Associate Professor

Approach to subfertile women older than 38 years-old: our experience in Tunisia

Radhouane ACHOUR (TN)

Emergency Department of Obstetrics and Gynecology, Faculty of medicine of Tunis-El Manar University Tunis-Tunisia

Context
In the case of women aged 38 and over; pregnancy is associated with increased rate of spontaneous miscarriage, and increased risk of obstetric complications. In addition, in natural cycle, there is a physiological decrease in female fertility potential with advanced age. In these cases, assisted procreation techniques (ART) finds a wide indication, with the help of which these women can get pregnant, carry a pregnancy to term in order to have a child.
Objective Our objective is to study the clinico-biological characteristics of the patients with advanced age, and the results of our center in terms of pregnancy.
Methods – Patient(s) We have conduct a retrospective study in our center in Tunisia. The women whose age at the time of study was 38 years or older were included. The duration of the study spanned 7 years. Any procedure of ARTs that was done before the age of 38 was excluded but taken into consideration.
In our study, beyond the age of forty, the rates of pregnancy and childbirth declined markedly and were 43% and 6.25%, respectively. 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. Result(s) The longer duration of higher education and the delay in obtaining a stable work situation partly explain a later desire for pregnancy among these couples. Nearly 12% of the patients consulted for secondary infertility within the current marriage and previous pregnancies had occurred outside the ARTs in 60% of the cases. Surprisingly, nearly 30% of couples consulted only after four years of infertility. Patients in whom pregnancy had never occurred did not consult promptly than the others.
Conclusions. socio-professional conditions are among the facets that can explain the delay in having a desire for pregnancy. In front of the development of techniques; these elderly women find invaluable help in having a child and a progressive increase in the age of patients who have undergone either in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) is being noted.