National trends and outcomes of autologous in vitro fertilization cycles among women ages 40 years and older

J Assist Reprod Genet. 2017 Jul;34(7):885-894. doi: 10.1007/s10815-017-0926-2. Epub 2017 Apr 28.


Purpose: The purpose of the study was to describe trends in and investigate variables associated with clinical pregnancy and live birth in autologous in vitro fertilization (IVF) cycles among women ≥40 years.

Methods: We used autologous IVF cycle data from the National ART Surveillance System (NASS) for women ≥40 years at cycle start. We assessed trends in fresh and frozen cycles (n = 371,536) from 1996 to 2013. We reported perinatal outcomes and determined variables associated with clinical pregnancy and live birth in fresh cycles between 2007 and 2013.

Results: From 1996 to 2013, the total number of cycles in women ≥40 years increased from 8672 to 28,883 (p < 0.0001), with frozen cycles almost tripling in the last 8 years. Cycles in women ≥40 years accounted for 16.0% of all cycles in 1996 and 21.0% in 2013 (p < 0.0001). For fresh cycles from 2007 to 2013 (n = 157,890), the cancelation rate was 17.1%. Among cycles resulting in transfer (n = 112,414), the live birth rate was 16.1%. The following were associated with higher live birth rates: multiparity, fewer prior ART cycles, use of standard agonist or antagonist stimulation, lower gonadotropin dose, ovarian hyperstimulation syndrome, more oocytes retrieved, use of pre-implantation genetic screening/diagnosis, transferring more and/or blastocyst stage embryos, and cryopreserving more supernumerary embryos. Of the singleton infants born (n = 14,992), 86.9% were full term and 88.3% normal birth weight.

Conclusions: The NASS allows for a comprehensive description of IVF cycles in women ≥40 years in the USA. Although live birth rate is less than 20%, identifying factors associated with IVF success can facilitate treatment option counseling.

Keywords: 40 years and over; In vitro fertilization (IVF); Infertility; Older women.

MeSH terms

  • Adult
  • Age Factors
  • Centers for Disease Control and Prevention, U.S.
  • Female
  • Fertilization in Vitro / statistics & numerical data
  • Fertilization in Vitro / trends*
  • Humans
  • Infertility / therapy
  • Pregnancy
  • Pregnancy Rate*
  • Treatment Outcome
  • United States