Gleicher Norbert, Kushnir Vitaly A, Albertini David F, Barad David H
The Center for Human ReproductionNew York, New York, USA The Foundation for Reproductive MedicineNew York, New York, USA The Brivanlou Stem Cell Biology and Molecular Embryology LaboratoryThe Rockefeller University, New York, New York, USA
The Center for Human ReproductionNew York, New York, USA Department of Obstetrics and GynecologyWake Forest University, Winston Salem, North Carolina, USA.
J Endocrinol. 2016 Jul;230(1):F1-6. doi: 10.1530/JOE-16-0105. Epub 2016 May 6.
Women above age 40 years in the US now represent the most rapidly growing age group having children. Patients undergoing in vitro fertilization (IVF) are rapidly aging in parallel. Especially where egg donations are legal, donation cycles, therefore, multiply more rapidly than autologous IVF cycles. The donor oocytes, however, are hardly ever a preferred patient choice. Since with use of own eggs, live birth rates decline with advancing age but remain stable (and higher) with donor eggs, older patients always face the difficult and very personal choice between poorer chances with own and better chances with donor oocytes. Physician contribution to this decision should in our opinion be restricted to accurate outcome information for both options. Achievable pregnancy and live birth rates in older women are, however, frequently underestimated, thereby mistakenly biasing fertility providers, private insurance companies and even regulatory government agencies. Restriction on access to IVF for older women is then often the consequence. In this review, we summarize the limited published data on best treatments of 'older' ovaries, while also addressing treatment approaches that should be avoided in older women. This focused review, therefore, to a degree is subjective. Research addressing aging ovaries in IVF has been disappointingly sparse, and has in our opinion too heavily concentrated on methods of embryo selection (ES), which, especially in older women, not only fail to improve IVF outcomes, but actually, negatively affect live birth chances. We conclude that, aside from breakthroughs in gamete creation, only pharmacological interventions into early (small growing follicle stages) follicle maturation will offer new potential to positively impact oocyte and embryo quality and, therefore, IVF outcomes. Research, therefore, should be accordingly redirected.
在美国，40岁以上的女性如今是生育增长最为迅速的年龄群体。接受体外受精（IVF）的患者也在同步快速老龄化。尤其是在卵子捐赠合法的地方，捐赠周期的增长速度比自体IVF周期快得多。然而，供体卵母细胞几乎从来都不是患者的首选。由于使用自身卵子时，活产率会随着年龄的增长而下降，但使用供体卵子时则保持稳定（且更高），老年患者总是面临着一个艰难且非常个人化的选择：使用自身卵子受孕几率较低，而使用供体卵母细胞受孕几率较高。我们认为，医生在这个决策中的作用应仅限于提供两种选择的准确结果信息。然而，老年女性可实现的妊娠率和活产率常常被低估，从而错误地影响了生育服务提供者、私人保险公司甚至政府监管机构。结果往往是对老年女性获取IVF服务进行限制。在本综述中，我们总结了关于“老龄”卵巢最佳治疗方法的有限已发表数据，同时也讨论了老年女性应避免的治疗方法。因此，这篇重点综述在一定程度上是主观的。关于IVF中老龄卵巢的研究少得令人失望，而且我们认为这些研究过于集中在胚胎选择（ES）方法上，而这一方法尤其在老年女性中不仅无法改善IVF结果，实际上还会对活产几率产生负面影响。我们得出结论，除了配子生成方面取得突破外，只有对早期（小生长卵泡阶段）卵泡成熟进行药物干预，才有可能对卵母细胞和胚胎质量产生积极影响，进而改善IVF结果。因此，研究方向应相应调整。
