The pattern of infertility diagnoses in women of advanced reproductive age

Objective: Our intention was to determine whether there is a unique pattern of infertility diagnoses in older infertile couples. Study Design: The design of this study was a retrospective chart review study. It was performed in a tertiary referral reproductive medicine unit. There were 2 groups of patients-couples: group 1, female partner aged 20-29 (n = 105) at presentation; group 2, female partner aged 40-45 (n = 112) at presentation. All women underwent infertility evaluations between 1989 and 1994. There were no interventions. The prevalence of standard infertility diagnoses was the main outcome measure. Results: The prevalence of 8 major infertility diagnoses in the younger and older groups (each couple could have ≥1 diagnosis) was as follows: (1) ovulatory factor—younger group, 56%; older group, 30%; (2) tubal factor—younger group, 34%; older group, 29%; (3) endometriosis—younger group, 13%; older group, 17%; (4) uterine factor—younger group, 1%; older group, 5%; (5) cervical factor—younger group, 4%; older group, 1%; (6) luteal deficiency—younger group, 4%; older group, 10%; (7) male factor—younger group, 32%; older group, 45%; (8) unexplained—younger group, 5%; older group, 10%. The only significant difference was an increase in ovulatory factor in the younger group. Conclusions: There is no unique pattern of infertility diagnoses in women of advanced reproductive age as seen at a tertiary referral center. We speculate that a high false-positive rate associated with standard infertility tests and a different referral pattern for older couples obscures any real differences in the etiology of infertility in older couples. (Am J Obstet Gynecol 1999;181:952-7.)