40岁及以上不孕女性患者助孕妊娠结局的相关影响因素分析

Analysis of related influencing factors of assisted pregnancy outcomes in infertile women aged 40 years and above

目的探讨影响40岁及以上高龄女性体外受精助孕妊娠结局的相关影响因素。方法回顾性分析2018年1月至2021年12月于山西医科大学第一医院行体外受精/卵胞浆内单精子注射(in vitro fertilization/intracytoplasmic sperm injection,IVF/ICSI)助孕且年龄≥40岁的不孕症患者资料。根据患者年龄分为6组:40岁组、41岁组、42岁组、43岁组、44岁组、≥45岁组,比较各年龄组患者的临床特征、实验室胚胎培养情况及妊娠结局;探讨不同促排方案、不同移植胚胎数时的妊娠结局。结果(1)临床妊娠率随着年龄的增长而下降,40~44岁之间各组的活产率逐步降低,差异有统计学意义(P<0.05)。(2)各促排方案间的妊娠结局比较,差异无统计学意义(P>0.05)。(3)移植1枚胚胎的临床妊娠率和活产率低于移植2、3枚胚胎的妊娠率,差异有统计学意义(P<0.05),移植2枚与3枚胚胎时的临床妊娠率和活产率差异无统计学意义(P>0.05)。结论临床上应对高龄不孕女性进行全面评估和治疗,根据患者的具体情况选择合适的促排方案;对于可移植胚胎数目在2枚以上的患者建议移植2枚胚胎。

Objective To explore the related factors affecting the pregnancy outcomes of in vitro fertilization(IVF)assisted pregnancy in women aged 40 years and above.MethodssThe data of infertility patients aged≥40 years who were admitted to the First Hospital of Shanxi Medical University for in vitro fertilization/intracytoplasmic sperm injection(IVF/ICSI)assisted pregnancy from January 2018 to December 2021 were retrospectively analyzed.Patients were divided into 6 groups according to different ages:40-years-old group,41-years-old group,42-years-old group,43-years-old group,44-years-old group and≥45 years old group,and the clinical characteristics,laboratory embryo culture situation and pregnancy outcome of patients in each age group were compared.The pregnancy outcomes were compared with different ovulation schemes and different number of embryos transferred.Results①The clinical pregnancy rate decreased with age,and the live birth rate decreased gradually between 40 and 44 years of age,and the difference was statistically significant(P<0.05).②There was no statistically significant difference in pregnancy outcomes among the stimulation regiments(P>0.05).③The clinical pregnancy rate of one embryo transfer was lower than that of two or three embryos transfer,and the difference was statistically significant(P<0.05).There was no significant difference in clinical pregnancy rate between 2 and 3 embryos transfering(P>0.05).Conclusion In clinical practice,comprehensive evaluation and treatment should be conducted for elderly infertile women,and appropriate ovulation promotion plans should be selected based on the specific situation of the patient.For patients with more than 2 transferable embryos,it is recommended to transfer 2 embryos.