Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, Brussel 1090, Belgium.
Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, Brussel 1090, Belgium; Department of Obstetrics and Gynaecology, CHU Tivoli La Louvière, Belgium.
Reprod Biomed Online. 2021 Apr;42(4):768-773. doi: 10.1016/j.rbmo.2020.12.002. Epub 2020 Dec 9.
What are the reproductive outcomes of women aged 43 years and older undergoing IVF and intracytoplasmic sperm injection (ICSI) treatment using their own eggs.
Retrospective study of 833 woman aged 43 years or older undergoing their first IVF and ICSI cycle using autologous oocytes at a tertiary referral hospital between January 1995 and December 2019. Live birth rate (LBR) after 24 weeks' gestation was the primary outcome.
Ninety-five out of 833 (11.4%) had a positive HCG, whereas 59 (62.1% per positive HCG) had a miscarriage before 12 weeks' gestation and 36 (4.3%) live births were achieved. Analysis by age showed that the number of cumulus-oocyte complexes retrieved was significantly different between the four age groups: 43 years (5 [3-9]); 44 years (5 [2-7]); 45 years (3 [2-8)]); ≥45 years (2.5 [2-6]); P < 0.01; the number of metaphase II oocytes, however, was similar. Positive HCG rates remained low: 43 years (78/580 [13.4%]); 44 years (14/192 [7.3%]); 45 years (1/39 [2.6%]; and ≥46 years (2/22 [9.1%]); P = 0.03, as did LBR: 43 years (28 [4.8%]); 44 (7 [3.6%]); 45 years (0 [0%]); and ≥46 years (1 [4.5%]); P = 0.5. Multivariate regression analysis revealed that only number of metaphase II was significantly associated with LBR, when age was considered as a continuous (OR 1.08, 96% CI 1.004 to 1.16) or categorical variable (OR 1.08, 95% CI 1.005 to 1.16).
The chances of achieving a live birth in patients aged 43 years and older undergoing IVF/ICSI with their own gametes are low, even in cases of patients with a relatively 'normal' ovarian reserve for their age.
年龄在 43 岁及以上的女性使用自身卵子进行体外受精和胞浆内单精子注射（ICSI）治疗的生殖结局如何。
对 1995 年 1 月至 2019 年 12 月在一家三级转诊医院接受首次自身卵母细胞 IVF 和 ICSI 周期治疗的 833 名年龄在 43 岁及以上的女性进行回顾性研究。24 周后妊娠的活产率（LBR）是主要结局。
833 例中有 95 例（11.4%）HCG 阳性，其中 59 例（12 周前流产率为 62.1%/HCG 阳性），36 例（4.3%）活产。按年龄分析显示，四组年龄组的卵丘-卵母细胞复合物的获取数量有显著差异：43 岁（5 [3-9]）；44 岁（5 [2-7]）；45 岁（3 [2-8]）；≥45 岁（2.5 [2-6]）；P < 0.01；然而，中期 II 卵母细胞的数量相似。HCG 阳性率仍然较低：43 岁（78/580 [13.4%]）；44 岁（14/192 [7.3%]）；45 岁（1/39 [2.6%]）；≥46 岁（2/22 [9.1%]）；P = 0.03，LBR 也是如此：43 岁（28/480 [4.8%]）；44 岁（7 [3.6%]）；45 岁（0 [0%]）；≥46 岁（1 [4.5%]）；P = 0.5。多变量回归分析显示，当考虑年龄为连续变量（OR 1.08，96%CI 1.004-1.16）或分类变量（OR 1.08，95%CI 1.005-1.16）时，只有中期 II 数量与 LBR 显著相关。
年龄在 43 岁及以上的患者使用自身配子进行 IVF/ICSI 的活产机会较低，即使患者的卵巢储备相对于其年龄“正常”。
