R, Winston RM. One thousand initiated cycles of in vitro fertilization in women > or = 40 years of age. Fertil Steril. 1998;70:1030–1034. doi: 10.1016/s0015-0282(98)00353-7. [DOI] [PubMed] [Google Scholar]
- 4.Dew JE, Don RA, Hughes GJ, Johnson TC, Steigrad SJ. The influence of advanced age on the outcome of assisted reproduction. J Assist Reprod Genet. 1998;15:210–214. doi: 10.1023/A:1023004503697. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Romeu A, Muasher SJ, Acosta AA, Veeck LL, Diaz J, Jones GS, Jones HW, Jr, Rosenwaks Z. Results of in vitro fertilization attempts in women 40 years of age and older: The Norfolk experience. Fertil Steril. 1987;47:130–136. doi: 10.1016/s0015-0282(16)49948-6. [DOI] [PubMed] [Google Scholar]
- 6.Toner JP, Flood JT. Fertility after the age of 40. Obstet Gynecol Clin North Am. 1993;20:261–272. [PubMed] [Google Scholar]
- 7.Faddy MJ, Gosden RG, Gougeon A, Richardson SJ, Nelson JF. Accelerated disappearance of ovarian follicles in mid-life: Implications for forecasting menopause. Hum Reprod. 1992;7:1342–1346. doi: 10.1093/oxfordjournals.humrep.a137570. [DOI] [PubMed] [Google Scholar]
- 8.Volarcik K, Sheean L, Goldfarb J, Woods L, Abdul-Karim FW, Hunt P. The meiotic competence of in-vitro matured human oocytes is influenced by donor age: evidence that folliculogenesis is compromised in the reproductively aged ovary. Hum Reprod. 1998;13:154–160. doi: 10.1093/humrep/13.1.154. [DOI] [PubMed] [Google Scholar]
- 9.Lim AS, Tsakok MF. Age-related decline in fertility: A link to degenerative oocytes? Fertil Steril. 1997;68:265–271. doi: 10.1016/s0015-0282(97)81513-0. [DOI] [PubMed] [Google Scholar]
- 10.Goswamy RK, Williams G, Steptoe PC. Decreased uterine perfusion-A cause of infertility. Hum Reprod. 1988;3:955–959. doi: 10.1093/oxfordjournals.humrep.a136825. [DOI] [PubMed] [Google Scholar]
- 11.Wada I, Hsu CC, Williams G, Macnamee MC, Brinsden PR. The benefits of low-dose aspirin therapy in women with impaired uterine perfusion during assisted conception. Hum Reprod. 1994;9:1954–1957. doi: 10.1093/oxfordjournals.humrep.a138366. [DOI] [PubMed] [Google Scholar]
- 12.Steer CV, Campbell S, Tan SL, Crayford T, Mills C, Mason BA, Collins WP. The use of transvaginal color flow imaging after in vitro fertilization to identify optimum uterine conditions before embryo transfer. Fertil Steril. 1992;57:372–376. doi: 10.1016/s0015-0282(16)54848-1. [DOI] [PubMed] [Google Scholar]
- 13.Cacciatore B, Simberg N, Fusaro P, Tiitinen A. Transvaginal Doppler study of uterine artery blood flow in in vitro fertilization-embryo transfer cycles. Fertil Steril. 1996;66:130–134. doi: 10.1016/s0015-0282(16)58400-3. [DOI] [PubMed] [Google Scholar]
- 14.Scott RT, Toner JP, Muasher SJ, Oehninger S, Robinson S, Rosenwaks Z. Follicle-stimulating hormone levels on cycle day 3 are predictive of in vitro fertilization outcome. Fertil Steril. 1989;51:651–654. doi: 10.1016/s0015-0282(16)60615-5. [DOI] [PubMed] [Google Scholar]
- 15.Toner JP, Philput CB, Jones GS, Muasher SJ. Basal folliclestimulating hormone level is a better predictor of in vitro fertilization performance than age. Fertil Steril. 1991;55:784–791. doi: 10.1016/s0015-0282(16)54249-6. [DOI] [PubMed] [Google Scholar]
- 16.Chang MY, Chiang CH, Hsieh TT, Soong YK, Hsu KH. Use of the antral follicle count to predict the outcome of assisted reproductive technologies. Fert Steril. 1998;69:505–510. doi: 10.1016/s0015-0282(97)00557-8. [DOI] [PubMed] [Google Scholar]
- 17.Marcus SF, Brinsden PR. In-vitro fertilization and embryo transfer in women aged 40 years and over. Hum Reprod Update. 1996;2:459–468. doi: 10.1093/humupd/2.6.459. [DOI] [PubMed] [Google Scholar]
- 18.Coulam CB, Bustillo M, Soenksen DM, Britten S. Ultrasono-graphic predictors of implantation after assisted reproduction. Fertil Steril. 1994;62:1004–1010. doi: 10.1016/s0015-0282(16)57065-4. [DOI] [PubMed] [Google Scholar]
- 19.Rubinstein M, Marazzi A, Polak de Fried E. Low-dose aspirin treatment improves ovarian responsiveness, uterine and ovarian blood flow velocity, implantation, and pregnancy rates in patients undergoing in vitro fertilization: A prospective, randomized, double-blind placebo-controlled assay. Fertil Steril. 1999;71:825–829. doi: 10.1016/s0015-0282(99)00088-6. [DOI] [PubMed] [Google Scholar]
- 20.de Ziegler D, Bessis R, Frydman R. Vascular resistance of uterine arteries: Physiological effects of estradiol and progesterone. Fertil Steril. 1991;55:775–779. [PubMed] [Google Scholar]
- 21.Hillard TC, Bourne TH, Whitehead MI, Crayford TB, Collins WP, Campbell S. Differential effects of transdermal estradiol and sequential progestogens on impedance to flow within the uterine arteries of postmenopausal women. Fertil Steril. 1992;58:959–963. doi: 10.1016/s0015-0282(16)55442-9. [DOI] [PubMed] [Google Scholar]
- 22.Dickey RP, Hower JF. Relationship of estradiol and progesterone levels to uterine blood flow during early pregnancy. Early Pregnancy. 1996;2:113–120. [PubMed] [Google Scholar]
- 23.Guanes PP, Remohi J, Gallardo E, Valbuena D, Simon Pellicer A. Age does not affect uterine resistance to vascular flow in patients undergoing oocyte donation. Fertil Steril. 1996;66:265–270. doi: 10.1016/s0015-0282(16)58451-9. [DOI] [PubMed] [Google Scholar]
- 24.Kurjak A, Kupesic S. Ovarian senescence and its significance on uterine and ovarian perfusion. Fertil Steril. 1995;64:532–537. doi: 10.1016/s0015-0282(16)57788-7. [DOI] [PubMed] [Google Scholar]
- 25.Chang MY, Chiang CH, Chiu TH, Hsieh TT, Soong YK. The antral follicle count predicts the outcome of pregnancy in a controlled ovarian hyperstimulation/intrauterine insemination program. J Assist Reprod Genet. 1998;15:12–17. doi: 10.1023/A:1022518103368. [DOI] [PMC free article] [PubMed] [Google Scholar]