Akino Nana, Isono Wataru, Wada-Hiraike Osamu
Department of Obstetrics and Gynecology, Graduate School of Medicine The University of Tokyo 7-3-1, Hongo, Bunkyo-ku 1113-8655 Tokyo Japan.
Reprod Med Biol. 2016 Mar 29;15(4):253-259. doi: 10.1007/s12522-016-0241-0. eCollection 2016 Oct.
It has been widely accepted that the age of women plays a fundamental role in fecundity, and age-related fertility decline has one of the most significant and detrimental effects on the success rate of infertility treatment. Therefore, treatment cycles of non-in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) treatment for infertile women of advanced aged have been limited due to their lack of efficacy, and they are often optimized, compared to IVF/ICSI treatment. Recent trends in infertility treatment apparently indicate that IVF/ICSI treatment, including egg donation, is frequently offered to aged women for first-line management, despite its heavy burden, but hasty IVF/ICSI treatment should be avoided, considering its socioeconomic problems. It is important to distinguish women who could conceive by non-IVF/ICSI treatment, although the optimization of non-IVF/ICSI treatment protocols remains poorly understood. This review focuses on extracting aged patients who have higher chance of conceiving with non-IVF/ICSI treatment and providing necessary and sufficient infertility treatment. After initial evaluation for fertility, including tubal factor, male factor, the presence of endometriosis and/or adenomyosis, and ovarian reserve, the outcomes of fertility treatment can be predicted to some extent in aged infertile women.
女性年龄在生育能力中起着根本性作用,这一点已被广泛认可,与年龄相关的生育能力下降对不孕治疗成功率具有最显著且有害的影响之一。因此,对于高龄不孕女性,非体外受精(IVF)和卵胞浆内单精子注射(ICSI)治疗周期因其疗效不佳而受到限制,与IVF/ICSI治疗相比,它们往往需要优化。不孕治疗的最新趋势显然表明,尽管负担沉重,但包括卵子捐赠在内的IVF/ICSI治疗经常被提供给高龄女性作为一线治疗方法,但考虑到其社会经济问题,应避免仓促进行IVF/ICSI治疗。区分哪些女性可以通过非IVF/ICSI治疗受孕很重要,尽管非IVF/ICSI治疗方案的优化仍知之甚少。本综述着重于筛选出通过非IVF/ICSI治疗受孕几率较高的高龄患者,并提供必要且充分的不孕治疗。在对生育能力进行初步评估,包括输卵管因素、男性因素、子宫内膜异位症和/或子宫腺肌病的存在以及卵巢储备之后,在一定程度上可以预测高龄不孕女性的生育治疗结果。