Assisted Reproductive Technology without Embryo Discarding or Freezing in Women ≥40 Years: A 5-Year Retrospective Study at a Single Center in Italy

Abstract

The protocols commonly used in assisted reproductive technology (ART) consist of long-term embryo culture up to the blastocyst stage after the insemination of all mature oocytes, the freezing of all the embryos produced, and their subsequent transfer one by one. These practices, along with preimplantation genetic testing, although developed to improve the live birth rate (LBR) and reduce the risk of multiple pregnancies, are drawing attention to the possible increase in obstetric and perinatal risks, and adverse epigenetic consequences in offspring. Furthermore, ethical–legal concerns are growing regarding the increase in cryopreservation and storage of frozen embryos. In an attempt to reduce the risk associated with prolonged embryo culture and avoid embryo storage, we have chosen to inseminate a limited number of oocytes not exceeding the number of embryos to be transferred, after two days or less of culture. We retrospectively analyzed 245 ICSI cycles performed in 184 infertile couples with a female partner aged ≥40 from January 2016 to July 2021. The results showed a fertilization rate of 95.7%, a miscarriage rate of 48.9%, and a LBR of 10% with twin pregnancies of 16.7%. The cumulative LBR in our group of couples was 13%. No embryos were frozen. In conclusion, these results suggest that oocyte selection and embryo transfer at the cleaving stage constitute a practice that has a LBR comparable to that of the more commonly used protocols in older women who have reduced ovarian reserve.

The Relationship Between Serum Anti-Müllerian Hormone and Basal Antral Follicle Count in Infertile Women Under 35 Years: An Assessment of Ovarian Reserve

“…Furthermore, there is deterioration of reproductive physiology by the age of 35-36 [160,163]. Moreover, for those women aged ≥40 to 45 years, her ability to get pregnant without assisted reproductive techniques (ART) remains most improbable [160,[164][165][166]. The mean age of our study population was 30.7±3.69 years (Figure 4).…”

Preimplantation genetic testing: A remarkable history of pioneering, technical challenges, innovations, and ethical considerations

“…Legal challenges arise as legislative and societal attitudes change that impact reproductive medicine. Prohibitions against embryo destruction and desires to avoid embryo freezing were reported to be addressed through the application of a rigorous set of oocyte selection criteria, achieving a fertilization rate of >95%, a miscarriage rate of 48.9%, and a live birth rate of 10% for women >40 years of age, without embryo destruction or freezing (Manna et al, 2023).…”

“…Legal challenges arise as legislative and societal attitudes change that impact reproductive medicine. Prohibitions against embryo destruction and desires to avoid embryo freezing were reported to be addressed through the application of a rigorous set of oocyte selection criteria, achieving a fertilization rate of >95%, a miscarriage rate of 48.9%, and a live birth rate of 10% for women >40 years of age, without embryo destruction or freezing (Manna et al, 2023). Nevertheless, an expansion of legal restrictions related to life‐at‐conception legislation could impact IVF and PGT by limiting options for how deselected embryos might be managed, possibly requiring embryo freezing at increased cost to the patient, and thereby a possible disparity in access to reproductive care.…”