高龄女性行人工辅助生殖治疗的临床结局分析

目的 探讨年龄≥40岁患者接受体外受精/卵胞浆内单精子显微注射-胚胎移植(IVF/ICSI-ET)治疗的临床结局,旨在为高龄女性助孕提供新策略.方法 回顾性分析行 IVF/ICSI-ET治疗1 075个周期患者的临床资料,按移植时间分为新鲜胚胎移植(N-ET)周期和冻融胚胎移植(F-ET)周期组,再按女方年龄分为A(40 ～41岁)、B(42 ～43岁)和C(≥44岁)组,并比较不同促排卵方案的结局.结果 N-ET组种植率为16. 15％,临床妊娠率为27. 36％,流产率为 24. 14％ , F-ET组种植率为14. 96％,临床妊娠率为23. 14％,流产率为39. 62％ ,两组间差异无统计学意义.各年龄组的 N-ET及F-ET亚组的临床结局差异无统计学意义.长方案的获卵数显著高于短方案、拮抗剂及微刺激方案(P< 0. 05),但促性腺激素(Gn)用量及使用天数也显著增加(P<0.001).结论 对于年龄≥40岁的高龄患者,冻融胚胎移植与新鲜胚胎移植具有相似的种植率及临床妊娠率,无禁忌者可选择鲜胚移植.

Clinical outcome of advanced age women undergoing assisted reproductive technology

Objective To analyze the clinical outcome of in vitro fertilization/intracytoplasmic sperm injection and embryo transfer (IVF/ICSI-ET) in women aged ≥ 40 years, and provide the most suitable strategy for advanced women. Methods 1 075 IVF/ICSD cycles were enrolled and patients were divided into fresh-embryo transfer (NET) and frozen-thawed embryo transfer (F-ET) groups. Then according to maternal age, patients were divided into three sub-groups;group A(40 ～41 years), B(42 ～43 years) and C(≥44 years). The clinical outcomes of different ovarian stimulation protocols were analyzed. Results The embryo implantation rate, clinical pregnancy rate and miscarriage rate was 16. 15％, 27. 36％ and 24. 14％, respectively in N-ET group and the parameters were 14. 96％, 23. 14％ and 39. 62％ in F-ET group. There were no statistical significance in these two groups, and there were no significant difference in clinical outcomes of the sub-group between the N-ET group and F-ET group. The mean retrieved oocyte numbers of GnRH-a long protocol, were significantly higher than GnRH--a short protocol, GnRH-antagonist protocol and mini-stimulation protocol (P <0. 05). And the stimulation days of Gn and the total dose of Gn were also significantly higher than others (P < 0. 001). Conclusion For patients ≥ 40 years, freeze-thaw embryo transfer and fresh embryo transfer has a similar planting rate and clinical pregnancy rate, no contraceptive can choose fresh embryo transplantation.