Pregnancy in the Sixth Decade of Life

Obstetric Outcomes in Women of Advanced Reproductive Age

Paulson, Richard J. MD
Boostanfar, Robert MD
Saadat, Peyman MD
Mor, Eliran MD
Tourgeman, David E. MD
Slater, Cristin C. MD
Francis, Mary M. BS
Jain, John K. MD

Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Keck School of Medicine of the University of Southern California, Women's and Children's Hospital, Los Angeles.

Corresponding Author and Reprints: Richard J. Paulson, MD, Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Keck School of Medicine of the University of Southern California, Women's and Children's Hospital, 1240 N Mission Rd, Room 8K9, Los Angeles, CA 90033 (e-mail: [email protected]).

Author Contributions:Study concept and design: Paulson, Boostanfar.

Acquisition of data: Paulson, Boostanfar, Saadat, Mor, Tourgeman, Slater, Francis, Jain.

Analysis and interpretation of data: Paulson, Boostanfar, Mor.

Drafting of the manuscript: Paulson, Boostanfar, Tourgeman, Slater, Jain.

Critical revision of the manuscript for important intellectual content: Paulson, Boostanfar, Saadat, Mor, Francis.

Statistical expertise: Paulson, Boostanfar, Mor.

Administrative, technical, or material support: Paulson, Boostanfar, Saadat, Tourgeman, Slater, Francis, Jain.

Study supervision: Paulson.

JAMA: The Journal of the American Medical Association 288(18):p 2320-2323, November 13, 2002.

Context

As a result of oocyte donation, women in their sixth decade of life are now able to conceive and carry pregnancies to term. However, little is known about pregnancy outcomes in this population.

Objective

To describe pregnancy outcomes in women aged 50 years or older who conceived after in vitro fertilization with donor oocytes.

Design and Setting

Retrospective analysis of cycles conducted at a US university assisted reproduction program during calendar years 1991–2001.

Patients

Seventy-seven postmenopausal women with no chronic medical conditions (mean [SD] age, 52.8 [2.9] years; range, 50–63 years) who underwent 121 embryo transfer procedures (89 fresh and 32 frozen). Pregnancy outcomes were ascertained by chart review and telephone follow-up.

Main Outcome Measures

Maternal and neonatal outcomes.

Results

There were 55 clinical pregnancies for a total pregnancy rate of 45.5%. The live birth rate was 37.2%. Of the 45 live births, 31 were singletons, 12 were twins, and 2 were triplets, for which the mean (SD) gestational ages at delivery were 38.4 (2.1) weeks, 35.8 (2.8) weeks, and 32.2 weeks, respectively. Mean (SD) birth weights were 3039 g (703 g), 2254 g (581 g), and 1913 g, respectively. Apgar scores at 1 and 5 minutes were 8.2 (0.9) and 9.1 (0.5), respectively. Of singletons, 68% were delivered by cesarean, and all multiples were delivered by cesarean. Mild preeclampsia was noted in 25% of patients and severe preeclampsia in 10%. Gestational diabetes required diet modification in 17.5%, and 2.5% required insulin.

Conclusions

Appropriately screened women aged 50 years or older can successfully conceive via oocyte donation and experience similar pregnancy rates, multiple gestation rates, and spontaneous abortion rates as younger recipients. During pregnancy, they appear at increased risk of preeclampsia and gestational diabetes. A majority can expect to deliver via cesarean. However, there does not appear to be any definitive medical reason for excluding these women from attempting pregnancy on the basis of age alone.