Pregnancy after age 50: application of oocyte donation to women after natural menopause.

The age at which the uterus no longer provides a receptive environment for embryo implantation and development remains unknown. We assessed whether menopausal women between the ages of 50 and 59 years could be prepared for pregnancy with oocyte donation. All potential recipients underwent extensive screening to ensure that they were in excellent physical, reproductive, and psychological health before enrollment. Of 18 patients initially screened (mean [SD] age 52.2 years [2.5]), 14 couples were entered into the study. Oocytes were donated by fertile women (28.1 [2.7] years) who provided gametes after pituitary downregulation with leuprolide acetate and routine ovarian hyperstimulation by human menopausal gonadotropin. 22 donor follicle aspirations resulted in 21 embryo transfers to 14 recipients. Pregnancies were established in 9 women. 1 pregnancy ended in a preclinical loss. The ratio of clinical pregnancies per transfer attempt was 38% (8/21), with an implantation rate per transferred embryo of 19%. Of the 8 clinical pregnancies, 1 spontaneous abortion occurred at 7 weeks' gestation. 3 women have delivered, 2 at 35 weeks' by emergency caesarean section for worsening preeclampsia and 1 at 37 weeks' after a normal vaginal birth. 4 pregnancies continue to progress normally beyond the second trimester. Women may become pregnant after the age of natural menopause by means of in-vitro fertilisation of donated oocytes. However, thorough medical screening before embryo transfer is essential to reduce to a minimum obstetric risks common in this older population.