Approach to Subfertile Women Older than 38 Years-Old: Our Experience in Tunisia

Abstract

Objective: The practitioners of assisted reproductive techniques (ARTs) are increasingly confronted by a strong desire that is expressed by women aged 38 and over, for having children. Our objective is to analyze the reasons behind this increasing tendency for women to have children later in life, to study the clinico-biological characteristics of these patients, and the results of our center. Methods and Materials: A retrospective study was conducted at the Military Hospital of Tunis over a period of 7 years. We analyzed the sociodemographic profile, biological characteristics and data of each ART cycle in 32 couples in whom the female was 38 years of age or older. Results: Several factors contribute to the increasing number of ARTs consultations in old ages: duration of study 07 years from January 2001 to January 2008, giving priority to career over other issues, socioeconomical stability, better control of contraception and late encounter with the partner, and false reassuring information on progress in ARTs. In our study, beyond the age of forty, the rates of pregnancy and childbirth declined markedly and were 43% and 6.25%, respectively. On the other hand, the rate of miscarriage increased (28.12% in our study). From the age of 40, most teams advocate for IVF at the outset. The ultrasound measurement of the antral follicular count makes it possible to assess the prognosis in terms of pregnancy and delivery rates. Discussion and Conclusion: ARTs fail to ameliorate the decreased pregnancy rates and increased rates of spontaneous miscarriages associated with age. Therefore, patients should be informed earlier about the negative effects of age on their potential fertility.