| 引用本文： |
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石礼红,纪亚忠,张迅轶,等.年龄对体外受精-胚胎移植妊娠结局的影响[J].同济大学学报（医学版）,2019,40(1):91-97. [点击复制]
- SHI Li-hong,JI Ya-zhong,ZHANG Xun-yi,et al.Impact of age on pregnant outcome of in vitro fertilization-embryo transfer cycles[J].同济大学学报（医学版）,2019,40(1):91-97. [点击复制]
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| 摘要: |
| 目的 评估年龄因素对不孕女性行体外受精-胚胎移植（in vitro fertilization and embryo transfer, IVF-ET）妊娠结局的影响。方法 回顾性分析2016年11月至2017年11月间同济大学附属同济医院生殖医学科因不孕行IVF-ET的665例不孕妇女的1092个移植治疗周期的临床、实验室和随访资料。将研究对象按年龄分为4组（≤35岁、36~39岁、40~42岁、≥43岁），比较各年龄组妇女在不同基础情况、不同获胚情况的临床妊娠结局，分析各年龄组段妇女使用不同超促排卵方案（长方案、拮抗剂和短方案）和不同移植方式（冻胚和鲜胚移植）行IVF-ET治疗的临床结局。单因素和多因素回归分析研究不孕妇女行IVF-ET治疗临床妊娠结局的影响因素。结果 单因素分析发现，女性年龄、窦卵泡计数、基础卵泡刺激素、获卵数、2PN数、卵裂数、优质胚胎数和移植胚胎数均影响临床妊娠结局(P＜0.05)。多因素回归模型分析发现年龄（OR=2.232，95%CI： 1.315～3.772）是不孕女性行IVF-ET治疗临床妊娠结局的独立风险因素。不同年龄组之间的临床妊娠率、流产率和活产率差异有统计学意义(P＜0.05)。高龄女性窦卵泡计数显著降低（P＜0.001），基础卵泡刺激素较年轻女性组明显升高（P＜0.001）。≥40岁的高育龄妇女获卵数、卵裂数、2PN数、优质胚胎数明显减少。不同年龄组的移植胚胎数差异无统计学意义。使用长方案促排，≥43岁组活产率明显下降，流产率显著升高（P＜0.05），但临床妊娠率无差异。拮抗剂方案促排各年龄组临床妊娠结局差异无统计学意义。短方案促排，≥36岁组临床妊娠率、活产率和流产率均显著下降（P＜0.05）。年轻女性（≤39岁）新鲜周期的妊娠率高于复苏周期，流产率低于复苏周期，差异有统计学意义(P＜0.05)，而活产率差异无统计学意义。40～42岁组冻胚移植妊娠成功率和活产率明显高于新鲜周期。结论 女性年龄是预测IVF-ET治疗临床妊娠结局的独立影响因素。应用GnRH拮抗剂促排能增加高龄患者IVF-ET治疗临床活产率，降低流产率， |
| 关键词: 高龄 体外受精-胚胎移植 临床妊娠率 回顾性研究 |
| DOI：10.16118/j.1008-0392.2019.01.018 |
| 投稿时间：2018-05-24 |
| 基金项目:上海市“科技创新行动计划”生物医药领域科技支撑项目（18441910100） |
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| Impact of age on pregnant outcome of in vitro fertilization-embryo transfer cycles |
| SHI Li-hong,JI Ya-zhong,ZHANG Xun-yi,YANG Min,SHEN Zhi-jun,YANG Feng |
| (Reproductive Center, Tongji Hospital, Tongji University, Shanghai, 200065, China) |
| Abstract: |
| Objective To analyze the impact of age on the pregnant outcome in vitro fertilization-embryo transfer(IVF-ET) cycles. Method Total 1092 IVF-ET cycles of from 665 infertile women admitted in Tongji Hospital Reproductive Center from November 2014 to January 2016 were retrospectively analyzed. The influencing factors on the clinical outcome of IVF-ET were examined through univariate and multivariate logistic regression analysis. The study categorized patients into four cohorts according to the age of infertile women（≤35, 36-39, 40-42 and ≥43）. The pregnant outcomes among the four cohorts with different basic ovarian function and various oocytes retrieval were analyzed, and the clinical results of different cohort using various ovarian stimulation protocols(GnRH-agonist long and short term protocol, GnRH-antagonist protocol) and different embryo transfer methods[(frozen-thawed embryo transfer (FET), fresh embryo transfer,(ET)] were analyzed. Results The univariate analysis showed that women’s age, antral follicle counts, basic follicle stimulation hormone, the numbers of retrieved oocytes, bipronulear oocytes, cleavage oocytes, high-quality embryos and transferred embryos significantly affected the clinical outcome(P<0.05). Multivariate logistic regression model showed that the women’s age was an individual impact factor（OR=2.232，95%CI： 1.315-3.772）in the IVF-ET cycles. There was significant difference in clinical pregnancy rate, abortion rate and live birth rate among the four cohorts(P＜0.05). In comparison to the younger women, the older-age group had fewer antral follicle counts（P＜0.001）and higher basic FSH level（P＜0.001）. The patients above 40 years old acquired a lower amount of oocytes, cleavage oocyts, bipronulear oocytes, high-quality embryos and transferable embryos（P＜0.001）.No difference in the number of transferred embryos was found between age groups. The group over 43 years old using GnRH-agonist long protocol manifested an evident decrease in live birth rates, and an increase in abortion rates, but no change in clinical pregnancy rates. The difference in clinical outcome between age groups using GnRH antagonist protocol was not significant. In GnRH-agonist short term protocol, the clinical pregnancy rate, live birth rate and abortion rate declined in the group above 36(P＜0.05). The younger group（≤39 years old）using fresh embryo transfer had a higher clinical pregnancy rate and lower abortion rate than FET(P＜0.05), however, the live birth rate was the same. The pregnancy rate and live birth rate of 40-42 years old group using FET was significantly higher than fresh transfer cycles. Conclusion Women age is an individual influencing factor to predict the clinical outcome of IVF-ET. |
| Key words: elder age in vitro fertilization-embryo transfer clinical outcome retrospective studies |
