Ovulation induction in women age 40 and older: the importance of basal follicle-stimulating hormone level and chronological age

Anthony C. Pearlstone, Nicole Fournet, Joseph C. Gambone, Samuel C. Pang, Richard P. Buyalos
In: Fertility and Sterility · 1992 · vol. 58(4) , pp. 674–679 · doi:10.1016/s0015-0282(16)55310-2 · PMID:1426308 · W3123017015
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This study investigated the impact of basal follicle-stimulating hormone levels and chronological age on ovulation induction success in women aged 40 and older.

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Abstract

ObjectivesTo determine pregnancy and livebirth rates for women age 40 and older undergoing ovulation induction and to assess the impact of basal follicle-stimulating hormone (FSH) on outcome in these patients.DesignProspective, observational.SettingFertility service of university medical center.PatientsInfertile couples in whom the female partner was age 40 or older referred for ovulation induction therapy.InterventionAssessment of basal hormonal status; ovulation induction.Main outcome measuresClinical pregnancy rate (PR), livebirth rate.ResultsAnalysis of 402 cycles in 85 women age 40 and older demonstrated a clinical PR of 3.5% per cycle (95% confidence interval [CI] 1.7% to 5.3%). The livebirth rate was 1.2% per cycle (95% CI 0.1% to 2.3%). Women with a basal FSH < 25 IU/L and age or = 25 IU/L or age was > or = 44 (P < 0.005). The prognostic importance of basal FSH and chronological age was confirmed by multivariate logistic regression analysis. The predictive value of the resulting regression equation was high (R2 = 0.94; P < 0.01).ConclusionsPregnancy and livebirth rates are generally low during ovulation induction in women age 40 and older. In combination, basal FSH and chronological age are accurate predictors of PR, in these couples and can define a subset of patients with a more favorable prognosis. The spontaneous abortion rate in women who do conceive is high, substantially lowering the livebirth rate.

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