Cabry Rosalie, Merviel Philippe, Hazout Andre, Belloc Stephanie, Dalleac Alain, Copin Henri, Benkhalifa Moncef
Reproductive Medicine and Medical Cytogenetics Department, Regional University Hospital and School of Medicine, Picardie University Jules Verne, CGO, 124 rue Camille Desmoulins, 80054 Amiens, France.
Eylau/Unilabs Laboratory, Reproductive Biology Unit, 55 Rue Saint Didier, 75016 Paris, France.
Maturitas. 2014 May;78(1):17-21. doi: 10.1016/j.maturitas.2014.02.014. Epub 2014 Mar 5.
Women's fertility potential is declining with age because of multiples intrinsic and extrinsic factors such as life style, oxidative stress and/or endocrine disruptors and is affecting the ability of these women to conceive naturally. This declining fertility potential and the late age of motherhood is increasing significantly the number of patients consulting infertility specialists. Different strategies of investigation and management are proposed to patients over 40 in order to overcome their infertility and improve the live birth rate in these patients. Intra Uterine Insemination (IUI) in women over 40 is associated with a low rate of ongoing pregnancy and IUI should not therefore be offered always as the first line of treatment. When the predictive factors are positive IVF/ICSI seem to be good alternatives until 43 years of age. Customized ovarian stimulation and flexible laboratory methods such as in vitro maturation (IVM), preimplantation genetic diagnosis (PGD), embryo vitrification and transfer after thawing in subsequent natural or artificial cycles can improve the success rate of ART in patients over 40. Meanwhile, oocyte and embryos donation remain good options for patient over 40 with a bad prognosis and can lead to successful ongoing pregnancies until 45 years of age. Ovarian tissue cryopreservation, oocyte vitrification at the germinal vesicle (GV) stage or metaphase II stage present a breakthrough for fertility preservation but the ideal age for starting fertility preservation is still debated as well as the minimum number of oocytes to be vitrified in order to optimize the chances of pregnancy when needed at an older age. This manuscript reports the results of our own experience from patients older than 40 in the light of the published data and discusses the different therapeutic alternatives which can be proposed to patients over 40 consulting ART centres.
由于多种内在和外在因素，如生活方式、氧化应激和/或内分泌干扰物，女性的生育潜力随着年龄的增长而下降，这影响了这些女性自然受孕的能力。生育潜力的下降和母亲年龄的增大显著增加了咨询不孕不育专家的患者数量。为40岁以上的患者提出了不同的检查和治疗策略，以克服他们的不孕问题并提高这些患者的活产率。40岁以上女性的宫内人工授精（IUI）与持续妊娠率较低相关，因此IUI不应总是作为一线治疗方法。当预测因素为阳性时，体外受精/卵胞浆内单精子注射（IVF/ICSI）似乎是43岁之前的良好替代方案。定制的卵巢刺激和灵活的实验室方法，如体外成熟（IVM）、植入前基因诊断（PGD）、胚胎玻璃化以及在随后的自然或人工周期解冻后移植，可以提高40岁以上患者辅助生殖技术（ART）的成功率。同时，卵子和胚胎捐赠对于预后不良的40岁以上患者仍然是很好的选择，并且可以导致成功的持续妊娠直至45岁。卵巢组织冷冻保存、生发泡（GV）期或减数分裂中期II期的卵子玻璃化是生育力保存的一项突破，但开始生育力保存的理想年龄以及为了在老年时优化妊娠机会而需要玻璃化的卵子的最小数量仍存在争议。根据已发表的数据，本手稿报告了我们自己对40岁以上患者的经验结果，并讨论了可以向咨询ART中心的40岁以上患者提出的不同治疗选择。
