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

Authors

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

Published in

Journal of assisted reproduction and genetics. Jul 24, 2026. Epub Jul 24, 2026.

Abstract

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

PMID:
42496955
Bibliographic data and abstract were imported from PubMed on 24 Jul 2026.

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