对于 40 岁及以上的不孕女性，最佳的治疗选择是什么？
What is the best treatment option for infertile women aged 40 and over?
机构信息
St Michael's Hospital, Bristol, UK.
出版信息
J Assist Reprod Genet. 2013 Jun;30(5):667-71. doi: 10.1007/s10815-013-9980-6. Epub 2013 Mar 29.
Abstract
PURPOSE
To summarise the causes of decreased fecundity with age and review chronological vs biological ovarian ageing. To explore the clinician's means of assessing a woman's ovarian reserve. To review the recent literature on the effectiveness of different assisted reproductive technology (ART) techniques for women aged 40 and over and offer a single best treatment option.
METHODS
Pubmed and google scholar were searched for relevant articles using key words. Data were extracted based on authors, year, aims, sample and results.
RESULTS
Success rates for women aged 40 or over with clomiphene, IUI, IUI with FSH are all extremely low, at less than 1% live birth per cycle. However, IVF offers a success rate of around 13.7% per cycle.
CONCLUSION
An exploration of the effectiveness of available treatment options for older infertile women using their own gametes suggests that IVF offers the best prospects of success. Attempting treatments other than IVF will delay conception unnecessarily.
摘要
目的
总结年龄导致生育能力下降的原因，回顾生理年龄与实际年龄的卵巢老化。探讨评估女性卵巢储备功能的临床方法。回顾最近关于 40 岁及以上女性不同辅助生殖技术（ART）技术有效性的文献，并提供单一最佳治疗选择。
方法
使用关键词在 Pubmed 和谷歌学术上搜索相关文章。根据作者、年份、目的、样本和结果提取数据。
结果
40 岁或以上接受克罗米酚、IUI、FSH 联合 IUI 的女性的成功率都极低，每个周期活产率不到 1%。然而，IVF 的成功率约为每周期 13.7%。
结论
对使用自身配子的老年不孕女性的可用治疗选择的有效性进行探讨表明，IVF 提供了最佳的成功前景。尝试 IVF 以外的治疗方法将不必要地延迟受孕。
相似文献
1
What is the best treatment option for infertile women aged 40 and over?对于 40 岁及以上的不孕女性，最佳的治疗选择是什么？
J Assist Reprod Genet. 2013 Jun;30(5):667-71. doi: 10.1007/s10815-013-9980-6. Epub 2013 Mar 29.
2
In vitro fertilization and multiple pregnancies: an evidence-based analysis.体外受精与多胎妊娠：一项基于证据的分析。
Ont Health Technol Assess Ser. 2006;6(18):1-63. Epub 2006 Oct 1.
3
Advanced reproductive age and fertility.高龄生育与生育力
J Obstet Gynaecol Can. 2011 Nov;33(11):1165-1175. doi: 10.1016/S1701-2163(16)35087-3.
4
In vitro fertilisation for unexplained subfertility.不明原因的亚生育力的体外受精。
Cochrane Database Syst Rev. 2015 Nov 19;2015(11):CD003357. doi: 10.1002/14651858.CD003357.pub4.
5
A randomized clinical trial to determine optimal infertility treatment in older couples: the Forty and Over Treatment Trial (FORT-T).一项旨在确定老年夫妇最佳不孕治疗方法的随机临床试验：四十岁及以上治疗试验（FORT-T）。
Fertil Steril. 2014 Jun;101(6):1574-81.e1-2. doi: 10.1016/j.fertnstert.2014.03.012. Epub 2014 Apr 30.
6
In vitro fertilisation for unexplained subfertility.不明原因的亚生育力的体外受精。
Cochrane Database Syst Rev. 2012 Apr 18(4):CD003357. doi: 10.1002/14651858.CD003357.pub3.
7
The long-term prognosis for live birth in couples initiating fertility treatments.夫妇开始进行生育治疗时活产的长期预后。
Hum Reprod. 2017 Jul 1;32(7):1439-1449. doi: 10.1093/humrep/dex096.
8
Biopsying, fragmentation and autotransplantation of fresh ovarian cortical tissue in infertile women with diminished ovarian reserve.对卵巢储备功能下降的不孕妇女进行新鲜卵巢皮质组织活检、分割和自体移植。
Hum Reprod. 2019 Oct 2;34(10):1924-1936. doi: 10.1093/humrep/dez152.
9
In vitro fertilisation for unexplained subfertility.不明原因的亚生育力的体外受精。
Cochrane Database Syst Rev. 2005 Apr 18(2):CD003357. doi: 10.1002/14651858.CD003357.pub2.
10
Aromatase inhibitors (letrozole) for subfertile women with polycystic ovary syndrome.芳香化酶抑制剂（来曲唑）用于多囊卵巢综合征的不孕女性。
Cochrane Database Syst Rev. 2018 May 24;5(5):CD010287. doi: 10.1002/14651858.CD010287.pub3.
引用本文的文献
1
The dynamics of DNA methylation, histone methylation and acetylation during oocyte aging in mammalian species and possible interventions to regulate them.哺乳动物物种卵母细胞衰老过程中DNA甲基化、组蛋白甲基化和乙酰化的动态变化以及调控它们的可能干预措施。
J Assist Reprod Genet. 2025 Jul 14. doi: 10.1007/s10815-025-03577-4.
2
Butylphthalide identified via Samul-tang-induced transcriptomic signatures improves oocyte quality in aged mice.通过四君子汤诱导的转录组特征鉴定出的丁苯酞可改善老龄小鼠的卵母细胞质量。
NPJ Aging. 2025 Mar 26;11(1):21. doi: 10.1038/s41514-025-00214-3.
3
Ovulation induction and intrauterine insemination in women of advanced reproductive age: a systematic review of the literature.高龄妇女的排卵诱导和宫腔内人工授精：文献系统评价。
J Assist Reprod Genet. 2022 Jul;39(7):1445-1491. doi: 10.1007/s10815-022-02551-8. Epub 2022 Jun 22.
4
Pregnancy rate in intrauterine insemination, is uterine biophysical profile of predictive value? A prospective study.宫腔内人工授精中的妊娠率，是否具有子宫生物物理特征预测价值？一项前瞻性研究。
J Ultrasound. 2022 Dec;25(4):949-955. doi: 10.1007/s40477-022-00670-7. Epub 2022 Mar 9.
5
Emulating a target trial of the comparative effectiveness of clomiphene citrate and letrozole for ovulation induction.模拟枸橼酸氯米酚和来曲唑用于诱导排卵的比较有效性的目标试验。
Hum Reprod. 2022 Apr 1;37(4):793-805. doi: 10.1093/humrep/deac005.
6
The Correlation Between Gross Domestic Product Per Capita and the Success Rate of Assisted Reproductive Technologies Worldwide.人均国内生产总值与全球辅助生殖技术成功率的相关性。
JBRA Assist Reprod. 2022 Aug 4;26(3):398-406. doi: 10.5935/1518-0557.20210078.
7
Predictive Factors for Live Birth in Autologous in Vitro Fertilization Cycles in Women Aged 40 Years and Older.40岁及以上女性自体体外受精周期活产的预测因素
Zdr Varst. 2019 Oct 1;58(4):173-178. doi: 10.2478/sjph-2019-0022. eCollection 2019 Dec.
8
Genetic Counseling and Assisted Reproductive Technologies.遗传咨询和辅助生殖技术。
Cold Spring Harb Perspect Med. 2020 Nov 2;10(11):a036566. doi: 10.1101/cshperspect.a036566.
9
Acupuncture for infertile women without undergoing assisted reproductive techniques (ART): A systematic review and meta-analysis.未接受辅助生殖技术（ART）的不孕女性的针灸治疗：一项系统评价和荟萃分析。
Medicine (Baltimore). 2019 Jul;98(29):e16463. doi: 10.1097/MD.0000000000016463.
10
Epigenetic changes in mammalian gametes throughout their lifetime: the four seasons metaphor.哺乳动物配子一生中的表观遗传变化：四季隐喻
Chromosoma. 2019 Sep;128(3):423-441. doi: 10.1007/s00412-019-00704-w. Epub 2019 Apr 27.
本文引用的文献
1
Anti-Müllerian hormone as a predictor of pregnancy following IVF.抗苗勒管激素在体外受精后妊娠预测中的作用。
Reprod Biomed Online. 2013 Mar;26(3):247-52. doi: 10.1016/j.rbmo.2012.11.018. Epub 2012 Dec 8.
2
Advanced reproductive age and fertility: no. 269, November 2011.高龄与生育：第 269 期，2011 年 11 月。
Int J Gynaecol Obstet. 2012 Apr;117(1):95-102. doi: 10.1016/j.ijgo.2011.11.002.
3
Ovarian stimulation and intrauterine insemination in women aged 40 years or more.年龄在 40 岁及以上的女性的卵巢刺激和宫腔内人工授精。
Reprod Biomed Online. 2012 Feb;24(2):170-3. doi: 10.1016/j.rbmo.2011.11.007. Epub 2011 Nov 20.
4
Data-driven assessment of the human ovarian reserve.基于数据的人类卵巢储备评估。
Mol Hum Reprod. 2012 Feb;18(2):79-87. doi: 10.1093/molehr/gar059. Epub 2011 Sep 20.
5
Cumulative live-birth rates after assisted reproductive technology.辅助生殖技术后的累积活产率。
Curr Opin Obstet Gynecol. 2010 Jun;22(3):189-92. doi: 10.1097/GCO.0b013e328338493f.
6
7
Anti-Mullerian hormone (AMH) as a predictive marker in assisted reproductive technology (ART).抗缪勒管激素（AMH）作为辅助生殖技术（ART）的预测标志物。
Hum Reprod Update. 2010 Mar-Apr;16(2):113-30. doi: 10.1093/humupd/dmp036. Epub 2009 Sep 30.
8
Biological versus chronological ovarian age: implications for assisted reproductive technology.生物学年龄与实际年龄：对辅助生殖技术的影响。
Reprod Biol Endocrinol. 2009 Sep 22;7:101. doi: 10.1186/1477-7827-7-101.
9
Assisted reproductive technology and intrauterine inseminations in Europe, 2005: results generated from European registers by ESHRE: ESHRE. The European IVF Monitoring Programme (EIM), for the European Society of Human Reproduction and Embryology (ESHRE).2005年欧洲的辅助生殖技术与宫内人工授精：欧洲人类生殖与胚胎学会（ESHRE）欧洲登记处产生的结果：ESHRE。欧洲体外受精监测项目（EIM），为欧洲人类生殖与胚胎学会（ESHRE）开展。
Hum Reprod. 2009 Jun;24(6):1267-87. doi: 10.1093/humrep/dep035. Epub 2009 Feb 18.
10
Predictive factors for pregnancy after intrauterine insemination (IUI): an analysis of 1038 cycles and a review of the literature.宫腔内人工授精（IUI）后妊娠的预测因素：1038 个周期的分析及文献复习。
Fertil Steril. 2010 Jan;93(1):79-88. doi: 10.1016/j.fertnstert.2008.09.058. Epub 2008 Nov 8.
Zotero 插件