Pal Lubna, Santoro Nanette
Reproductive Endocrinology and Infertility, Albert Einstein College of Medicine, Department of Obstetrics, Gynecology, and Women's Health, 1300 Morris Park Avenue, Mazer 325, Bronx, NY 10461, USA.
Endocrinol Metab Clin North Am. 2003 Sep;32(3):669-88. doi: 10.1016/s0889-8529(03)00046-x.
A progressive decline in fecundity with advancing age is a reality, attributed primarily to the detrimental impact of various aging processes on female gametes. Despite medical advances that have dramatically prolonged the female life span, declining numbers and deteriorating quality of oocytes, and an increasing incidence of meiotic errors and aneuploidy of gametes and embryos, reduce clinical pregnancy rates and escalate pregnancy wastage. Increased fetal aneuploidies in ongoing pregnancies and an increased predisposition to obstetric morbidities further contribute to the diminishing reproductive successes associated with advancing age. The age of male partners, despite the decline in semen parameters and sexual performance with aging, does not appear to have a major impact on the eventual fertility of the aging couple. The contributions of age-related impaired sexuality and ejaculatory problems, although slight albeit significant, to declining fertility in the aging should be appreciated in appropriate cases. With the realization of the age-related detriment on fertility potential and the limitations of available therapeutic interventions, management of subfecundity in women beyond their mid-30s should be approached aggressively. Success of ovulation induction with clomiphine citrate or gonadotropins is marginal in women aged older than 40 years; a case can be made to proceed directly with ART in women in this age group, especially when there is coexisting male factor or pelvic disease. Except for the use of donor oocytes, the outcome of various therapeutic interventions to optimize reproductive performance in women aged older than 44 years remains dismal. A broader application of PGD techniques may contribute to improved live birth rates in reproductively aging women. The greater likelihood of obstetric complications in pregnancies resulting from donor oocytes and an increased prevalence of age-related medical problems complicating pregnancy should prompt a thorough medical evaluation before proceeding with ART.
随着年龄增长，生育能力逐渐下降是一个现实情况，这主要归因于各种衰老过程对女性配子的有害影响。尽管医学进步显著延长了女性寿命，但卵母细胞数量减少、质量下降，以及配子和胚胎减数分裂错误和非整倍体发生率增加，降低了临床妊娠率并增加了妊娠流失率。持续妊娠中胎儿非整倍体增加以及产科疾病易感性增加，进一步导致与年龄增长相关的生殖成功率下降。男性伴侣的年龄，尽管随着年龄增长精液参数和性功能会下降，但似乎对老年夫妇的最终生育能力没有重大影响。在适当情况下，应认识到与年龄相关的性功能障碍和射精问题对老年生育能力下降的贡献，尽管轻微但很显著。随着人们认识到年龄对生育潜力的不利影响以及现有治疗干预措施的局限性，对于35岁以上女性的生育力低下问题应积极进行管理。对于40岁以上的女性，使用枸橼酸氯米芬或促性腺激素进行促排卵的成功率很低；对于这个年龄组的女性，可以直接进行辅助生殖技术（ART），特别是当存在男性因素或盆腔疾病时。除了使用供体卵母细胞外，对于44岁以上女性进行各种优化生殖性能的治疗干预的结果仍然很不理想。植入前基因诊断（PGD）技术的更广泛应用可能有助于提高生殖衰老女性的活产率。供体卵母细胞导致的妊娠中产科并发症的可能性更大，以及与年龄相关的医学问题使妊娠复杂化的患病率增加，这应该促使在进行ART之前进行全面的医学评估。
