Women’s Age as a Determinant of Pregnancy Outcomes in ICSI Treatment: A Retrospective Cohort Study

Background: Female age is a major determinant of assisted reproductive technology outcomes, and data on intracytoplasmic sperm injection (ICSI) outcomes in women aged 40 years and older is limited. This study evaluated the association between maternal age and reproductive outcomes after IVF/ICSI. Methods: A retrospective cohort study was conducted at the Reproductive Endocrine and Infertility Medicine Department, King Fahad Medical City, Riyadh, Saudi Arabia, including IVF/ICSI cycles performed between January 2022 and December 2024. Women were grouped as ≤34 years, 35–39 years, and >39 years, with additional analysis using ≤35 and >35 years. Demographic, clinical, stimulation, embryological, and reproductive outcome data were analyzed. Results: A total of 2,507 cycles were included; 1,280 (51.1%) were in women aged ≤34 years, 741 (29.6%) in women aged 35–39 years, and 486 (19.4%) in women aged >39 years. Embryo transfer rates declined significantly with age (77.9%, 75.6%, and 60.3%, respectively; p<0.001). Older women had lower baseline antral follicle count, higher baseline FSH, required higher gonadotropin doses, and had fewer retrieved oocytes, mature oocytes, fertilized oocytes, and cleaved embryos (all p<0.001). Clinical pregnancy rates decreased from 28.0% to 21.3% and 14.3%, while miscarriage increased and live birth significantly decreased with age (p<0.001). Conclusion: Advancing maternal age was associated with reduced ovarian response and poorer reproductive outcomes after IVF/ICSI, among women older than 39 years.