PECULIARITIES OF INFERTILITY AND ITS TREATMENT BY ART METHODS IN OLDER REPRODUCTIVE AGE WOMEN
The mother's older reproductive age is an important social and clinical issue. Currently, the proportion of women who postpone childbirth until the end of the 3rd - beginning of the 4th decade of life has increased significantly, especially in Western societies. The success rate of in vitro fertilization (IVF) decreases significantly when women enter the 5th decade of life.
The aim of the research: to determine the features of infertility and its treatment by ART methods in women of older reproductive age.
Materials. An analysis of 658 patient histories of IVF programs for 2015-2019. Given the purpose and objectives of our research for further analysis, we divided patients into 2 groups: the main group - 333 women aged 35 and over and the control group - 325 women under 35 years. Additionally, in the main group there were 2 subgroups: the first - 199 women aged 35-39 years, the second - 124 women over 40 years.
Results. There is a tendency to a gradual increase in the share of older women who want to become mothers: in 2019 the share of women aged 35 and over increased by 6.1% compared to 2015 (from 47.6% to 53.7%), the share of the oldest age group over 40 years is also growing (from 18.3% in 2015 to 21.6% in 2019), and the total share of such patients is quite significant (on average 20.4% in 5 years, which even higher than patients under 30 years of age - 18.5%), which corresponds to the global trend of «delayed motherhood».
In recent years, intraplasmic sperm injection (ICSI) has been the most frequently used among ART methods in both the main and control groups: 42.2% in the main group and 47.7% in the control group (p> 0.05), with the share of the oldest women age group was significantly lower than in the control (38.7%, p <0.05). Women in the assisted reproductive technology (ART) programs of the older age group were much more likely to be forced to use oocyte donation (14.2% vs. 3.7% under 35 years of age). After 40 years, this method of ART was used by almost a quarter of patients (23.4%).
The analysis revealed a significant discrepancy in the distribution of the etiology of infertility: if in the control the largest share fell on a combination of factors (31.1%) and tubal factor (25.2%), then half (48.0%) of older women are classified in the subgroup «only another female factor», which includes endocrinological disorders, ovarian insufficiency and others. After the age of 35 and 40, the share of women with primary infertility decreases (34.1% and 27.4% against 48.0% under the age of 35) and the share of those who suffer from infertility for more than 5 years increases. Decreased ovarian reserve was diagnosed in 48.0% of patients after 35 years, after 40 years this figure reaches 57.3%, which corresponds to the rates of increase in follicle-stimulating hormone and decrease in anti-mullerian hormone relative to age.
A quarter (24.0%) of women over the age of 35 have already had one failed IVF attempt, and 12.6% had 2 or more attempts. After 40 years, the proportion of women with at least two IVF attempts increases to 16.9%.
After 35 years, the share of clinical pregnancies per started cycle (30.0% vs. 39.1%) and live births (21.1% vs. 30.2%) significantly decreases. After 40 years, these 2 indicators fall sharply and are 21.8% and 13.7%.
Conclusions. Given the increase in the proportion of women who resort to ART in older reproductive age, as well as a number of factors that worsen the prognosis of ART, among which the reduction of ovarian reserve is the least controlled, it is important to find methods to optimize approaches to preparing patients of late reproductive age quality mature oocytes.
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