目的:探讨在40岁以上高龄患者中最适的IVF-ET促排方案。方法:回顾性比较分析176例年龄≥40岁接受IVF-ET助孕患者的临床结局,根据患者促排方案的不同分为GnRH激动剂长方案组(A组,56个周期)、GnRH激动剂短方案组(B组,103个月周期)和微刺激组(C组,86个周期)。比较3组患者的临床资料及助孕结局。结果:3组患者的平均年龄、基础FSH、不孕年限、妊娠率、流产率、每可利用胚胎所需Gn量等均无统计学差异(P>0.05)。3组患者的Gn使用天数、可利用胚胎数、成熟卵子数、每成熟卵子所需Gn量两两比较结果显示:A组最高,B组次之,C组最低,组间均有统计学差异(P<0.001)。3组患者的周期取消率A组最低,B组次之,C组最高,组间均有统计学差异(P<0.05)。3组患者hCG注射日内膜厚度B、C组间差异无统计学意义,但均低于A组,差异有明显统计学意义(P<0.001)。结论:适当增加Gn用量可以改善高龄患者的助孕结局;长方案和微刺激方案更适合于高龄患者。长方案耗时及花费较高,但可以改善部分高龄患者助孕结局,是一种有效的促排卵方案;而微刺激方案是一种经济的促排卵方案,可以获得相当的累计妊娠率。 Objective: To explore the most suitable IVF-ET in 40 years old patients. Methods: A retrospective analysis of 176 cases of patients aged ≥ 40 years receiving IVF-ET in patients with clinical outcomes, according to patients with different types of schedule is divided into GnRH agonist long-term group (A group, 56 cycles), GnRH agonist Short-term group (group B, 103 months) and micro-stimulation group (group C, 86 cycles). The clinical data and the results of pregnancy-assisted pregnancy in 3 groups were compared. Results: There was no significant difference in average age, basic FSH, duration of infertility, pregnancy rate, abortion rate and Gn per embryo available (P> 0.05). Three groups of patients using the number of days Gn, the number of embryos available, the number of mature eggs, the amount of Gn required per mature egg pairwise comparison results showed that: the highest in group A, the second in group B, the lowest in group C, between groups were statistically significant (P <0.001). The cancellation rate of group 3 was the lowest in group A, group B was the second, group C was the highest, there were significant differences among groups (P <0.05). There was no significant difference in intima thickness between groups B and C on the day of hCG injection in the three groups, but all of them were lower than that in group A, the difference was statistically significant (P <0.001). Conclusion: Appropriate increase of Gn dosage can improve the pregnancy outcome of elderly patients. The long-term and micro-stimulation regimens are more suitable for elderly patients. Long program time-consuming and costly, but can improve the outcome of some elderly patients assisted pregnancy, ovulation is an effective program; and micro-stimulation program is an economical ovulation program, you can get a considerable cumulative pregnancy rate.