Prediction of Pregnancy Rate of In Vitro Fertilization and Embryo Transfer in Women Aged 40 and over with Basal Uterine Artery Pulsatility Index

Purpose: The purpose was to determine the effect of basaluterine perfusion on the pregnancy rates of in vitro fertilizationand embryo transfer (IVF-ET) in women aged 40 and above. Methods: A total of 47 patient aged 40 and over underwentIVF-ET. The conception cycles and the nonconception cycleswere compared. Results: Of the 47 patients, 4 patients were pregnant (8.5%).The mean age, basal follicle stimulating hormone (FSH),basal estradiol (E₂) level, antral follicle count (AFC), numberof ampoules of gonadotropin used, E₂ levels and endometrial thickness on the day of human chorionic gonadotropin(hCG) administration, number of retrieved and fertilizedoocytes, and number of transferred embryos were not statisticallysignificant between the conception and nonconceptioncycles. However, the basal uterine artery pulsatility index(UA PI) was significantly lower in the conception cycles(P < 0.001). The receiver operating characteristics (ROC)curve analysis for basal FSH, AFC, and basal UA PI inpredicting the pregnancy rate of IVF in patients aged 40were demonstrated. The best prediction rate was achievedby a pulsatility index cutoff of < 2.0 for a receptive uterus. Conclusions: Increased uterine perfusion in the early follicularphase enhanced the pregnancy rate of IVF in womenaged 40 and above. It is therefore essential that patientsaged 40 with poor basal uterine perfusion should beidentified early in the early follicular phase of the menstrualcycle to apply appropriate intervention to improve the uterinecirculation for the subsequent chance of pregnancy.