Retrospective outcome in women aged 45 years and older undergoing natural cycle IVF treatment

ABSTRACT Research question Is natural cycle in vitro fertilization (IVF) treatment beneficial to middle-aged women with poor ovarian response? Design We aimed to retrospectively investigate outcomes in women aged 45 years and older, who underwent natural cycle IVF treatment between 2008 and 2017 in a single assisted reproduction clinic, and to report several successful outcomes. Results In total, 2,408 IVF retrievals in women aged 45 years and older were included in this study. Mean serum follicle-stimulating hormone (FSH) level on day 3 was 21.4 ± 12.5 (range, 0.3–93.7) IU/mL. One fresh cleavage-stage embryo was transferred in 37.3% (900/2408) of the initiated cycles. The overall clinical pregnancy rate and live birth rate per fresh embryo transfer were 2.8% (25/900) and 0.8% (7/900), respectively. Natural cycle IVF treatment led to seven successful deliveries during the period. All seven women who successfully delivered were poor ovarian responders who met the diagnostic Bologna criteria, and among them, three had elevated serum FSH levels on day 3 (range: 39.0–47.1 mIU/mL). All seven had full-term delivery, and no congenital abnormalities were observed in their infants. No significant difference was found in serum FSH level on day 3 between those with and without positive β-HCG test results. Conclusions These findings suggest that natural cycle IVF treatment could be an option for older poor responders in countries that do not permit egg donation. However, careful counselling is required because of the low probability of live births after IVF in middle-aged women.