IVF unit, Dept of Obstetrics and Gynecology, Shaare-Zedek Medical Center, Jerusalem, Israel.
Reprod Biomed Online. 2009;19 Suppl 4:4334.
The tendency to postpone childbearing in developed countries and the relatively high rate of infertility in older women contribute to an increase in the portion of women aged 40 years and older opting for infertility treatments. The main factor for infertility in this group is oocyte senescence, but since this process does not have a specific diagnosis many of those will be classified as having 'unexplained infertility'. The efficacy of the traditional clinical approach for 'unexplained infertility' in older women is questionable. Reviewing the current literature, clomiphene citrate seems to be inefficient in this group of patients, while delivery rates of gonadotrophins and intrauterine insemination cycles are less than 5%. Although low in absolute terms, IVF is more efficient. The chance for delivery, however, diminishes with each year of age above 40. Therefore, after a short trial of gonadotrophins and intrauterine insemination, women aged 40-41 years should be quickly referred to IVF. At an older age, IVF is the primary treatment option.
在发达国家，推迟生育的趋势以及大龄女性相对较高的不孕率导致越来越多的 40 岁及以上女性选择接受不孕治疗。该年龄段女性不孕的主要因素是卵母细胞衰老，但由于该过程没有特定的诊断，因此许多人将被归类为“不明原因不孕”。传统的针对大龄女性“不明原因不孕”的临床方法的疗效值得怀疑。回顾当前的文献，枸橼酸氯米酚在这组患者中似乎效果不佳，而促性腺激素和宫腔内人工授精周期的分娩率低于 5%。虽然绝对数量较低，但体外受精更为有效。然而，随着年龄每增加 1 岁，分娩的机会就会减少。因此，对于 40-41 岁的女性，在接受促性腺激素和宫腔内人工授精的短期试验后，应尽快转介进行体外受精。年龄较大时，体外受精是主要的治疗选择。
