A Profound Impact of Patient Age on Pregnancy Outcome after Demonstration of a Live Fetus following IVF-ET

Yoo, Keun Jai; Song, Ji Hong; Lee, Jong Pyo; Yeon, Hye Jung; Song, In Ok; Paik, Eun Chan; Son, Il Pyo; Koong, Mi Kyoung; Jun, Jong Young; Kang, Inn Soo

Abstract

In infertile patients, the pregnancy loss rate after demonstration of fetal heart beat ranges about 7 % to 11 %, which is relatively higher than that of normal population(about 1.5~3.3 %). But scanty data are available in evaluation of the influence of maternal age on pregnancy outcomes in IVF-ET patients. Thus, this study was done to assess the imp-act of maternal age on pregnancy loss rate after the early sonographic detection of fetal cardiac activity following IVF-ET. Pregnancy outcomes of 338 IVF-ET cycles from January 1, 1994 through December 31, 1995 were analyzed. Trans vaginal ultrasonography was done serially from the day 21 postconception and the presence of fetal heart activity was documented using a Samsung 125-MAX scanner with a 6.5-MHz transvaginal probe. Logistic regression analysis was done to determine the possible effects of various independent factors such as treatment pr- otocol, infertility factors, basal LH, FSH and E2, multifetal pregnancy reduction, and age of the wife, on probability of spontaneous pregnancy loss after confirmation of positive fetal heart beat. The overall pregnancy loss rate was 8.0 %(27/338). The probability of pregnancy loss after positive fetal heart beat increased with age of the wife(logistic regression analysis, P<0.05). The probability of spontaneous pregnancy loss at a given age was expressed as the following formula:probability=ex/(1+ex), in which x=-3.9+0.2xage. The older women age over 35 had approximately twice the pregnancy loss rate compared to the younger women ; 14.9 %(7/47) vs. 6.9 %(20/291). The pregnancy loss rate after multifetal pregnancy reduction was 9.8 %(6/61), which was not significantly different from tht 7.6 %(21/277) without multifetal pregnancy reduction(p>0.05). We conclude that spontaneous pregnancy loss rate after documentation of fetal cardiac activity increases as a function of the maternal age and a profound effect was observed after age 35. Thus, older patients should be counselled on the higher risk of spontaneous pregnancy loss.