INTRODUCTION
The observed trend of delayed maternity leads to an increased demand for assisted reproductive technology (ART) programs among women of older reproductive age. In women of older age group, as a result of physiological and functional changes, there is a decrease in the quality and quantity of oocytes, an increase in the number of chromosomal anomalies, which negatively affects implantation, leads to an increased risk of miscarriage and a decrease in live births. The development and implementation of modern methods of ART treatment: vitrification, extended culturing, time lapse, and preimplantation genetic testing provides an opportunity for qualitative selection of more viable and genetically normal embryos, and allows us to develop an algorithm for the management of older patients, which is of great importance for improving the effectiveness of ART.
The aim of this study is to comparison of clinical outcomes of «fresh» and frozen-thawed embryo transfer after IVF/ICSI programs from own oocytes in women over 40 years. To analyze the outcomes of ART and the relationship to the age of the woman as a result of transferring one or two of her own «fresh» or frozen-thawed blastocysts.
MATERIAL AND METHODS
Clinical and laboratory data of 406 couples in IVF/ICSI programs and 347 couples after the program of frozen-thawed embryos transfer using their oocytes aged 40—46 years who were treated in 2010—2021 at the Institute of Reproductive Medicine (IRM) in Almaty were analyzed. The patients were divided into groups according to age (40, 41, 42, 43, 44, ≥45) and the number of transferred embryos.
RESULTS
Analysis of the results of transferring «fresh» embryos revealed a statistically significant increase in the transfer of two own blastocysts compared to one at CPR and IR at 12 weeks gestation (37.2% vs. 20% and 15.4% vs. 10%, respectively, p<0.05) and in the live birth rate (30.8% vs. 10%, respectively, p<0.001) only in the group of women 40 years old. In age groups 41, 42, 43, 44, and ≥45, no significant differences (p>0.05) were observed when transferring one or two «fresh» or frozen-thawed blastocysts from their oocytes. The results of transferring «fresh» blastocysts or performing frozen-thawed embryos (FETs) showed no significant increase between the two sample distributions in pregnancy loss in women over 40 years (p>0.05).
CONCLUSION
With the increasing reproductive age of women with «fresh» embryos transferred in IVF/ICSI protocols and PRE programs from their oocytes, there is no significant difference in the rates of CPR and IR at 12 weeks’ gestation, pregnancy loss, frequency of multiple births and live birth rate. There is a tendency to increase the incidence of early pregnancy loss in women over 40 years of age, regardless of the embryo transfer protocol.
