40岁以上妇女行体外受精-胚胎移植治疗的结局分析

目的探究40岁以上高龄妇女行体外受精-胚胎移植（IVF/ICSI-ET）治疗的治疗结局。方法2007年1月~2015年12月在南方医科大学南方医院生殖医学中心进行非赠卵IVF/ICSI-ET的≥40岁妇女的1050个起始周期的临床资料进行回顾性分析。按妇女年龄分为4组：40岁组（n=393），41岁组（n=266），42岁组（n=158），43岁组（n=107），44岁组（n=64），≥45岁（45~51岁）组（n=62），比较分析各组的临床特征和助孕结局。比较不同促排卵方案和不同移植胚胎数目的妊娠结局。结果共1032个取卵周期，750个移植周期，113个周期获得临床妊娠，临床妊娠率为17.7%，其中64个周期获得活产，活产率为8.5%。各组的临床妊娠率分别为23.4%、21.0%、13.1%、9.2%、5.6%和0%，胚胎着床率为11.2%、10.2%、6.3%、5.1%、2.3%和0%，各组的早期自然流产率分别为31.0%、35.9%、42.9%、42.9%和100%，各组的活产率分别为11.9%、11.8%、2.8%和3.9%。长方案、短方案、拮抗剂方案、促排卵方案的临床妊娠率分别为23.6%、10.2%、13.3%、2.3%。750个移植周期中，移植1个胚胎，临床妊娠率为3.8%，移植2个胚胎，为12.6%，移植3个胚胎，为23.0%。结论年龄大于40岁的患者临床妊娠率逐年显著下降，并且年龄≥44岁获活产的概率极低。对于≥40岁妇女即使无其他明显导致不孕的病因，应在知情告知后实施辅助生殖技术治疗，对于年龄≥44岁妇女，则寻求赠卵是更好的选择。

Clinical outcome of in vitro fertilization or intracytoplasmic sperm injection-embryo transfer in women aged 40 years and above

Objective To investigate the clinical outcomes in vitro fertilization or intracytoplasmic sperm injection-embryo transfer (IVF/ICSI-ET) in women aged over 40 years.Methods We retrospectively analyzed 1050 non-donor IVF/ICSI-ET cycles performed from January,2007 to December,2015 in women at the age 40 years or above,including 393 women at 40 years of age,266 at 41 years,158 at 42 years,107 at 43 years,64 at 44 years,and 65 at 45-51 years.The clinical characteristics and outcomes of the women in different age groups were compared and analyzed.The pregnancy outcome of different ovarian stimulation protocols and different numbers of embryo transferred were also compared.Results Oocyte retrieval was achieved in 1032 treatment cycles.Of the 750 embryo transfer cycles,the clinical pregnancy rate was 17.7％ (113/750),and the live birth rate was 8.5％ (64/750).The clinical pregnancy rate in the 5 age groups was 23.4％,21.0％,13.1％,9.2％,5.6％ and 0％,and the implantation rate was 11.2％,10.2％,6.3％,5.1％,2.3％ and 0％,respectively;the early spontaneous abortion rate was 31.0％,35.9％,42.9％,42.9％ and 100％,and the live birth rate was 11.9％,11.8％,2.8％ and 3.9％.The clinical pregnancy rates of long protocol,short protocol,GnRHa antagonist protocol,and ovulation induction protocol were 23.6％,10.2％,13.3％,and 2.3％,respectively.In the 750 transfer cycles,the clinical pregnancy rate was 3.8％ with single embryo transfer,12.6％ with double embryos transfer,and 23.0％ with 3 embryos transfer.Conclusion In women aged 40 years or above,the clinical pregnancy rate decreased signiacantly with age,and the live birth rate was extremely low in women aged beyond 44 years.Assisted reproductive technique is recommended for women aged 40 years and above even when no identifiable causes of sterility are present.For women aged above 44 years of age,oocyte donation may be a better option.