Effect of Female Age on Infertility Diagnostic Factors and In-vitro Fertilization Treatment Outcomes: A Single-center Retrospective Cohort Study

BackgroundInfertility has become an important issue in modern world because of the increasing number of infertile couples around the world. Advanced maternal age was considered to be a main factor of infertile problem. With second child policy published in China and more women in China intend to seek help for infertility problem, this study provided information of fertility diagnostic factors and IVF treatment outcomes of female IVF patients in different age groups, which can be a guidance for infertility diagnostic and treatment. MethodsA retrospective cohort study was conducted to IVF patient data collected by Jinjiang District Maternal and Child Health Hospital, Chengdu, China. Clinical and laboratory data of 45,743 fresh, autologous IVF cycles from January 2008 to September 2017 were included in the analysis. The diagnostic factors and treatment outcomes were analyzed for different age groups (age<35, n=30,708; age 35-41, n=11,921 and age[&ge;]42, n=3,114) as well as further stratified advanced age groups (age 42, n=933; age 43, n=744; age 44, n=556; age[&ge;]45, n=881). The characteristics including number of previous cycles, duration of infertility, BMI, basic FSH, basic AFC, AMH, retrieved oocyte number, fertilized oocyte number, transferred embryo number, baby number and economic cost were stratified according to patient age. ResultsThe basic characteristics of obesity rate, basic FSH and cancellation rate of IVF cycles in [&ge;]42 years old group were significantly higher than other groups (p<0.01). Basic AFC, AMH, retrieved oocyte number, fertilized oocyte number and transferred embryo number in [&ge;]42 years old group were significantly lower than other groups (p<0.01). Diagnostics characteristics and IVF-ET outcome declined significantly when maternal age increased (p<0.05). In the meanwhile, a preliminary analysis of cost per cycle showed that cost per child increased with patients age increase. ConclusionAlthough with increasing number of advanced maternal age IVF cycles, the age group of [&ge;]42 years would intend to get unsatisfied outcome and higher cost per child. More guidance and considerations should be focused on encouraging earlier age treatment of infertility. Plain English summaryWith more and more women in the global range choose to get late pregnancy because of changes in society and economy, age has become an unavoidable factor in infertility diagnostic and treatment. Advanced age women may experience more infertility problems and negative IVF outcomes. A better understanding of the effect of maternal age on infertility would offer help to both diagnostic and treatment of IVF patient. This study conducted a single-center retrospective cohort analysis to female patients of different age groups and found that women with more advanced age ([&ge;]42) would be more easily to experience unsatisfied IVF outcome and higher economic cost to obtain one child. After the publication of second child policy in China in 2013, the number of advanced age patients increased, the necessity of special guidance for AMA patient may need to be taken into consideration.