高龄妇女生育力评估及助孕策略

Fertility evaluation and assisted reproduction strategy for women in advanced age

现代社会随着事业和生活压力的增加,许多女性生育年龄逐渐推迟,随着国家对“二孩”生育政策的调整,有生育需求的高龄女性进一步增多,高龄女性生育力下降,需要借助辅助生殖技术怀孕的比例也进一步增多.高龄女性生殖功能的变化主要体现在以雌激素下降、促性腺激素水平升高为特征的生殖内分泌改变,同时以卵泡数目减少和卵子质量下降为特征的卵巢功能衰退.临床应结合多项指标进行综合评估,为高龄患者提供生育咨询.对于输卵管性不孕的高龄患者,体外受精-胚胎移植可能比输卵管手术更有效,拟行体外受精-胚胎移植助孕的高龄女性选择合适的助孕方式也很重要.

In modem society,more and more women choose to delay childbearing due to their increased pressure of career and life.Especially as the gradual adjustment of the second child birth policy in China,the number of women in advanced age with infertility increases quickly.However,the lower fecundity in advanced age pushes them to seek the help of assisted reproductive technology.The change of the female reproductive function mainly reflects in the decrease of estrogen,and the increase of gonadotropin level of reproductive endocrine,and is characterized by reduced number of follicle and diminished oocyte quality.Comprehensive evaluation of fertility and counseling should be provided for women in advanced age in clinical practice.For the advanced patients with tubal factor infertility,IVF-ET may have a higher cumulative pregnancy rate than tubal surgery,and it is important to find out a more appropriate ovarian stimulation protocol for women in advanced age who should receive IVF-ET.