Fecundity disorders in older women: declines in follicular development and endometrial receptivity

Abstract

Background: Little research is available on follicular development and endometrial receptivity in older women. This study aimed to assess follicular development and endometrial receptivity, and to evaluate ultrasonic parameters in predicting endometrial receptivity during the implantation window in older women. Methods: For this prospective case-control study, 224 older women and 215 young women were recruited. The follicular development and endometrial thickness were monitored by transvaginal ultrasound. During the implantation window, the pulsatility index (PI) and resistance index (RI) of the uterine arteries and subendometrial region, endometrial volume, vascularization index (VI), flow index (FI) and vascularization flow index (VFI) were calculated between the two groups. The ultrasonic parameters were used to assess endometrial receptivity in older women. Results: The serum anti-Mullerian hormone (AMH) concentration and antral follicle count (AFC) were significantly lower in older women than in young women. The average diameter of the dominant follicle on days 14, 16, and 18 of the menstrual cycle were significantly smaller, and the subendometrial region RI on days 12, 14, 16, and 18 of the menstrual cycle were significantly higher in older women than in young women. The normal ovulation rate was significantly lower in older women than in young women. The subendometrial region RI was significantly higher, and the endometrial VI, FI, and VFI were significantly lower in older women compared with young women. The biochemical pregnancy rate, clinical pregnancy rate and ongoing pregnancy rate of older women were significantly lower than in young women. The best ultrasonic parameter for predicting endometrial receptivity during the implantation window in older women was VI (AUC =0.889, sensitivity 92.6% and specificity 85.4%). Conclusions: Older women present decreased serum AMH concentrations and AFC, defined as indicators of ovarian reserve function. Older women are characterized by decreased follicular development and endometrial receptivity, which may lead to fecundity disorders.

Hormonal Replacement Treatment for Frozen-Thawed Embryo Transfer With or Without GnRH Agonist Pretreatment: A Retrospective Cohort Study Stratified by Times of Embryo Implantation Failures

“…According to the results of age stratification of one failure of embryo implantation sub-group, the pretreatment of GnRH-a can obtain greater benefits in the 35-37 age group (HRT: 35.67%, G-HRT: 46.15%, P=0.059), followed by the younger (<35 years old) group (HRT: 53.26%, G-HRT: 55.33%, P=0.402), while older (>37 years old) women do not benefit significantly (HRT: 28.22%, G-HRT: 30.41%, P=0.661). The possible explanation for this parabolic phenomenon is that most young women do not have endometrial problems, and the efficacy of GnRH-a pretreatment and is limited (24,25). Similarly, the main reason of implantation failure is the high rate of embryo aneuploidy for older women, which coincides with most RIF's definition of restricting the age of women (9).…”

Thin endometrium is associated with the risk of hypertensive disorders of pregnancy in fresh IVF/ICSI embryo transfer cycles: a retrospective cohort study of 9,266 singleton births

“…Secondly, maternal age was higher in the thin endometrium group than the other two groups in our study. Several previous studies also reported that older mothers were tended to have a thinner EMT [ 16 , 17 , 47 ]. However, we used an RCS to adjust for age in multivariate analysis, which may achieve a better adjustment of this variable.…”

The effect of female age on pregnancy outcomes in patients with pre-implantation testing for aneuploidy (PGT-A): a multicenter retrospective study

“…Whether aging also affects the endometrium's ability to support embryo implantation and growth? A prospective case-control study evaluating endometrial receptivity by measuring endometrial thickness and blood ow with threedimensional energy Doppler ultrasound found decreased endometrial receptivity in older women [19].…”