高龄妇女接受体外受精-胚胎移植的结局

目的　探讨高龄妇女接受体外受精 胚胎移植 (IVF ET)治疗后妊娠及围产情况。方法　对 1999年 1月至 1999年 12月 ,139例接受常规IVF ET治疗和 6 9例卵母细胞浆内单精子注射(ICSI)治疗的 2 0 8例高龄 (36～ 4 5岁 )妇女的临床资料进行回顾性分析。结果　 2 0 8例共妊娠 4 8例 ,妊娠率为 2 3 1%。 36、37、38、39及 4 0～ 4 5岁组妇女的不孕原因、不孕年限、治疗次数、卵裂率、移植胚胎情况等比较 ,差异均无显著性 (P >0 0 5 )。随年龄增加 ,卵泡数明显减少 ,各年龄组分别为 (14 7±1 2 )、(13 0± 2 0 )、(11 3± 0 9)、(9 7± 0 9)及 (6 5± 1 9)个 ;妊娠率明显下降 ,分别为 2 4 1、2 0 5、13 2、11 1及 9 8% ;种植率也明显下降 ,分别为 15 6、11 2、10 5、6 5和 2 2 % ;而流产率则明显增高 ,分别为 2 3 0、2 7 2、33 4、4 1 2及 4 3 3% ;多胎妊娠率分别为 31 2、2 7 3、15 4、6 7及 0 0 %。各年龄组上述指标比较 ,差异均有显著性 (P <0 0 5 )。除新生儿体重外 ,各年龄组在产科结局方面差异无显著性。结论　 37岁以上妇女接受IVF ET的妊娠率及种植率明显下降 ,≥ 4 0岁妇女下降明显加快 ;移植3个以上胚胎可能有利于提高妊娠率 ,同时不增加多胎妊娠。

Influence of advanced age on the outcome of in vitro fertilization and embryo transfer

OBJECTIVE: To determine the influence of age on the outcome of In vitro fertilization and embryo transfer (IVF-ET). METHODS: A retrospective study of 139 cycles of conventional IVF and 69 intracytoplasmic sperm injection (ICSI) cycles was performed between January 1999 and December 1999. RESULTS: A total of 208 patients (age 36 to 45 years) after IVF or ICSI were divided into five age groups (36 years group, n = 78; 37 years group, n = 49; 38 years group, n = 50; 39 years group, n = 18; 40 approximately 45 years group, n = 13). Pregnancy rate is 23.1%. There appear to be no significant difference between infertility duration, IVF cycles, fertilization rate and cleavage rate, the number and the quality of embryos transferred, and the prenatal outcome in each age group. But with the age growing, the number of follicles in each group decreased significantly (14.7 +/- 1.2, 13.0 +/- 2.0, 11.3 +/- 0.9, 9.7 +/- 0.9 and 6.5 +/- 1.9 respectively), the pregnancy rate were significantly lower (24.1, 20.5, 13.2, 11.1 and 9.8% respectively), implantation rate were significantly lower too (15.6, 11.2, 10.5, 6.5 and 2.2% respectively). But the abortion rate increase significantly (23.0, 27.2, 33.4, 41.2 and 43.3% respectively), and multiple pregnancy rate decreased (31.2, 27.3, 15.4, 6.7 and 0.0% respectively). The pregnancy rates of the ICSI and IVF were similar after stratification by age. CONCLUSIONS: The fecundity reduct significantly at the age older than 36 years old. It reduct more obviously when the age older than 40 years old. Transferring four or more embryos may increase pregnancy rate, but without increasing multiple pregnancy in women older than 40 years.