Cimadomo Danilo, Fabozzi Gemma, Vaiarelli Alberto, Ubaldi Nicolò, Ubaldi Filippo Maria, Rienzi Laura
Clinica Valle Giulia, G.en.e.r.a. Centers for Reproductive Medicine, Rome, Italy.
Catholic University of the Sacred Heart, Rome, Italy.
Front Endocrinol (Lausanne). 2018 Jun 29;9:327. doi: 10.3389/fendo.2018.00327. eCollection 2018.
The overall success of human reproduction, either spontaneously or after IVF, is highly dependent upon maternal age. The main reasons for age-related infertility include reduced ovarian reserve and decreased oocyte/embryo competence due to aging insults, especially concerning an increased incidence of aneuploidies and possibly decreased mitochondrial activity. Age-related chromosomal abnormalities mainly arise because of meiotic impairments during oogenesis, following flawed chromosome segregation patterns such as non-disjunction, premature separation of sister chromatids, or the recent reverse segregation. In this review, we briefly discuss the main mechanisms putatively impaired by aging in the oocytes and the deriving embryos. We also report the main strategies proposed to improve the management of advanced maternal age women in IVF: fertility preservation through oocyte cryopreservation to prevent aging; optimization of the ovarian stimulation and enhancement of embryo selection to limit its effects; and oocyte donation to circumvent its consequences.
人类自然受孕或体外受精（IVF）后的整体生殖成功率高度依赖于母亲的年龄。与年龄相关的不孕不育的主要原因包括卵巢储备减少以及由于衰老损伤导致的卵母细胞/胚胎能力下降，特别是非整倍体发生率增加以及线粒体活性可能降低。与年龄相关的染色体异常主要是由于卵子发生过程中的减数分裂损伤，遵循错误的染色体分离模式，如不分离、姐妹染色单体过早分离或最近的反向分离。在本综述中，我们简要讨论了衰老可能损害卵母细胞和衍生胚胎的主要机制。我们还报告了为改善高龄产妇在体外受精中的管理而提出的主要策略：通过卵母细胞冷冻保存来防止衰老以保留生育能力；优化卵巢刺激并加强胚胎选择以限制其影响；以及卵母细胞捐赠以规避其后果。
