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目的:探讨≥40岁接受体外受精/卵胞质内单精子显微注射-胚胎移植(IVF/ICSI-ET)治疗者的临床结局,旨在为高龄女性推荐更合理的助孕策略。方法:对接受IVF/ICSI-ET治疗的248例年龄≥40岁妇女的320个起始周期按年龄分为40岁、41岁、42岁及≥43岁4组,回顾性分析各组的临床资料。结果:320个起始周期,临床妊娠率为12.50%,活产率为7.19%。4组的周期取消率分别为18.99%、21.43%、32.20%和42.06%;临床妊娠率分别为29.11%、17.86%、10.17%和0.79%;胚胎种植率分别为16.25%、11.02%、6.54%和0.56%;活产率分别为20.25%、7.14%、5.08%和0.00%。各组上述指标比较,差异均有统计学意义(P<0.05);年龄≥43岁组无1例活产。结论:女性≥40岁,年龄每增加1岁即对IVF/ICSI的结局有显著影响,≥43岁获得妊娠和活产的几率极低。建议年龄≥40岁的女性,即使无其他不孕原因亦应积极行IVF/ICSI治疗。而对于年龄≥43岁的女性寻求赠卵治疗或提前冷冻胚胎可能是更好的选择。
Objective: To investigate the clinical outcome of 40-year-old in vitro fertilization / intracytoplasmic sperm injection-embryo transfer (IVF / ICSI-ET) in order to propose a more reasonable strategy for pregnancy-assisted pregnancy in elderly women. METHODS: A total of 320 initiation cycles of 248 women aged 40 years and older who were treated with IVF / ICSI-ET were divided into 4 groups of 40 years old, 41 years old, 42 years old and ≥43 years old according to their age. Retrospective analysis of clinical data. Results: 320 initial cycles, clinical pregnancy rate was 12.50%, live birth rate was 7.19%. The pregnancy rates of the four groups were respectively 18.99%, 21.43%, 32.20% and 42.06%. The clinical pregnancy rates were 29.11%, 17.86%, 10.17% and 0.79% respectively. The embryo implantation rates were 16.25%, 11.02% and 6.54% And 0.56% respectively. The live birth rates were 20.25%, 7.14%, 5.08% and 0.00% respectively. The above indicators in each group were compared, the differences were statistically significant (P <0.05); no one live births ≥ 43 years old group. CONCLUSIONS: Women ≥40 years of age, each additional year of age has a significant effect on the outcome of IVF / ICSI, and there is a very low risk of pregnancy and live birth at ≥43 years of age. Suggested age ≥ 40-year-old female, even without other causes of infertility should also be active IVF / ICSI treatment. For women aged ≥43 years seeking egg donation treatment or premature freezing embryos may be a better choice.