Table 2.
Medical complications of advanced maternal age
| Author, year | Methods | Number of subjects | Number of clinical pregnancies | Maternal characteristics | Conclusions |
|---|---|---|---|---|---|
| Donor oocyte studies | |||||
| Sauer et al,25 1992 | Prospective study of 100 patients using oocyte donation for infertility. | 100 | 34 | Women 40+ requesting oocyte donation. | Success rates are similar to younger counterparts with assisted reproductive technologies (ARTs). |
| Antinori et al,26 1993 | Oocyte donation by in vitro fertilization (IVF) and embryo transfer in 82 women. | 82 | 32 | Average age 48 (26–60 range). 71 were over 40. Normal prenatal serology.* |
Uterus of a post-menopausal woman has the great ability to maintain a pregnancy. |
| Sauer et al,19 1993 | Oocyte donation by embryo transfer. All gametes anonymously donated. |
14 | 9 | 50+ (range 50–59). Normal prenatal serology.* |
Women beyond natural menopause may still achieve uterine receptivity. Uterus able to maintain a pregnancy with correct hormonal support. |
| Antinori et al,22 1995 | Oocyte donation program. | 162 | 44 | 113/162 were >45 years old. 49 were <45 years old. 75% reached term. |
Women in menopause, if selected carefully, are able to bring pregnancy to term with the same success as their younger counterparts. |
| Sauer et al,27 1995 | Oocyte donation case study. | 1 | 3 | G3P3. Menopause diagnosis at age 50 taking HRT. No hypertension. No diabetes mellitus. |
The overall health of the mother remained stable throughout the pregnancy. Her chronological age did not appear to alter the pregnancy course or outcome. |
| Antinori et al,28 2002 | Post-menopausal oocyte donation programs. Total of 1,150 accepted into program. | 1,150 | 489 | Women aged 45–63 years. | Post-menopausal women do not have a greater risk associated with pregnancy if they do not exhibit any medical disorders. |
| Paulson et al,2 2002 | Oocyte donation in women over 50. | 121 | 55 | 77 post-menopausal women (50–63). Normal prenatal serology.* |
Appropriately screened women aged 50 and older can successfully conceive via oocyte donation and experience similar pregnancy rates, multiple gestations, and spontaneous abortion rates as younger recipients. |
| Fonttis et al,29 2004 | Case report. Post-menopausal woman with cancer undergoing IVF. |
1 | 0 | Did not receive her first progesterone injection at the correct time. | One gestational sac was recorded at 8 weeks of gestation by ultrasonography and a healthy baby was born. |
| Krieg et al,21 2008 | IFV oocyte recipients vs autologous IFV reception. | 179 | 450 | Women over 38 years of age vs all infertile women with donor oocyte. | Women undergoing IVF with donor oocytes are not at increased risk for complications of neonate or pregnancy compared with women of advanced maternal age. |
| Usta and Nassar,30 2008 | N/A | N/A | N/A | N/A | Although these patients seem to be at higher risks of maternal and perinatal morbidity and mortality, pregnancies in such women are still considered relatively safe in the absence of preexisting medical conditions. |
| Ameratunga et al,20 2009 | Retrospective analysis of 54 recipients with either premature ovarian failure or physiological menopause undergoing oocyte donation. | 54 | 40 | Group A (POF group) with an average age of 28.3 years (±6.1) vs post-menopausal group. | Oocyte donation in both premature ovarian failure and physiological menopause is successful. Higher rates of complications occur in older women. Individual risk-factor analysis needs to be considered when counseling post-menopausal women. |
| Karadag and Roffi,31 2009 | Case report. 52-year-old woman with IVF pregnancy. | 1 | 2 | There was nothing unusual in her medical history, and no cardiovascular risk factors were identified. | Uneventful delivery by cesarean section. Further studies are required to determine the degree of risk that these pregnancies confer in regard to the potentially catastrophic complication of spontaneous coronary artery dissection. |
| Non-donor oocyte studies | |||||
| Benshushan and Schenker,1 1993 | Review | N/A | N/A | N/A | To minimize maternal health risks, thorough evaluation of maternal health should be evaluated before pregnancy. |
| Hirst and Ferrier,32 2004 | Case study: post-menopausal woman on HRT becomes pregnant with hydatidiform mole. | 1 | 0 | 55-year-old nulliparous woman. | Hydatidiform mole pregnancy. Women in this age group are often thought to be post-menopausal. It is important to remain suspicious of molar disease in this age group. |
| Tower,4 2009 | Review | N/A | N/A | N/A | Pregnancy in post-menopausal women is associated with increased risks. Women conceiving spontaneously are at significant risk of fetal aneuploidy, thus they must be offered screening. |
| Schimmel et al,3 2015 | Retrospective, single center study comparing spontaneously conceived in age 24–27 vs >35. | 24,579 eligible women | 80,053 | ART excluded. Single pregnancies. Normal prenatal serology.* | Advanced maternal age has more adverse maternal and neonatal outcomes than younger women; large for gestational age, cesarean section. Primiparous women are at higher risk than multiparous. |
Note:
*
Normal prenatal testing: medical screening of stress test, mammography, chest X-ray, glucose tolerance test, partial prothrombin time/international normalized ratio, thyroid-stimulating hormone, complete blood count, cervical pap, HIV, syphilis, hepatitis screening.
Abbreviations: HRT, hormone replacement therapy; N/A, not available; POF, premature ovarian failure.