Isono Wataru, Wada-Hiraike Osamu, Shirane Akira, Fujimoto Akihisa, Osuga Yutaka, Yano Tetsu, Taketani Yuji
Department of Obstetrics and Gynecology, Graduate School of Medicine The University of Tokyo 7-3-1, Hongo, Bunkyo-ku 113-8655 Tokyo Japan.
Reprod Med Biol. 2011 Aug 13;11(1):69-72. doi: 10.1007/s12522-011-0107-4. eCollection 2012 Jan.
This study aimed to maximize the chance of pregnancy and provide an optimal protocol for infertile female patients of advanced reproductive age as an alternative to in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) treatment.
We retrospectively analyzed medical records of 432 infertile women aged ≥38 at the beginning of the treatment. Stepwise non-IVF/ICSI treatments using timed intercourse or intrauterine insemination, with or without controlled ovarian stimulation, were adopted for all patients. In this population, we extracted 8 representative infertility factors and examined these effects on fertility rate by calculating clinical pregnancy rate.
The prognosis for infertile women possessing at least one of the three factors, 'advanced female age (≥42 years)', 'endometriosis/adenomyosis', and 'tubal infertility' was apparently poor because only 5 out of 155 women were able to conceive (1.02% per cycle). In contrast, 95 patients without the four factors, 'advanced female age', 'endometriosis/adenomyosis', 'tubal infertility', and 'male infertility', were more likely to conceive (9.14% per cycle).
Fertility centers can offer appropriate protocols for non-IVF/ICSI treatment and establish guidelines for aged infertile patients by examining infertility factors and considering their combinations.
本研究旨在最大化怀孕几率，并为高龄不孕女性患者提供一种优化方案，作为体外受精（IVF）/卵胞浆内单精子注射（ICSI）治疗的替代方案。
我们回顾性分析了432例治疗开始时年龄≥38岁的不孕女性的病历。所有患者均采用逐步非IVF/ICSI治疗，即定时性交或宫腔内人工授精，可进行或不进行控制性卵巢刺激。在这一人群中，我们提取了8个具有代表性的不孕因素，并通过计算临床妊娠率来研究这些因素对生育率的影响。
具有“高龄（≥42岁）”“子宫内膜异位症/子宫腺肌病”和“输卵管性不孕”这三个因素中至少一个的不孕女性预后明显较差，因为155名女性中只有5人能够怀孕（每个周期1.02%）。相比之下，95名没有“高龄”“子宫内膜异位症/子宫腺肌病”“输卵管性不孕”和“男性不育”这四个因素的患者更有可能怀孕（每个周期9.14%）。
生育中心可以通过检查不孕因素并考虑其组合情况，为非IVF/ICSI治疗提供合适的方案，并为高龄不孕患者制定指导原则。
