In women over 40 years old, pregnancy loss in a first IVF cycle is not predictive of improved delivery rate in subsequent cycles. "In women over 40 years old, pregnancy loss in a first in vitro fertilization (IVF) cycle is not predictive of an improved delivery rate in subsequent cycles, as is the case in women under 40, according to a report in the February issue of Fertility and Sterility.

"Cumulative live birth rates for women 40 years or older with and without prior pregnancy losses are the same," Dr. Rita Sneeringer told Reuters Health.

Dr. Sneeringer from Beth Israel Deaconess Medical Center, Boston, Massachusetts and associates explain that for women younger than 40 undergoing IVF, pregnancy in a prior cycle - even a pregnancy loss - is associated with improved odds of pregnancy in subsequent cycles.

To investigate the situation in older women, the researchers analyzed data on 584 women who had an initial IVF cycle over the age of 40. Fifty-seven of these women delivered and were excluded from the analysis, while 49 had a pregnancy loss and 478 did not conceive.

There was no significant difference in the percent of women who achieved a subsequent liveborn delivery in the prior pregnancy loss group (18.0 per cent) and the negative beta-hCG group (21.9 per cent), the team found.

Most women in both groups had all negative subsequent cycles, the investigators report, and the total subsequent pregnancy losses were similar in the pregnancy-loss and negative beta-hCG groups.

Summing up, Dr. Sneeringer concluded: "For younger women, a prior pregnancy loss selects for women most likely to have a successful ongoing pregnancy in a future cycle. However, this is not true for older women over forty years."

She pointed out that her IVF center has published a descriptive report on pregnancy rates for women over age forty. "In this analysis of over 2700 cycles, higher live birth rates were associated with greater number of embryos available for transfer, embryos available for cryopreservation, and twin gestation on initial ultrasound," Dr. Sneeringer explained. "This analysis showed that fertility rapidly declines in the forties and IVF can be successful in this age group if done before age 44."

Fertil Steril 2008;89:364-367"