40岁及以上不孕患者的治疗结局—单中心回顾性分析

Pregnancy outcomes of infertile women aged 40 years and over-a single center retrospective analysis

目的了解≥40岁不孕女性的病因现状,探索手术治疗后影响妊娠结局的相关因素。方法回顾性分析2017年1月至2019年12月在北京协和医院妇科行腹腔镜及宫腔镜手术治疗、≥40岁不孕症患者的临床资料,共100例,统计患者不孕因素,分析各不孕因素与妊娠结局的关系。结果纳入患者的各不孕因素占比情况分别如下:子宫因素占比为76.0%(76/100)、子宫内膜异位症占比为55.0%(55/100)、输卵管因素占比为45.0%(45/100)、排卵障碍占比为3.0%(3/100)、男方因素占比为2.0%(2/100)。在手术及辅助生育技术辅助后的总临床妊娠率为28.0%(28/100),活产率为12.0%(12/100),其中年龄≥43岁的患者临床妊娠率为0%,尝试自然妊娠者与进行IVF-ET者相比,妊娠率和活产率均无统计学差异(P>0.05)。与未获得妊娠患者相比,获得临床妊娠患者的年龄更年轻、不孕年限≤3年患者的占比更高,且差异有统计学意义(P<0.05)。Logistic回归分析发现,年龄[OR=0.392,95%CI(0.220,0.697),P=0.001]及不孕年限[OR=0.834,95%CI(0.708,0.983),P=0.031]与能否获得临床妊娠密切相关;而试孕方式、不孕因素、基础FSH水平与妊娠结局之间无显著关联(P>0.05)。结论40岁及以上不孕患者的总临床妊娠率和活产率均较低,IVF-ET治疗的妊娠结局并不优于自然受孕,患者的年龄和不孕年限是影响临床妊娠率的主要因素。

Objective:To investigate the etiology of infertile women≥40 years old,and explore the related factors affecting pregnancy outcome after surgical treatment.Methods:The clinical data of 100 elderly infertile women≥40 years old who underwent laparoscopic and hysteroscopic surgery in Department of Obstetrics and Gynecology of Peking Union Medical College Hospital from January 2017 to December 2019 were retrospectively analyzed.The infertility factors of patients and the relationship between infertility factors and pregnancy outcome were statistically analyzed.Results:The proportion of infertility factors of the patients included was as follows:uterine factors accounted for 76.0%(76/100),endometriosis 55.0%(55/100),oviduct factors 45.0%(45/100),ovulation disorders 3.0%(3/100),and male factors 2.0%(2/100).The total clinical pregnancy rate after surgery and assisted reproduction was 28.0%(28/100),and the live birth rate was 12.0%(12/100).No pregnancy occurred among the patients≥43 years old.There was no significant difference in pregnancy rate and live birth rate between those who tried natural pregnancy and those who underwent IVF-ET(P>0.05).Compared with the patients without pregnancy,the patients with clinical pregnancy were significantly younger,and the proportion of patients with infertility≤3 years was significantly higher(P<0.05).Logistic regression analysis indicated that age[OR=0.392,95%CI(0.220,0.697),P=0.001]and infertility duration[OR=0.834,95%CI(0.708,0.983),P=0.031]were significantly correlated to clinical pregnancy.There was no significant correlation between the way of getting pregnancy,the infertility factors,basal FSH level and pregnancy outcome(P>0.05).Conclusions:The overall pregnancy rate and live birth rate of infertile women≥40 years old are lower,and the IVF-ET outcome is not better than that of natural pregnancy.The age of patients and the infertility duration are the main factors affecting the reproductive outcome.