行体外受精-胚胎移植的40岁以上妇女妊娠结局分析

Clinical outcomes of in vitro fertilization and embryo transfer in women over the age of 40

目的探讨行体外受精-胚胎移植(IVF-ET)40岁以上妇女的结局及其影响因素。方法采用回顾性分析方法,收集2001年3月至2006年3月于广东省妇幼保健院行IVF-ET治疗不孕症的40岁以上妇女82例,共93个周期,从中找出不同年龄妇女进行IVF-ET的临床结局及其影响因素。结果82例患者共行93个超促排卵周期,其中取消周期11个,取消率11.83%;行新鲜胚胎移植74个周期,临床妊娠率25.68%,着床率10.87%,流产率36.4%;40岁、41岁、42岁、43岁及以上组临床妊娠率分别为32.14%、36.36%、25.00%和0;前3组的流产率分别为44.44%、25.00%和50.00%;与短方案组比较,长方案组促性腺激素(Gn)刺激时间、用量明显增多,获胚胎数和移植胚胎数更多(P<0.05),但两组临床妊娠率、着床率和流产率差异并无显著意义;42岁及以下妇女当获卵数超过4个,妊娠率明显增加。结论40岁以上妇女行IVF-ET妊娠率和着床率均明显降低,并且流产率升高。对于40岁以上妇女,一定数量的卵子可能提高IVF成功率。

Objective To analyze the clinical results and predictors of success of in vitro fertilization （IVF） initiated in women≥40 years. Methods Ninety-three IVF cycles initiated in women aged 40 or above from Mar,2001 to Mar,2006 were analyzed retrospectively; the clinical outcomes were compared between different aged groups. Results Eighty-two women underwent 93 cycles at age 40 or above and 11 cycles were cancelled because of poor response, the cancellation rate being 11.83% ; embryos were transferred in 74 cycles, the overall clinical pregnancy rate（ PR）, implantation rate and abortion rate being 25.68%, 10. 87%, and 36.84% respectively. At age 40, 41,42 and ≥43 years, the clinical PR was 32.14% , 36.36%, 25% and 0, respectively. The abortion rate among the first three groups was 4. 44%, 25% and 50%, respectively. Comparing with short protocol, days of stimulation, amount of gonadotropin administrated, number of embryos obtained and transferred are significantly higher in long protocol. But the pregnancy rate, implantation rate and abortion rate among these two groups have no significant difference. The pregnancy rate is much higher in women younger than 43 years who obtain more than 4 eggs. Conclusion For women over 40 years old seeking IVF treatment, the chances of pregnancy and implantation fall with the concurrent rising miscarriage rate. A certain number of oocytes might predicate a higher success rate for women older than 40.