Gindoff P R, Jewelewicz R
Fertil Steril. 1986 Dec;46(6):989-1001. doi: 10.1016/s0015-0282(16)49869-9.
There is a definite increase in the number of women bearing children in the 30- and 40-year-old age groups. The total number of women who are 35 to 40 years of age in the United States is projected to increase 42% and the percent births to this age group is projected to increase 37%. This is apparently because of a trend to postpone childbearing and first birth due to women's career priorities, advanced education, control over fertility, financial concerns, late and second marriages, and infertility. Associated with this is an increase in visits to the infertility specialist for older women who have an intrinsic decrease in fecundity with advancing age. Although, on the average, a woman will not experience menopause until about 50 years of age, her effective childbearing period may stop almost a decade earlier. A woman in her late 30s and, especially, early 40s is at some disadvantage in terms of conception delay, ability to carry a chromosomally normal fetus until term, and risk of trisomic conception. Certain endocrinologic parameters have been identified for the woman entering the transition to menopause. Biologic aging of the hypothalamic-pituitary-ovarian axis is intertwined with changes in the endocrine milieu of the perimenopause and preperimenopause. Despite a clear association of decreased fecundity in older women due to multiple biologic and social influences, so long as the individual has regular cycles and essentially normal endocrine parameters, she should be a candidate for an expedited infertility workup and ovulation induction, if not more aggressive treatment. Her obstetric profile is much improved, except for an increase in congenital anomalies and chromosomal defects. Chorionic villus biopsy study or amniocentesis is advised in all cases, regardless of therapy.
30至40岁年龄段生育子女的女性数量有明显增加。预计美国35至40岁女性的总数将增加42%，该年龄组的生育百分比预计将增加37%。这显然是由于女性出于职业优先考虑、高等教育、生育控制、经济担忧、晚婚和再婚以及不孕等原因而倾向于推迟生育和首次生育。与此相关的是，随着年龄增长生育能力内在下降的老年女性前往不孕不育专家处就诊的人数有所增加。虽然平均而言，女性直到50岁左右才会经历更年期，但其有效的生育期可能几乎提前十年就停止了。30多岁后期尤其是40岁出头的女性在受孕延迟、将染色体正常的胎儿怀至足月的能力以及三体受孕风险方面存在一些劣势。对于进入更年期过渡阶段的女性，已确定了某些内分泌参数。下丘脑 - 垂体 - 卵巢轴的生物衰老与围绝经期和绝经前期内分泌环境的变化相互交织。尽管由于多种生物和社会影响，老年女性的生育能力下降存在明显关联，但只要个体月经周期规律且内分泌参数基本正常，她就应该成为加速不孕不育检查和促排卵治疗的候选对象，即便不是更积极的治疗。除了先天性异常和染色体缺陷有所增加外，她的产科情况有了很大改善。无论采用何种治疗方法，所有病例均建议进行绒毛膜绒毛活检或羊水穿刺检查。
