Centre for Human Reproduction, New York, NY, USA; The Foundation for Reproductive Medicine, New York, NY, USA; Laboratory for Stem Cell Biology and Molecular Embryology, Rockefeller University, New York, NY, USA; Department of Obstetrics and Gynecology, Vienna Medical School, Vienna, Austria.
Centre for Human Reproduction, New York, NY, USA; Department of Obstetrics and Gynecology, Wake Forest University, Winston Salem, NC, USA.
Reprod Biomed Online. 2018 Aug;37(2):172-177. doi: 10.1016/j.rbmo.2018.05.010. Epub 2018 May 24.
What level of IVF pregnancy success is currently possible in women of extremely advanced age?
This study reports on outcomes in women aged 43-51 years at the Centre for Human Reproduction, an academically affiliated private clinical fertility and research centre in New York City.
During the study years of 2014-2016, 16 pregnancies were established, all through day 3 transfers. Based on 'intent to treat' (cycle start), clinical pregnancy rates were 4/190 (2.1%), 5/234 (2.1%) and 7/304 (2.3%) and live birth rates were 2/190 (1.1%), 1/234 (0.43%) and 4/304 (1.3%) in 2014, 2015 and 2016, respectively. With reference to embryo transfer, clinical pregnancy rates were 4/140 (2.9%), 5/159 (3.1%) and 7/167 (4.2%) and live birth rates were 2/140 (1.4%), 1/159 (0.63%) and 4/167 (2.4%) for the same years. The results for 2016 also included what are probably the two oldest autologous IVF pregnancies ever reported in the literature. These results were obtained with patient ages, percentage of cycle cancellations and other adverse outcome parameters steadily increasing year by year.
Female age above 42 is widely viewed as the ultimate barrier to conception with IVF. Data reported here, although small and preliminary, demonstrate that potential outcomes are better than widely perceived, while pregnancy and live birth rates remain significantly inferior to donor egg recipient cycles. However, for selected women at very advanced ages, especially with higher egg/embryo numbers, autologous oocyte IVF offers a better option than widely acknowledged, if they are given individualized age-specific care.
在极其高龄的女性中，试管婴儿的妊娠成功率目前能达到什么水平？
本研究报告了在纽约市一家学术附属的私人临床生育和研究中心——人类生殖中心，年龄在 43-51 岁的女性的治疗结局。
在 2014-2016 年的研究期间，通过第 3 天的移植共建立了 16 例妊娠。基于“意向治疗”（周期开始），临床妊娠率分别为 2014 年的 4/190（2.1%）、5/234（2.1%）和 7/304（2.3%），活产率分别为 2/190（1.1%）、1/234（0.43%）和 4/304（1.3%）；2015 年的 2/234（0.86%）、3/304（0.99%）和 5/304（1.6%）；2016 年的 4/140（2.9%）、5/159（3.1%）和 7/167（4.2%）。对于胚胎移植，2016 年的临床妊娠率分别为 4/140（2.9%）、5/159（3.1%）和 7/167（4.2%），活产率分别为 2/140（1.4%）、1/159（0.63%）和 4/167（2.4%）。2016 年的结果还包括可能是文献中报道的最年长的两例自体试管婴儿妊娠。这些结果是在患者年龄、周期取消率和其他不良结局参数逐年稳步增加的情况下获得的。
女性年龄超过 42 岁被广泛认为是接受试管婴儿治疗的最终生育障碍。这里报告的数据虽然很小且初步，但表明潜在的结果优于普遍预期，而妊娠和活产率仍明显低于供卵受者周期。然而，对于非常高龄的特定女性，如果给予个体化的年龄特异性护理，自体卵母细胞试管婴儿提供了比广泛认可的更好的选择，尤其是对于那些拥有更高数量的卵子/胚胎的女性。
