| Objective: To explore the outcome of IVF/ICSI treatment and the influencing factors for the elderly women,and to provide opinions for the decision makers of the elderly.Methods: The general situations and clinical outcomes of 725 cycles of IVF/ICSI for women aged 40 and over were analysised in this study.A total of 725 cycles were devided into five groups according to the different controlled ovatian hyperstimulation(COH)schemes.As GnRH-a long scheme(group A,230 cycles),GnRH-ant antagonist(group B,279 cycles),PPOS(group C,62 cycles)and luteal phase of ovulation induction(group D,83 cycles)and other COH programs(group E,71 cycles).And then,compared the clinical datas and pregnancy outcomes among them.There were 459 transplanted cycles,including fresh and frozen thawed embryo transfer,were divided into two age ranges: F group(40-42 y,308 cycles)and G group(? 43 y,151 cycles).Datas were compared between the two groups of clinical outcomes.In addition,Comparisons of between group I(pregnancy group,90 cycles)and group II(the non pregnant group,369 cycles)were based on whether obtained clinical pregnancy,and the factors influencing outcomes were analysised between the two groups.Results:(1)The average number of oocytes obtained by IVF/ICSI in women age 40 and over was 3.7,and the clinical pregnancy rate per cycle was 19.61%,in 33 cycles miscarriaged(36.67%),and the live birth rate was 10.89%.Nevertheless the cycle cancellation rate was 25.10%.There was no significant difference in BMI,duration of infertility,type of infertility and natural abortion history among the five groups,P>0.05.(2)There were significant differences in age,AFC and basal FSH between group A and group B,C,D and E groups,P<0.05.Dose of Gn and Days of stimulation in group A were significantly more than other four groups,and the same as the number of oocytes,embryos,implantation rate,clinical pregnancy rate and live birth rate,P<0.05.(3)There was no statistically significant difference in clinical pregnancy rate,live birth rate and miscarriage rate among group B,group C,group D and group E,but the cancellation rate in group B was lower than that in group C,group D and group E,P<0.05.(4)The pregnancy rate and live birth rate in group F were higher than that in group G(P<0.05),but there was no significant difference in the rate of miscarriage between the two groups,P>0.05.(5)There was statistical difference in the age,AFC,basal FSH and oocyte number between the pregnant groups(I group)and the non-pregnant group(II group),P<0.05.Compared with the non-pregnancy group(group II),the difference of age,AFC,base FSH and the number of acquired oocytes in the two groups were statistically significant,P<0.05.(6)Multivariate Logistic regression analysis showed that pregnancy was negatively correlated with age.OR=0.82,95%CI(0.69-0.96),P<0.05.However,it was positively correlated with the number of oocytes retrieved,OR=1.14,95%CI(1.07-1.21),P<0.05.Conclution: Women age 40 and over should be more active in IVF/ICSI assisted treatment using their own gametes,and individualization should be encouraged to increase the number of oocytes retrieved,and transfer embryos before the age of 43,so as to improve the success rate.The selection of COH schemes are based on the assessment of a woman's ovarian reserve,and the individualized treatment is emphasized.More than two times attempting treatments still have a chance of live birth.At present,there is no evidence absolutely supported for setting up the age limit of ART treatment,and reproductive centers should understand and accept the patients who still willing to have a baby age 40 or over if conditions permit. |
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