| Background:In recent years,with the development of society and the change of conception of fertility,the number of women who choose to delay their childbearing age has increased significantly.With age,a woman’s ovarian reserve decreases,egg quality declines,and a history of uterine fallopian tube disease increases,leading to significantly reduced fertility.At the same time,the incidence of complications and complications and offspring diseases during pregnancy has also increased,seriously affecting maternal and child health.It is more difficult for elderly women to conceive naturally,and the risk of adverse pregnancy outcomes increases.As a result,more and more elderly women who want to have children choose assisted reproductive technology(ART)to realize their fertility desire.However,the pregnancy outcome of elderly women undergoing in vitro fertilization-embryo transfer is not ideal.Data from multiple reproductive medical centers at home and abroad show that with the increase of age,the number of eggs acquired by older women decreases,the number of transplantable embryos decreases,the success rate of pregnancy decreases,and the abortion rate increases significantly.Therefore,how to improve the outcome of external assisted pregnancy in elderly women has become a heated topic for reproductive medicine workers.Objectives:To investigate the changes of ovarian reserve capacity,clinical characteristics of ovulat ion induction process and pregnancy outcome of women of reproductive aged 40 years old and over in our hospital with age,and to make statistical analysis of the above l aboratory and clinical data,in order to provide reference for clinical diagnosis and tre atment aged 40 years old and over in assisted reproduction and assisted pregnancy.Methods:A Clinical data of 4914 cycles of women ≥ 40 years of age who underwent in vitro fertilization/intracytoplasmic sperm injection-embryo transfer(IVF/ICSI-ET)in our hospital from January 2017 to December 2019 were retrospectively analyzed.All cycles are divided into six groups according to women’s age:40 years old group(n=1243),41 years old group(n=1045),42 years old group(n=976),43 years old group(n=718),44 years old group(n=475),≥45 years old group(n=457).The subjects were observed including the general situation of each age group,indicators of ovarian reserve function evaluation,ovulation induction and pregnancy outcome of different ages.The changes of the above indexes were compared with the increase of age.Then,different ovulation induction programs were divided into 6 groups:long program(n=540),short program(n=2139),antagonist program(n=772),super long program(n=219),micro stimulation program(n=349),and other programs(n=859).The pregnancy outcomes of different programs were analyzed.The clinical pregnancy rates of different ovulation induction programs in different age groups were compared according to different age groups and ovulation induction programs.Results:(1)Basic information of each group:in 4914 assisted pregnancy cycles,a total of 2212 cycles were transplanted,with a cycle transplantation rate of 45.0%.The cycle cancellation rate increased with age,and the difference was statistically significant(P<0.05).In women aged 40 years and over,secondary infertility accounted for a large proportion,and the proportion of primary infertility was about 9:1,the difference was statistically significant(P<0.05).The number of pregnancies and body mass index(BMI)increased with age,and the differences among different age groups were statistically significant(P<0.05).(2)Differences in ovarian reserve capacity among different age groups:Basal follicle stimulating hormone(FSH)increased with age,while anti-mullerian hormone(AMH)and antral follicle counts(AFC)decreased with age,and the differences among different age groups were statistically significant(P<0.05).Among them,the mean AMH of patients over 43 years old were all<1.0 ng/mL;The mean AMH level of patients aged 45 years and above was only 0.76 ng/mL.(3)Conditions of ovulation induction in different age groups:there was no statistical difference in the amount of gonadotropin(Gn)initiation and the total amount of Gn used in different age groups(P>0.05).With the increase of age,the number of follicles with the daily diameter of chorionic gonadotropin(HCG)over 14mm decreased,the egg harvesting rate decreased,and the endometrial thickness decreased gradually,and the difference among different age groups was statistically significant(P<0.05).There was no significant difference in normal fertilization rate among different age groups(P>0.05).(4)Comparison of pregnancy outcomes among groups:among 2212 transplant cycles,512 cycles were clinical pregnancy,with a clinical pregnancy rate of 23.1%.The clinical pregnancy rates were 35.7%,26.4%,21.1%,10.5%,9.9%and 9.3%,respectively,and decreased gradually with the increase of age,with statistical significance(P<0.05).The abortion rate of each group increased significantly with age(39.5%,48.5%,49.5%,54.8%,52.6%,86.7%,respectively),and the difference was statistically significant(P<0.05).The live birth rates in each group were 26.1%,13.4%,10.7%,4.7%,4.7%,1.2%,respectively.Only 2 women aged 45 and older had a live birth.(5)Comparison of different ovulation induction programs:the pregnancy rates of long program,short program,antagonist program,ultra-long program,micro-stimulation program and other ovulation induction programs were 29.3%,23.4%,25.5%,31.1%,10.3%,11.1%,respectively,and the differences among each group were statistically significant(P<0.05).According to different age groups and different ovulation induction programs,the clinical pregnancy rates of different control ovulation induction programs in different age groups were compared.In the 40-year group,the incidence of clinical pregnancy was highest in the ultra-long regimen(45.7%)and highest in the 41-year group(33.7%).The highest clinical pregnancy rate was 24.5%at 42 years of age.At 43 years of age,the clinical pregnancy rate was the highest in the antagonist regimen(21.7%).The highest clinical pregnancy rate was 16.7%in the mid-to-older 44 years.The highest clinical pregnancy rate was 14.3%(≥45 years old).The difference of clinical pregnancy rate between different regimens in the 41-year-old group was statistically significant(P<0.05),there was no statistically significant difference in the clinical pregnancy rate between different ovulation induction regiments in the other groups(P>0.05).Conclusions:Age is significantly correlated with IVF/ICSI-ET success rate.With the increase of age of ≥ 40 years old patients,the ovarian reserve capacity decreased,the number of eggs harvested decreased,the clinical pregnancy rate,live birth rate decreased significantly,abortion rate increased significantly.It is necessary to comprehensively evaluate the fertility of elderly women,select suitable ovulation promotion program and implement individualized treatment. |
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