Instituto Universitario-IVI, Plaza Policía Local, No. 3, 46015-Valencia, Spain.
Reprod Biomed Online. 2010 Nov;21(5):649-57. doi: 10.1016/j.rbmo.2010.06.020. Epub 2010 Jun 19.
In this retrospective study, the utility of preimplantation genetic screening (PGS) in patients with advanced maternal age is evaluated. The patient population consisted of women aged 38-44years and included in a regular IVF programme with or without PGS analysis. Transfer rate, ongoing implantation rate and ongoing pregnancy rate were the main outcome parameters measured. A trend of better ongoing pregnancy rate per oocyte retrieval was observed in patients aged 38 and 39years in the non-PGS group when compared with PGS groups, but better ongoing pregnancy rate per oocyte retrieval was observed in patients 41-44years old in the PGS group. When patients with a low ovarian response accumulated oocytes in several stimulation cycles, clinical outcomes were comparable to those of normal-responder patients. These results show that, although PGS does not benefit patients less than 40years of age, reproductive success increases more than two-fold in patients over 40years, especially in patients with more than six metaphase II oocytes, as a result of a good ovarian response or gamete accumulation, suggesting a redefinition of advanced maternal age as indication for PGS. In this retrospective study, the utility of preimplantation genetic screening (PGS) in patients with advanced maternal age is evaluated. Patient population consisted of women aged 38-44 years and included in a regular IVF programme with or without PGS analysis. Transfer rate, ongoing implantation rate and ongoing pregnancy rate were the main outcome parameters measured. A trend of better ongoing pregnancy rate per ovarian stimulation cycle was observed in patients aged 38-39 years in the non-PGS group when compared with PGS groups, but better ongoing implantation rate was observed in patients aged 41-44 years old in the PGS group. When patients with a low ovarian response (low number of oocytes available for the IVF cycle) accumulated oocytes in several stimulation cycles, their reproductive possibilities were comparable to those of normal-responder patients. These results show that, although PGS does not benefit patients less than 40 years of age, reproductive success increases more than 2-fold in patients over 40 years, especially in patients with more than six metaphase II oocytes, as a result of a good ovarian response or gamete accumulation, suggesting a redefinition of advanced maternal age as indication for PGS.
在这项回顾性研究中，评估了高龄产妇进行胚胎植入前遗传学筛查（PGS）的效用。患者人群为年龄在 38-44 岁的女性，包括在常规体外受精（IVF）计划中，或接受 PGS 分析。主要的结局参数包括移植率、持续着床率和持续妊娠率。在非 PGS 组中，与 PGS 组相比，38 岁和 39 岁的患者每取卵周期的持续妊娠率呈上升趋势，但在 41-44 岁的患者中，PGS 组的每取卵周期的持续妊娠率更高。当卵巢反应不良的患者在几个刺激周期中积累卵子时，其临床结局与正常反应患者相当。这些结果表明，尽管 PGS 对年龄小于 40 岁的患者没有益处，但对于年龄大于 40 岁的患者，生殖成功率增加了两倍以上，特别是对于那些有超过 6 个中期 II 卵母细胞的患者，这是由于卵巢反应良好或配子积累，提示重新定义高龄产妇为 PGS 的适应证。
