Intracytoplasmic sperm injection, results in women older than 39, according to age and the number of embryos replaced in selective or non-selective transfers.

The aim of this study was to assess the results of intracytoplasmic sperm injection (ICSI) in a large cohort of women older than 39 according to age and to embryo transfer policy. In all, 736 ICSI cycles were analysed retrospectively. In 576 (78.3%) cycles an embryo transfer was carried out. The embryo transfer was defined as non-selective when all the available embryos were transferred, and as selective when fewer than the available number of embryos were replaced. A statistically significant gradual decrease in the number of embryos available for transfer, the number of good or excellent quality embryos available for transfer, the pregnancy rates, the clinical pregnancy rates, the implantation rates and the viable pregnancy rates was found with advancing age. No viable pregnancies ensued in women from 45 years old onwards. There was a statistically significant gradual increase in the pregnancy rates, the clinical pregnancy rates, the implantation rates and the viable pregnancy rates from non-selective to selective transfers. The results were similar in women with five or more embryos available, irrespective of the embryo transfer policy. It seems, therefore, that the ovarian reserve and the chances for a successful pregnancy decrease gradually with advancing age, and it is pointless to treat women from 45 years old onwards. A subgroup of patients with better ovarian response and more embryos available for transfer have higher chances of conception. Conception and implantation rates depend mainly on the quality of the transferred embryos. However, the implantation capacity of the embryos is generally lower irrespective of their good morphology.