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Purpose <p>To investigate whether uterine aging independently affects reproductive outcomes in oocyte donation cycles and to evaluate reproductive outcomes across increasing recipient age groups.</p> Methods <p>A retrospective cohort study includes 1774 women undergoing 2760 single blastocyst transfers with donor oocytes (March 2021–December 2024). Transfers were stratified by age: 35–40, 41–45, 46–49, and &gt; 49&#xa0;years. Multivariable logistic regression was adjusted for BMI, embryo quality, endometrial parameters, sperm characteristics, paternal age, number of inseminated oocytes, and PGT-A use. Uncensored and exploratory censored Kaplan–Meier analyses estimated cumulative live birth rates (CLBR).</p> Results <p>Live birth rates declined progressively with advancing recipient age. Women aged &gt; 49&#xa0;years had significantly lower live birth rates (OR 0.62, 95% CI 0.41–0.93, <i>p</i> = 0.02) and higher miscarriage risk (OR 2.07, 95% CI 1.16–3.69, <i>p</i> = 0.01). CLBR decreased from 80% (35–40&#xa0;years) to 62.5% (&gt; 49&#xa0;years) in uncensored analysis (<i>p</i> &lt; 0.0001). The prevalence of trilaminar endometrium significantly declined in women ≥ 46 (<i>p</i> &lt; 0.0001), while endometrial thickness remained comparable. Although advanced paternal age was associated with reduced fertilization and poorer embryo quality (<i>p</i> &lt; 0.0001), it was not associated with implantation, live birth, or miscarriage rates in the subgroup of recipients aged &gt; 49&#xa0;years.</p> Conclusion <p>A clinically significant decline in live birth occurs in recipients aged &gt; 49&#xa0;years, suggesting a late-onset uterine aging effect. These findings may help guide counseling and risk assessment in women of advanced maternal age.</p>

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Recipient age and reproductive outcomes in donor oocyte cycles: exploring the potential contribution of uterine aging

  • 期刊论文

  • 发表日期：

    2026年7月24日

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  • Beatrice Crestani,
  • Maria Giulia Massaro,
  • Annalisa Parisi,
  • Pietro Molinaro,
  • Antonio Pellicer,
  • Mauro Cozzolino

摘要

Purpose

To investigate whether uterine aging independently affects reproductive outcomes in oocyte donation cycles and to evaluate reproductive outcomes across increasing recipient age groups.

Methods

A retrospective cohort study includes 1774 women undergoing 2760 single blastocyst transfers with donor oocytes (March 2021–December 2024). Transfers were stratified by age: 35–40, 41–45, 46–49, and > 49 years. Multivariable logistic regression was adjusted for BMI, embryo quality, endometrial parameters, sperm characteristics, paternal age, number of inseminated oocytes, and PGT-A use. Uncensored and exploratory censored Kaplan–Meier analyses estimated cumulative live birth rates (CLBR).

Results

Live birth rates declined progressively with advancing recipient age. Women aged > 49 years had significantly lower live birth rates (OR 0.62, 95% CI 0.41–0.93, p = 0.02) and higher miscarriage risk (OR 2.07, 95% CI 1.16–3.69, p = 0.01). CLBR decreased from 80% (35–40 years) to 62.5% (> 49 years) in uncensored analysis (p < 0.0001). The prevalence of trilaminar endometrium significantly declined in women ≥ 46 (p < 0.0001), while endometrial thickness remained comparable. Although advanced paternal age was associated with reduced fertilization and poorer embryo quality (p < 0.0001), it was not associated with implantation, live birth, or miscarriage rates in the subgroup of recipients aged > 49 years.

Conclusion

A clinically significant decline in live birth occurs in recipients aged > 49 years, suggesting a late-onset uterine aging effect. These findings may help guide counseling and risk assessment in women of advanced maternal age.