| With the releasing of second child policy in our country,the number of elderly patients seeking for treatents is increasing in each reproductive center.Elderly patients assistting with pregnancy has become a hot and difficult spot in reproductive medicine field at present.Female age is an important factor affecting fertility and the assisted pregnancy outcome of advanced age female is not ideal.Consecutive cycles treatment is necessary and cumulative live birth rate(CLBR)is more valuable for their outcomes and prognosis.At present,most researches concentrate upon outcome of IVF treatment per cycle and outcome of multicycle in general population.Few comparative data of repeated cycles in older women have been published until now and there has been no specific upper limit of age and the number of treatment cycles.Before performing ART,elderly patients with normal ovarian reserve function could show high ovarian reserve,normal ovarian reserve and low ovarian reserve during ovarian stimulation.It remains to be seen whether there is a difference in the prognosis after multiple treatment cycles according to the different number of oocytes in the first initiated cycle in elderly patients with normal ovarian reserve function.Therefore,looking for indicators that influence live births is also very important.objectiveThe aim of the present study was to analyze the LBR and CLBR in women aged 35 years and above undergoing consecutive cycles of IVF/ICSI-embryo transfer,and to compare the pregnancy outcome among different age,multiple treatment cycles and the different number of oocytes in the first initiated cycle in elderly patients with normal ovarian reserve function.Moreover,multivariable logistic regression analysis was performed to identify potential factors contributing to live births.Materials and methodsAll the clinical data and followed outcomes of women aged 35 years and above undergoing their first initiated IVF/ICSI cycles were acquired in Data Managing System in Reproductive Medical Center of the First Affiliated Hospital of Zhengzhou University between January1,2012,and December31,2013,and the followed outcomes of consecutive cycles were also inquired and recorded.,the end of followed time was December31,2015.Results1.This retrospective study included 1,462 patients undergoing 2,427 initiated treatment cycles and 2,018 fresh embryo transferred cycles,the total cycle cancellation rate was 16.85%,the average LBR per cycle was 23.79% and the CLBR per woman was 42.1%.2.From initiated cycle 1 to ?cycle 4,the rate of cancellation increased significantly from 5.1% to 67.0%(P<0.01);the LBR was significantly higher for cycle 1 than that in other three cycyles(26.8%,19.2%,14.8% and 8.3%,respectively,P<0.01).Obviously low LBR was obtained in patients with four cycles and more.The CLBR was significantly lower for cycle 1 than that in other three cycyles(32.8%,40.2%,41.5% and 42.1%,respectively,P<0.01)and increased not obviously in patients with four cycles and more.3.Stratified for female age,the age of the patients in the first initiated cycle was divided into 4 groups : 35-37 years old,38-40 years old,41-43 years old,and > 43 years old.In the first cycle,the LBR of 35-37 years was significantly higher than other three groups(P < 0.01).In the second cycle,the LBR of 35-37 years was significantly higher than 38-40 years and 41-43 years patients(P<0.01).However,there was no statistical significance among the third and subsequent treatment cycles(P>0.05).After multi-cycles,the rate of cancellation in patients aged 35-37 years was significantly lower than other groups(10.9%,18.6%,23.8% and 30.7%,respectively,P < 0.01).The LBR decreased with age.The LBR in patients aged 35-37 years was 32.5%,38-40 years was 21.5%,41-43 years was 8.1%(P<0.005);The LBR in patients aged >43 years was 5.3% and was obviously lower than patients aged 35-37 years and 38-40 years(P<0.005).The CLBR also decreased with age.The CLBR in patients aged 35-37 years was 55.7%,38-40 years was 38.0%,41-43 years was17.1%(P<0.005);The LBR in patients aged >43 years was 11.7% and was obviously lower than patients aged 35-37 years and 38-40 years(P<0.005).The CLBR of different age patients gradually increased with the increasing cycles and plateaued in cycle 3.The number of live births increased not clearly after ?4 cycles.4.Stratified for the number of oocytes in the first initiated cycle in elderly patients with normal ovarian reserve function.Patients with normal ovarian reserve function were divided into 3 groups(0-5,6-10,> 10).In the first cycle,the LBR in patients with 0-5 oocytes was significantly lower than other two groups(P < 0.01).However,there was no statistical significance among the second and subsequent treatment cycles(P>0.05).After multi-cycles,the rate of cancellation decreased significantly with increasing oocytes(P<0.01).The LBR was significantly lower(P<0.01)in patients with 0-5 oocytes when compared with patients with 6-10 oocytes and >10 oocytes(17.9%,34.2% and 31.5,respectively,P<0.01).Accordingly,the CLBR was also significantly lower(P<0.01)in patients with 0-5 oocytes when compared with patients with the later two groups(31.5%,54.8%and 58.9,respectively,P<0.01).he CLBR of different oocytes patients gradually increased with the increasing cycles and plateaued in cycle 3.The number of live births increased not clearly after ?4 cycles.5.Multivariable logistic regression analysis of the first treatment cycle showed that age,the total days of gonadotrophin,endometrial thickness and number of embryos are related to the LBR.The ORs for live birth were AOR=0.831,95%CI=0.785-0.879,AOR=0.911,95%CI=0.849-0.979,AOR=1.077,95%CI=1.028-1.127,AOR=1.702,95%CI=1.377-2.104.respectively.Conclusions1.The LBR and CLBR of advanced women had a decreasing trend with the age,in patients aged >43 years gradually decreased.The CLBR increased with the increasing cycles and increased not clearly after ?4 cycles.2.Advanced women who had normal ovarian reserve in COS obtained relatively high LBR and CLBR than that in patients with low ovarian reserve;The cycle cancellation rate was lower.3.Age,the total days of gonadotrophin,endometrial thickness and number of transferred embryos in the first initiated cycle might be influenced factors of LBR. |
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