A decision tree analysis applied to women aged 43–45: who should be referred for ovum donation?

Bercovich, Or; Almog, Benny; Fouks, Yuval; Kalma, Yael; Hasson, Joseph; Azem, Foad; Cohen, Yoni

doi:10.1016/j.rbmo.2021.09.025

Cited by 3 publications

(1 citation statement)

References 20 publications

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“…There are a few studies analyzing live birth rates (LBR) in women over the age of 42 [ 7 – 10 ] and even fewer assessing cumulative live birth rates (CLBR) in older women. The largest of these studies examined fewer than 1300 cycles [ 11 , 12 ]. In 2010, Stern et al analyzed the Society for Assisted Reproductive Technology Clinical Outcomes Reporting System (SART CORS) database to describe the cumulative live birth rates for age groups (< 35; 35–37; 38–40; 41–42; and ≥ 43) as provided by the Centers for Disease Control (CDC) under the Fertility Clinic Success Rate and Certification Act (FCSRCA) of 1992.…”

Section: Introductionmentioning

confidence: 99%

Cumulative live birth rates with autologous oocytes plateau with fewer number of cycles for each year of age > 42

Seifer,

Wang,

Frankfurter

2023

Reprod Biol Endocrinol

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Objective 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. Design Retrospective cohort study of autologous linked ART cycles. Setting 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. Results 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. Conclusions 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.

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Section: Introductionmentioning

confidence: 99%

Cumulative live birth rates with autologous oocytes plateau with fewer number of cycles for each year of age > 42

Seifer,

Wang,

Frankfurter

2023

Reprod Biol Endocrinol

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A clinical predictive model for live birth in women of advanced age undergoing PGT cycles

Bercovich,

Klar,

Shaulov

et al. 2024

Arch Gynecol Obstet

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Modelling futility in the setting of fertility treatment

2022

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When is a fertility treatment futile? This question has great practical importance, given the role futility plays in ethical, legal and clinical discussions. Here, we outline a novel method of determining futility for IVF treatments. Our approach is distinctive for considering the economic value attached to the intended aim of IVF treatments, i.e. the birth of a child, rather than just the effects on prospective parents and the health system in general. We draw on the commonly used metric, quality-adjusted life years (QALYs), to attach a monetary value to new lives created through IVF. We then define futility as treatments in which the chance of achieving a live birth is so low that IVF is no longer a cost-effective intervention given the economic value of new births. This model indicates that IVF treatments in which the chance of a live birth are <0.3% are futile. This suggests IVF becomes futile when women are aged between 47 and 49 years of age. This is notable older than ages currently considered as futile in an Australian context (∼45). In the UK, government subsidized treatment with the couple’s own gametes stops at the age of 42, while privately funded treatments are self-regulated by individual providers. In most European countries and the USA, the ‘age of futility’ is likewise managed by clinical consensus.

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A decision tree analysis applied to women aged 43–45: who should be referred for ovum donation?

Cited by 3 publications

References 20 publications

Cumulative live birth rates with autologous oocytes plateau with fewer number of cycles for each year of age > 42

Cumulative live birth rates with autologous oocytes plateau with fewer number of cycles for each year of age > 42

A clinical predictive model for live birth in women of advanced age undergoing PGT cycles

Modelling futility in the setting of fertility treatment

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