Study of 118 pregnant women over 43 years old after infertility treatment

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  • 不妊治療により43歳以上で妊娠が成立した118症例の検討
  • フニン チリョウ ニ ヨリ 43サイ イジョウ デ ニンシン ガ セイリツ シタ 118 ショウレイ ノ ケントウ

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<p>Purpose: Aids for infertility couples by the government are limited for women under 42 years old after April 2016. However, pregnancy of women older than 43 years old is not uncommon in infertility treatment. Therefore, it is an urgent issue to consider the treatment options for these women. In this study, we examined women who were over 43 years old and achieved pregnancy by infertility treatment to be of some help toward this issue. Materials and Methods: There were 3743 women who became pregnant after infertility treatment between January 2011 and December 2013 at our infertility center. Among these, we selected 118 patients older than 43 years old and examined their background, history, treatment and outcome of pregnancy retrospectively. Results: The patients were diagnosed as pregnancy at the age of 44.2 on average, and the oldest was at the age of 48.7. The duration of the treatment is 508 days on average (27-2260 days), which is significantly longer than that of the patients younger than 40 years old. 69% of cases (81 patients) had no history of treatment at other hospitals or clinics and 71% of cases (84 patients) had history of pregnancy including spontaneous abortion. Most of the patients (85%, 100 patients) achieved pregnancy by assisted reproductive technology (ART), and 13% of cases (15 patients) by timed intercourse, 3% (3 patients) by intrauterine insemination (IUI). 95% of women who had been treated previously and 94% of those who had no history of pregnancy achieved pregnancy by ART. In ART, although about half of cases (54 patients) used clomiphene citrate for ovarian stimulation because of ovarian dysfunction from advanced maternal age, 36 patients used short protocol, and frozen embryos were transferred in 49 patients. Only 34% of cases (40 patients) resulted in live birth, in which 26 patients gave birth by cesarean section. Among the rest, 68 patients (58% of all cases) ended in spontaneous abortion, 3 patients in ectopic pregnancy and five patients in artificial abortion. Conclusion: ART attained pregnancy in 85% of cases, especially, in almost of women who had been treated previously and those who had no history of pregnancy. Thus, history of previous treatment and pregnancy are important factors in choosing treatment options. Although clomiphene citrate was used most in ovarian stimulation for ART, short protocol achieved pregnancy in many cases and it would be a positive option in patients with appropriate ovarian reserve. The outcome of pregnancy is unfavorable in these patients, in which more than half of cases resulted in abortion. In addition to that, artificial abortion was chosen in five cases. Thorough information including outcome of pregnancy should be offered to patients when commencing treatments for infertility. [Adv Obstet Gynecol, 69(3) : 262-268, 2017 (H29.8)]</p>

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