输卵管因素不育夫妇年龄和值或差值对辅助生殖结局的影响

Effects of the sum or the difference of ages of tubal infertile couples on the results of assisted reproductive technology

目的探讨输卵管因素不育夫妇年龄和值或差值对体外受精-胚胎移植(IVF-ET)治疗结局的影响。方法回顾性分析本中心2011年至2016年因输卵管因素接受IVF-ET治疗的1937对夫精夫妇和466对供精受精者的资料并随访至2019年9月。按男女年龄和值以及差值分组比较正常受精率、有效及优质胚胎数、临床妊娠率、流产率、累积活产率、婴儿出生体质量等。结果夫妇一般会经过4年尝试自然受孕或常规治疗后选择IVF治疗;夫妇年龄和值分组与正常受精率无关,而与胚胎发育和移植后妊娠结局密切相关。当年龄和值≥70则有效胚胎数、优质胚胎数、临床妊娠率及活产率明显降低,和值≥80则产生明显的叠加累积效应(P<0.01)。夫妇年龄差值仅女方≥男方5岁会对妊娠率有统计学意义(P<0.05)。夫妇年龄和、差值与生化妊娠率、流产率、新生儿出生缺陷、低体质量儿之间差异无统计学意义(P>0.05)。结论评估双方年龄和值比差值更有临床意义,双方会彼此弥补年龄对生育力的影响,双方都应尽量在40岁之前生育,减少年龄对生育和妊娠结果的影响。

Objective To discuss the effects of the sum and the difference of ages of tubal infertile couples on the results of in vitro fertilization-embryo transfer(IVF-ET)treatment.Methods Clinical data of 1,937 tubal infertile couples who received IVF-ET treatment at the center between 2011 and 2016 and the information of 466 sperm donors and recipients and their follow-up status till September of 2019 were retrospectively analyzed in the study.The male and female subjects were divided into groups according to the sum or the difference of their ages.The normal fertilization rate,the number of effective and high-quality embryos,clinical pregnancy rate,miscarriage rate,cumulative live birth rate and the condition of new-born infants were comparatively analyzed between groups.Results The couples usually chose IVF-ET treatment after four-year efforts of natural conception or conventional treatment.The sum of ages of a couple had nothing to do with their normal fertilization rate,but had close relation with the development of embryo and pregnancy outcome after embryo transfer.When the sum of ages of a couple was equal to or more than 80 years,the results showed obvious superimposed and cumulative effects(P<0.01).In regards to the difference of ages,only if the woman was older than the man by 5 years or above,the results showed a statistical significance in the pregnancy rate(P<0.05).Besides,the sum and difference of ages of the couples had no statistical significances in biochemical pregnancy rate,premature birth and miscarriage rates,birth defect of neonate,or low birth weight infants(P>0.05).Conclusion It is more clinically significant to assess the sum of the ages of a couple than to assess their difference of ages.The changes in fertility caused by the relative age gap can be made up for by each other of a couple.Both men and women should try to have children before age of 40 to decrease the effects of ages on the fertility and pregnancy outcomes.