高龄女性不孕诊治指南

随着越来越多的育龄夫妇推迟其生育计划,以及我国“二孩政策”全面放开,高龄希望生育父母的比例逐渐增加。然而,随着女性年龄增加,卵巢功能逐渐下降,且子宫肌瘤、瘢痕子宫、盆腔炎症等发生率显著增加,不孕症的发生率逐渐增加。高龄女性即使通过辅助生殖技术(ART)获得成功妊娠,妊娠并发症风险和内、外科合并症的发生风险亦会随年龄增大而增加,如流产、胎死宫内、低出生体质量、早产以及妊娠期糖尿病和高血压疾病等。对于高龄不孕患者的诊治策略目前尚缺乏一致性,患者的诊治疗效更是参差不齐。基于以上情况,中国医师协会生殖医学专业委员会组织生殖内分泌及ART专家编写了本“高龄女性不孕诊治指南”,希望本指南可以规范我国高龄不孕女性患者的诊治流程。本指南从高龄女性的生育状况、需要进行的相关生育力评估及指标解读以及高龄女性孕前身体和营养准备、咨询、相关妊娠风险评估等入手进行深入探讨,分析了目前临床、实验室的热点问题:高龄女性子代遗传学特征及评估、咨询以及相应的实验室筛查、诊断方法和操作规范。另外,对于高龄女性妇产科及内外科合并症发生率高的状况,针对不同合并症状况探讨了相应的诊疗规范。最后,综合各方面情况制定了高龄女性不孕症的助孕策略,为高龄不孕女性的诊治提供依据和指导。

Guideline for diagnosis and treatment of infertility in advanced age women

As more and more couples postponing their childbearing plan,as well as China's two-child policy fully liberalized,the proportion of advanced age parents gradually increased.In addition,with the age in women,ovary fuction gradually descend and the incidence of uterine fibroids,scarred uterus and pelvic inflammation disease significantly increased,which increased the risk of infertility.Even advanced age women succeeded get pregnancy through assisted reproductive technology (ART),they also have increased risk of miscarriage,gestational diabetes,gestational hypertension,intrauterine fetal death,low birth weight of newborn,or premature birth.The strategy of diagnosis and treatment of elderly patients with infertility is still lack of uniformity.In the light of the above situation,the specialized committee organized experts of reproductive endocrinology and ART to compose this guideline,with the intent of standardizing the process of diagnosis and treatment of advanced aged infertile patients.This guideline interpreted reproductive status and related fertility evaluation of advanced age infertile women,and discussed prepregnancy body and nutrition preparation and consultation,and related risk assessment of pregnancy of these patients.It also analyzed current clinical and laboratory hot issues:the genetic characteristics and evaluation,counseling,and corresponding laboratory screening,diagnostic methods and operating norms of advanced age women.In addition,for elderly women with high incidence of internal and surgical medicine complications,this guideline gave us norms of diagnosis and treatment of different complications.Finally,strategies of treatment were provided for advanced age infertile women.