40岁以上高龄妇女体外受精/卵胞质内单精子显微注射-胚胎移植临床结局分析

Outcomes of in vitro fertilization and intracytoplasmic sperm injection in women aged≥40 years

目的:探讨≥40岁接受体外受精/卵胞质内单精子显微注射-胚胎移植(IVF/ICSI-ET)治疗者的临床结局,旨在为高龄女性推荐更合理的助孕策略。方法:对接受IVF/ICSI-ET治疗的248例年龄≥40岁妇女的320个起始周期按年龄分为40岁、41岁、42岁及≥43岁4组,回顾性分析各组的临床资料。结果:320个起始周期,临床妊娠率为12.50%,活产率为7.19%。4组的周期取消率分别为18.99%、21.43%、32.20%和42.06%;临床妊娠率分别为29.11%、17.86%、10.17%和0.79%;胚胎种植率分别为16.25%、11.02%、6.54%和0.56%;活产率分别为20.25%、7.14%、5.08%和0.00%。各组上述指标比较,差异均有统计学意义(P<0.05);年龄≥43岁组无1例活产。结论:女性≥40岁,年龄每增加1岁即对IVF/ICSI的结局有显著影响,≥43岁获得妊娠和活产的几率极低。建议年龄≥40岁的女性,即使无其他不孕原因亦应积极行IVF/ICSI治疗。而对于年龄≥43岁的女性寻求赠卵治疗或提前冷冻胚胎可能是更好的选择。

Objective： To evaluate the results of in vitro fertilization/intracytoplasmic sperm injection- embryo transfer （IVF/ICSI-ET） in women aged ≥ 40 years using their own oocytes, expecting to select the most suitable strategy for advanced women. Methods： A total of 248 women aged ≥40 years undergoing 320 initiated treatment cycles were analyzed retrospectively. All the cycles were divided into four groups by female age： 40 years, 41 years, 42 years and ≥ 43 years. Results： The overall clinical pregnancy rate per initiated cycle was 12.50% and the live-birth rate was 7.19%. The cancellation rates in four groups （18.99% vs 21.43% vs 32.20% vs 42.06%）increased gradually, while the clinical pregnancy rates （29.11% vs 17.86% vs 10.17% vs 0.79%） and the implantation rates （16.25% vs 11.02% vs 6.54% vs 0.56%） as well as the live birth rates （20.25% vs 7.14% vs 5.08% vs 0.00%） in four groups decreased significantly following the age increasing （P〈0.05）. No live birth was obtained in women aged ≥43 years. Conclusion： The effect of each year of age is very important in predicting outcomes of IVF/ICSI in women aged ≥40 years. The pregnancy rate and the live birth rate are extremely low in women aged≥43 years. The women aged 40 years or older should be treated with IVF/ICSI actively even if there are no reasons for their infertility. Once women have attained 43 years old, alternative methods such as oocyte donation cycles or previously cryopreserved embryos are likely to be more effective.