不同年龄女性行体外受精-胚胎移植妊娠及产科结局

目的:探讨不同年龄女性接受体外受精-胚胎移植(IVF-ET)的妊娠及产科结局,并为不同年龄女性推荐更合理的助孕策略。方法:将2002年1月~2005年5月1 301例行IVF-ET的女性按年龄分为5组:≤25岁,26~29岁,30~34岁,35~39岁和≥40岁。回顾分析各年龄组的妊娠及产科结局。结果:种植率及妊娠率随年龄增加而降低(各组分别为40.8%、39.7%、33.8%、29.6%、13.9%和58.2%、60.0%、52.3%、45.7%、29.41%,P<0.05)。流产率随年龄增加而增加,≥40岁组的流产率为26.7%,显著高于其他组(P<0.05)。总的多胎发生率为44.5%,5组比较有显著性差异(P<0.05)。≥40岁组多胎率为6.7%,其他组都在40%以上,≤25岁组高达57.9%。各年龄组在产科结局方面(早产率、孕周、新生儿体重、剖宫产率等)无显著性差异(P>0.05)。结论:随着年龄的增加,种植率、妊娠率及多胎率逐渐降低,而流产率逐渐增高,40岁后这种变化更为显著。选择合适的促排卵方案及提高卵子质量,可能有助于改进高龄女性的妊娠结局。而对于年轻女性,应根据移植胚胎的质量制定个体化移植方案,尽可能降低多胎妊娠率而不影响总的临床妊娠率。

Influence of Female Age on the Pregnancy and Obstetric Outcome in in vitro Fertilization and Embryo Transfer

OBJECTIVE: To investigate the influence of female age on the pregnancy and obstetric outcome of in vitro fertilization and embryo transfer, expecting to select the most suitable strategy for women with different ages. METHODS: One thousand three hundred and one IVF-ET cycles from January 2002 to May 2005 were analyzed retrospectively. All the cycles were divided into five groups by female age: < or = 25, 26 to approximately 29, 30 to approximately 34, 35 to approximately 39 and > or = 40 years. RESULTS: The pregnancy rate was significantly lower( 58.2%, 60.0%, 52.3%, 45.7% and 29.41% respectively, P < 0.05), and implantation rate was significantly lower too(40.8%, 39.72%, 33.78%, 29.6% and 13.9% respectively, P < 0.05). But the abortion rate increased dramatically (5.3%, 6.8%, 9.7%, 11.6% and 26.7% respectively) and multiple pregnancy rate decreased (57.9%, 45.5%, 41.9%, 46.5% and 6.7% respectively). There were no significant differences about the obstetric results (premature delivery, gestational age, birth weight, caesarean). CONCLUSION: With the age growing, the implantation rate, pregnancy rate and multiple rate decreased, while the abortion rate increased, especially when the age over 40. Suitable controlled ovarian hyperstimulation regimens and improving oocyte quality were described for elder women. For younger women, suitable transfer strategy should be advised to decrease multiple pregnancy without decrease in the ongoing pregnancy rate.