Having a baby in your 40s with ART: the reproductive dilemma of autologous versus donor oocytes

Background 

Increasing numbers of women ≥40 years old are accessing assisted reproductive technology (ART) due to age‐related infertility. There is limited population‐based evidence about the impact on the cumulative live birth rate (CLBR) of women aged ≥40 years using their own oocytes, compared to women of a similar age, using donor oocytes. 

Aims 

To compare the CLBR for women ≥40 years undergoing ART using autologous oocytes and women of similar age using donor oocytes. 

Materials and Methods 

This population‐based retrospective cohort study used data from all women aged ≥40 years undergoing ART with donated (n = 987) or autologous oocytes (n = 19 170) in Victoria, Australia between 2009 and 2016. A discrete‐time survival model was used to evaluate the CLBR following ART with donor or autologous oocytes. The odds ratio, adjusted for woman’s age; male age; parity; cause of infertility; and the associated 95% confidence intervals (CI), were calculated. The numbers needed to be exposed (NNEs) were calculated from the adjusted odds ratio (aOR) and the CLBR in the autologous group. 

Results 

The CLBR ranged from 28.6 to 42.5% in the donor group and from 12.5% to 1.4% in the autologous group. The discrete‐time survival analysis with 95% CI demonstrated significant aOR on CLBR across all ages (range aOR: 2.56, 95% CI: 1.62–4.01 to aOR: 15.40, 95% CI: 9.10–26.04). 

Conclusions 

Women aged ≥40 years, using donor oocytes had a significantly higher CLBR than women using autologous oocytes. The findings can be used when counselling women ≥40 years about their ART treatment options and to inform public policy.