al-Shawaf T, Nolan A, Guirgis R, Harper J, Santis M, Craft I
London Fertility and Gynaecology Centre, UK.
Hum Reprod. 1992 Sep;7(8):1106-10. doi: 10.1093/oxfordjournals.humrep.a137802.
Fecundity declines with increasing age in women. The pregnancy rate is lower in in-vitro fertilization/embryo transfer (IVF/ET) in women aged greater than or equal to 40 years. We analysed 349 consecutive gamete intra-Fallopian transfer (GIFT) cycles in women aged greater than or equal to 40 years to identify factors which affected the outcome. A maximum of four oocytes were transferred in GIFT as recommended by the Interim Licensing Authority; 61 women (17.5%) had a positive serum beta-human chorionic gonadotrophin, 35 (10%) had a miscarriage and 26 (7.5%) delivered live infants. The pregnancy rate was lower than with younger women while the conception loss was higher. Pregnancy and delivery rates increased as the number of oocytes retrieved increased but declined again if greater than 10 oocytes were retrieved. If 1-3 oocytes were retrieved, the pregnancy rate was 9.7% and the delivery rate was 3.9%; if 4-10 oocytes were retrieved, the pregnancy rate was 22.1% and the delivery rate was 10.1%, and when greater than 10 oocytes were retrieved, the rates were 17.6 and 5.9% respectively. The highest pregnancy rate was when four oocytes were transformed in GIFT (22.4%) and the delivery rate was 10.0%. An adequate response to long down-regulation with gonadotrophin-releasing hormone agonist was also a factor associated with high delivery rates (13.5%). We conclude that the delivery rate after GIFT in women aged greater than or equal to 40 years is low, but there is a subgroup who have an acceptable delivery rate because of a good ovarian response. In this group, pituitary down-regulation improves the outcome of treatment.
女性的生育能力随年龄增长而下降。40岁及以上女性进行体外受精/胚胎移植（IVF/ET）时的妊娠率较低。我们分析了349例连续的40岁及以上女性的配子输卵管内移植（GIFT）周期，以确定影响结局的因素。按照临时许可当局的建议，GIFT中最多移植4个卵母细胞；61名女性（17.5%）血清β-人绒毛膜促性腺激素呈阳性，35名（10%）发生流产，26名（7.5%）分娩活婴。妊娠率低于年轻女性，而妊娠丢失率更高。妊娠率和分娩率随着获取的卵母细胞数量增加而上升，但如果获取的卵母细胞超过10个则再次下降。如果获取1-3个卵母细胞，妊娠率为9.7%，分娩率为3.9%；如果获取4-10个卵母细胞，妊娠率为22.1%，分娩率为10.1%，当获取的卵母细胞超过10个时，妊娠率和分娩率分别为17.6%和5.9%。GIFT中移植4个卵母细胞时妊娠率最高（22.4%），分娩率为10.0%。对促性腺激素释放激素激动剂进行充分的长效降调节也是与高分娩率相关的一个因素（13.5%）。我们得出结论，40岁及以上女性进行GIFT后的分娩率较低，但有一个亚组由于卵巢反应良好而有可接受的分娩率。在这个亚组中，垂体降调节可改善治疗结局。
