Reproductive Medicine Center, Xiangya Hospital of Central South University, Changsha, Hunan, China.
Clinical Research Center for Women’s Reproductive Health in Hunan Province, Changsha, Hunan, China.
Aging (Albany NY). 2023 Feb 27;15(7):2460-2472. doi: 10.18632/aging.204555.
Female fertility decreases with age. A decline in oocyte quality plays a key role in reproductive problems in older women. Whether advanced maternal age (AMA) is associated with a decline in endometrial receptivity (ER) remains controversial. A systematic review and meta-analysis were conducted to evaluate the relationship between AMA and ER. Eighteen eligible studies were included in this meta-analysis. Of the 18 studies, 17, 8, 14, and 9 studies reported the impact of AMA on clinical pregnancy rate (CPR), implantation rate (IR), miscarriage rate (MR), and live birth rate (LBR), respectively. The combined results showed a trend (without significance) toward lower CPR in women with AMA than in younger women. A similar trend of worse outcomes in terms of IR was observed in women with AMA. A significantly higher MR and lower LBR were observed in infertile women with AMA than in younger women. In conclusion, there was a slightly lower IR and CPR without significance; however, significantly increased MR and decreased LBR were observed in women with AMA than in younger women, indicating that AMA is related to the decline of ER. Further prospective cohort studies with a preimplantation genetic testing for aneuploidy model are needed to observe the relationship between AMA and ER and explore the possible mechanisms.
女性生育能力会随着年龄的增长而下降。卵母细胞质量的下降在老年女性的生殖问题中起着关键作用。高龄产妇（AMA）是否与子宫内膜容受性（ER）下降有关仍存在争议。本系统评价和荟萃分析旨在评估 AMA 与 ER 之间的关系。这项荟萃分析纳入了 18 项符合条件的研究。其中，17、8、14 和 9 项研究分别报道了 AMA 对临床妊娠率（CPR）、着床率（IR）、流产率（MR）和活产率（LBR）的影响。综合结果显示，AMA 组的 CPR 呈下降趋势（无统计学意义）。AMA 组的 IR 也呈现出较差的结局趋势。与年轻女性相比，AMA 不孕女性的 MR 显著升高，LBR 显著降低。总之，虽然没有统计学意义，但 AMA 组的 IR 和 CPR 略低；然而，与年轻女性相比，AMA 组的 MR 显著升高，LBR 显著降低，这表明 AMA 与 ER 的下降有关。需要进一步开展前瞻性队列研究，采用非整倍体胚胎植入前遗传学检测模型，以观察 AMA 与 ER 之间的关系，并探讨可能的机制。
