Saldeen Pia, Källen Karin, Sundström Per
IVF kliniken CURA, Malmö, Sweden.
Acta Obstet Gynecol Scand. 2007;86(4):457-61. doi: 10.1080/00016340701194948.
To evaluate the relationship between age and poor ovarian response to pregnancy and cancellation rate after IVF stimulation.
Poor ovarian response was defined as <or=5 follicles at ovum pick up (OPU). Out of 1,706 consecutive OPUs performed during 2003/2004, 290 poor responders were identified. This cohort of poor responders was divided into two groups, 'older' and 'younger', with a cut-off at the median age of 37 years. The pregnancy and cancellation rates after OPU were analysed.
Women aged >37 years, who were poor responders, had a significantly lower pregnancy rate per OPU (3.0%) compared to normal to high responders in the same age group (22.1%, p<0.05). Also, 43.6% of women >37 years, who were classified as poor responders, did not receive an embryo transfer (ET), compared to 13.2% of normal to high responders in this age group (p<0.05). Poor responders who were <or=37 years had a significantly lower pregnancy rate/OPU compared to normal to high responders who were <or=37 years (14.0 versus 34.5%, p<0.05) and a higher cancellation rate (40.1 versus 10.5%). Logistic regression analyses showed strong correlations between treatment outcome and the number of oocytes, age, and the mean and cumulative FSH dose given. The variable with the strongest impact on negative outcome was an interactive term between mean age and mean-FSH dose (p=5.0 x 10(-5)), indicating that women >37 years, who receive high doses of FSH have a significantly poorer treatment outcome than can be explained by either age or FSH dose alone.
Poor ovarian response after IVF stimulation requires thorough counselling prior to OPU, regardless of the woman's age. In poor responders >37 years of age, especially those who require high FSH doses, we suggest that the decision whether or not to proceed to OPU should include the couple after thorough counselling, even though the chance of successful outcome is extremely low.
评估年龄与体外受精（IVF）刺激后卵巢反应不良、妊娠及取消率之间的关系。
卵巢反应不良定义为取卵时卵泡数≤5个。在2003/2004年连续进行的1706次取卵中，识别出290例反应不良者。将这组反应不良者分为“年龄较大”和“年龄较小”两组，以37岁的中位数年龄为界。分析取卵后的妊娠率和取消率。
年龄>37岁的反应不良女性，每次取卵的妊娠率（3.0%）显著低于同年龄组的正常至高反应者（22.1%，p<0.05）。此外，年龄>37岁且被归类为反应不良的女性中，43.6%未接受胚胎移植（ET），而该年龄组正常至高反应者中这一比例为13.2%（p<0.05）。年龄≤37岁的反应不良者每次取卵的妊娠率显著低于年龄≤37岁的正常至高反应者（14.0%对34.5%，p<0.05），取消率更高（40.1%对10.5%）。逻辑回归分析显示治疗结果与卵母细胞数量、年龄以及给予的平均和累积促卵泡激素（FSH）剂量之间存在强相关性。对负面结果影响最大的变量是平均年龄和平均FSH剂量之间的交互项（p=5.0×10⁻⁵），表明年龄>37岁且接受高剂量FSH的女性治疗结果明显较差，这不能仅用年龄或FSH剂量来解释。
IVF刺激后卵巢反应不良，无论女性年龄大小，在取卵前都需要进行全面咨询。对于年龄>37岁的反应不良者，尤其是那些需要高剂量FSH的患者，我们建议即使成功几率极低，在全面咨询后，决定是否进行取卵时应让夫妇双方共同参与。
