高龄女性行人工辅助生殖治疗的临床结局分析  

Clinical outcome of advanced age women undergoing assisted reproductive technology

作　　者：周燕君[1] 陈福才[1] 洪宝丽[1] 邹慧娟 张小为 陈蓓丽[1,2,3] 章志国 曹云霞[1,2,3] 周平 

机构地区：[1]安徽医科大学第一附属医院妇产科生殖医学中心,合肥230022 [2]安徽医科大学生殖健康与遗传安徽省重点实验室,合肥230022 [3]安徽省生命资源保存与人工器官工程技术研究中心,合肥230022

出　　处：《安徽医科大学学报》2018年第2期241-245,共5页Acta Universitatis Medicinalis Anhui

基　　金：国家重点研发计划(编号:2017YFC1002004)

摘　　要：目的探讨年龄≥40岁患者接受体外受精/卵胞浆内单精子显微注射-胚胎移植(IVF/ICSI-ET)治疗的临床结局,旨在为高龄女性助孕提供新策略。方法回顾性分析行IVF/ICSI-ET治疗1 075个周期患者的临床资料,按移植时间分为新鲜胚胎移植(N-ET)周期和冻融胚胎移植(F-ET)周期组,再按女方年龄分为A(40~41岁)、B(42~43岁)和C(≥44岁)组,并比较不同促排卵方案的结局。结果 N-ET组种植率为16.15%,临床妊娠率为27.36%,流产率为24.14%,F-ET组种植率为14.96%,临床妊娠率为23.14%,流产率为39.62%,两组间差异无统计学意义。各年龄组的N-ET及F-ET亚组的临床结局差异无统计学意义。长方案的获卵数显著高于短方案、拮抗剂及微刺激方案(P<0.05),但促性腺激素(Gn)用量及使用天数也显著增加(P<0.001)。结论对于年龄≥40岁的高龄患者,冻融胚胎移植与新鲜胚胎移植具有相似的种植率及临床妊娠率,无禁忌者可选择鲜胚移植。Objective To analyze the clinical outcome of in vitro fertilization/intracytoplasmic sperm injection and embryo transfer （IVF/ICSI-ET） in women aged ≥ 40 years, and provide the most suitable strategy for advanced women. Methods 1 075 IVF/ICSD cycles were enrolled and patients were divided into fresh-embryo transfer（ N- ET） and frozen-thawed embryo transfer （F-ET） groups. Then according to maternal age, patients were divided into three sub-groups ： group A （40 - 41 years）, B （42 - 43 years） and C （ ≥ 44 years）. The clinical outcomes of different ovarian stimulation protocols were analyzed. Results The embryo implantation rate, clinical pregnancy rate and miscarriage rate was 16. 15%, 27.36% and 24. 14%, respectively in N-ET group and the parameters were 14. 96% ,23.14% and 39.62% in F-ET group. There were no statistical significance in these two groups, and there were no significant difference in clinical outcomes of the sub-group between the N-ET group and F-ET group. The mean retrieved oocyte numbers of GnRH-a long protocol, were significantly higher than GnRH-a short protocol, GnRH-antagonist protocol and mini-stimulation protocol （ P 〈 0. 05 ）. And the stimulation days of Gn and the total dose of Gn were also significantly higher than others （ P 〈 0. 001 ）. Conclusion For patients ≥ 40 years, freezethaw embryo transfer and fresh embryo transfer has a similar planting rate and clinical pregnancy rate, no contraceptive can choose fresh embryo transplantation.

关 键 词：高龄 新鲜胚胎移植 冻融胚胎移植 促排卵方案 

分 类 号：R711.6[医药卫生—妇产科学]