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Obstetric Outcomes in Women of Advanced Reproductive Age

Richard J. Paulson, MD; Robert Boostanfar, MD; Peyman Saadat, MD; Eliran Mor, MD; David E. Tourgeman, MD; Cristin C. Slater, MD; Mary M. Francis, BS; John K. Jain, MD

JAMA. 2002;288:2320-2323.

Context  As a result of oocyte donation, women in their sixth decade of life are now able to conceive and carry pregnancies to term. However, little is known about pregnancy outcomes in this population.

Objective  To describe pregnancy outcomes in women aged 50 years or older who conceived after in vitro fertilization with donor oocytes.

Design and Setting  Retrospective analysis of cycles conducted at a US university assisted reproduction program during calendar years 1991-2001.

Patients  Seventy-seven postmenopausal women with no chronic medical conditions (mean [SD] age, 52.8 [2.9] years; range, 50-63 years) who underwent 121 embryo transfer procedures (89 fresh and 32 frozen). Pregnancy outcomes were ascertained by chart review and telephone follow-up.

Main Outcome Measures  Maternal and neonatal outcomes.

Results  There were 55 clinical pregnancies for a total pregnancy rate of 45.5%. The live birth rate was 37.2%. Of the 45 live births, 31 were singletons, 12 were twins, and 2 were triplets, for which the mean (SD) gestational ages at delivery were 38.4 (2.1) weeks, 35.8 (2.8) weeks, and 32.2 weeks, respectively. Mean (SD) birth weights were 3039 g (703 g), 2254 g (581 g), and 1913 g, respectively. Apgar scores at 1 and 5 minutes were 8.2 (0.9) and 9.1 (0.5), respectively. Of singletons, 68% were delivered by cesarean, and all multiples were delivered by cesarean. Mild preeclampsia was noted in 25% of patients and severe preeclampsia in 10%. Gestational diabetes required diet modification in 17.5%, and 2.5% required insulin.

Conclusions  Appropriately screened women aged 50 years or older can successfully conceive via oocyte donation and experience similar pregnancy rates, multiple gestation rates, and spontaneous abortion rates as younger recipients. During pregnancy, they appear at increased risk of preeclampsia and gestational diabetes. A majority can expect to deliver via cesarean. However, there does not appear to be any definitive medical reason for excluding these women from attempting pregnancy on the basis of age alone.

Author Affiliations: Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Keck School of Medicine of the University of Southern California, Women's and Children's Hospital, Los Angeles.

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