The Impact of Maternal Age on Clinical Pregnancy an Spontaneous Abortion in Women Undergoing In Vitro Fertilization and Gamete Intra‐Fallopian Transfer

EDITORIAL COMMENT: We accepted this paper for publication because it neatly summarizes the data available in the literature regarding maternal age and prospects for successful treatment of infertility with in vitro fertilization and gamete intra‐Fallopian transfer. The author also discusses why different regimens may have superior results with older women. The editorial committee of this Journal also believes that it is very unlikely that prospective controlled trials will ever be performed to settle the issue of whether the older infertile woman should be treated by GIFT or IVF technologies, or by conservative management. The GIFT IVF choice is a matter for the reproductive medicine specialist, and presumably the patency of the Fallopian tubes, as well as which method offers the best chance of a living child, will be a major deciding factor. For many ‘older’ infertile women however, the choice is between patience and the technology; particularly ovulation induction and clomiphene. Counselling should include the possibility of acceptance of infertility; many couples are not willing to undergo the rigours of the more complicated regimens of ovulation induction, GIFT or the available variations of the IVF technologies. We would like to be offered a publication showing an audit of the reproductive histories of women after failed GIFT ± IVF, or after successful GIFT ± IVF; there are many women who reproduce naturally, spontaneously and successfully after undergoing sophisticated treatment in infertility clinics. Summary: The age at which women should be advised against proceeding with initial or further infertility treatment is one of the many unresolved questions in this area of women's health and was the subject of investigation in this study. One of the major difficulties in determining the impact of maternal age on outcomes is the practice of researchers (publishing in journals) and infertility practitioners (reporting to national registers) of coding age as a categorical rather than a continuous variable. In this study, groups of younger (<30 years) and older (>35 years) women undergoing assisted reproduction treatments were compared with regards to clinical pregnancy and spontaneous abortion rates following in vitro fertilization (IVF) or gamete intra‐Fallopian transfer (GIFT). Response to different ovarian stimulation protocols was also assessed for the 2 groups. The significance of the relationship between maternal age, clinical pregnancy rates, spontaneous abortion rates and the type of treatment and stimulation protocol employed, was tested using a series of binomial distributions. The results indicated that maternal age adversely affects both clinical pregnancy rates and rates of spontaneous abortion, when summed across treatments and stimulation protocols. However, while the age/outeome relationship held for IVF, the GIFT by age relationship was not significant. Stimulation protocols using clomiphene citrate (CC) or gonadotrophin agonists (GnRHa) may impact negatively on older women. Since it is unlikely that these data will be replicated on larger prospective samples, the basis for counselling couples about the advisability of undergoing assisted reproduction after the maternal age of 35 years should incorporate both a knowledge of the statistical trends reported in both the literature and national registers, and careful assessment of each participant's unique characteristics and responses to treatment.