40岁以上高龄女性体外受精-胚胎移植妊娠结局分析

目的:探讨40岁以上高龄女性体外受精-胚胎移植(IVF-ET)的妊娠结局,旨在为高龄女性提供生育咨询以及为改善高龄女性个体化辅助生殖治疗结局提供临床依据。方法:选择我院生殖中心2015年1月-2017年12月女方年龄≥40岁且使用自身卵子行体外受精的共2 467个治疗周期资料,对各项临床数据进行回顾性分析。结果:40岁及以上行辅助生殖治疗的患者,随着女性年龄增加获卵数明显减少(40~48岁女性平均获卵数分别为2.97、2.69、2.17、2.01、1.77、1.61、1.68、1.29和1.00,44~48岁与40~43岁依次组间比较均P<0.05),尤其是44岁以上女性胚胎发育潜能明显降低(40~48岁囊胚形成率分别为48.90%、43.72%、33.67%、34.29%、24.39%、21.14%、26.32%、16.67%和0%,44~48岁与40~43岁组间依次比较均P<0.05)。共有518个周期行新鲜胚胎移植,结果显示,随女性年龄增加,临床妊娠率(40~48岁临床妊娠率分别为26.92%、21.15%、20.79%、10.96%、18.87%、11.11%、5.88%、0%和0%,43~48岁与40~42岁组间依次比较均P<0.05)、种植率(40~48岁种植率分别为23.65%、19.51%、17.70%、8.54%、7.49%、10.81%、5.56%、0%和0%,43~48岁与40~42岁组间依次比较均P<0.05)和活产率均显著降低(40~46岁活产率分别为18.46%、10.58%、9.90%、5.48%、5.66%、2.78%和5.88%,43~46岁与40~42岁组间依次比较均P<0.05),43岁以上者结局更差。44岁以上女性自然流产率明显增高(40~45岁流产率分别为31.43%、50.00%、52.38%、50.00%、70.00%和75.00%,44~45岁与40~43岁组间依次比较均P<0.05)。46岁女性仅1例妊娠并分娩,47岁和48岁女性均无成功妊娠。与抗苗勒管激素(AMH)>1.0 ng/mL组相比,AMH≤1.0 ng/mL组妊娠率、种植率及活产率均显著下降(27.04%vs. 14.74%,22.99%vs. 13.50%,15.88%vs. 7.37%;均P<0.05),流产率明显升高(41.27%vs. 50.00%,P<0.05)。结论:≥40岁高龄女性随年龄增长生育力逐渐降低。40~43岁年龄段女性助孕仍有一定的价值,尤其是卵巢仍有一定储备者(AMH>1.0 ng/mL),但44岁以上女性原则上不再建议ART助孕,对于46岁以上卵巢功能衰竭的女性强烈建议卵子捐赠或收养。

Pregnancy Outcomes of IVF-ET in Women Aged More Than 40 Years

Objective：To investigate the pregnancy outcomes of in vitro fertilization-embryo transfer (IVF-ET) therapy in women aged ≥ 40 years, so as to provide a clinical reference for the fertility counseling the individualized assisted reproductive treatment (ART) for those ageing women. Methods：The clinical data of 2 467 women aged 40 and older years who used autologous oocytes in ART cycles between January 2015 and December 2017 in our center were retrospectively analyzed. Results：In the IVF-ET cycles, the retrieved oocytes were decreased with increased age in women aged ≥40 years (the average retrieved oocytes in women aged 40-48 years were 2.97, 2.69, 2.17, 2.01, 1.77, 1.61, 1.68, 1.29 and 1.00; when compared the 44-48 years′ group and the 40-43 years′ group, P＜0.05). In particular, the embryo development potential was decreased significantly, especially in women aged ≥44 years (the percentage of blastocyst formation in women aged 40-48 years were 48.90%, 43.72%, 33.67%, 34.29%, 24.39%, 21.14%, 26.32%, 16.67%, and 0%; when compared the 44-48 years′ group and the 40-43 years′ group, P＜0.05). There were a total of 518 cases with fresh embryo transfer cycles. The clinical pregnancy rate (in women aged 40-48 years, were 26.92%, 21.15%, 20.79%, 10.96%, 18.87%, 11.11%, 5.88%, 0% and 0%; when compared the 43-48 years′ group and the 40-42 years′ group, P＜0.05), the implantation rate (in women aged 40-48 years, were 23.65%, 19.51%, 17.70%, 8.54%, 7.49%, 10.81%, 5.56%, 0% and 0%; when compared the 43-48 years′ group and the 40-42 years′ group, P＜0.05) and the live-birth rate (in women aged 40-46 years, were 18.46%, 10.58%, 9.90%, 5.48%, 5.66%, 2.78%, and 5.88%; when compared the 43-46 years′ group and the 40-42 years′ group, P＜0.05) were decreased with age, while these parameters in women aged over 43 years were worse. The abortion rate was increased significantly in women aged ≥44 years (in women aged 40-45 years, were 31.43%, 50.00%, 52.38%, 50.00%, 70.00%, and 75.00%; when compared the 44-45 years′ group and the 40-43 years′ group, P＜0.05), while there was only one case of pregnancy and delivery in all woman aged 46 years, and no successful pregnant case in those women aged 47 and 48 years. The pregnancy rate, implantation rate and live birth rate in the AMH≤1.0 ng/mL group were significantly decreased than those in the AMH＞1.0 ng/mL group (27.04% vs. 14.74%, 22.99% vs. 13.50%, and 15.88% vs. 7.37%; all P＜0.05), while the abortion rate was increased significantly (41.27% vs. 50.00%, P＜0.05). Conclusions：The fertility was declined gradually with the increased age in women aged ≥40 years. It is still worthy to do ART in women aged 40 43, especially in women with potential ovarian reserve (AMH＞1.0 ng/mL). However, in principle, ART treatment should not be recommended for women aged over 44 years, and oocytes donation or adoption should be strongly recommended for those women aged over 46 years and with the exhausted ovarian function.