| 【Objective】To explore the changing process of endometrial receptivity and its influencing factors in the process of reproductive age decline of elderly women,and provide data support for clinical strategies for pregnancy of elderly women.【Methods】Analyze the embryo implantation of oocytes donated by young women in the embryo implantation of women at different ages,compare with the embryo implantation and clinical pregnancy outcomes of women of the corresponding age using their own oocytes,explore the influence of age and other factors on endometrial receptivity.The medical records of couples who underwent IVF-ET assisted conception from January 2005 to December 2019 in the Reproductive Medicine Center of the First Affiliated Hospital of Hainan Medical College were collected.Included 2660 transplantation cycles,divided them into the oocyte donation group,the oocyte recipient group and the control group,compared the embryo implantation rate,clinical pregnancy rate and taking baby home rate between groups,in addition,the effects of the total number of days and total dose of estrogen used for preparing the endometrium in the oocyte recipient group,the thickness of the endometrium on the day of h CG/transformation,and the type of endometrium on the implantation rate of embryos were studied.【Results】1.Research background data:From January 2005 to December 2019,the medical records of IVF-ET assisted women were used as baseline data in the Reproductive Medicine Center of the First Affiliated Hospital of Hainan Medical College,and oocyte recipient was excluded.A total of 32,358 transplant cycles were included,including 16,035 fresh transplant cycles and 16,323 freeze-thaw cycles.The average ages of the women in the fresh transfer cycle and the freeze-thaw transfer cycle were 33.50±5.00 years old and 33.70±5.20 years old;The average number of embryos transferred per transfer cycle were 1.97±1.65 and 2.02±0.70 respectively;The embryo implantation rates during the transfer cycle were 23.28%and 20.68%;The clinical pregnancy rates during the transplantation cycle were 34.22%and33.29%,respectively;Taking baby home rate during the transplantation cycle were25.03%and 29.90%,respectively.2.Basic situation of the oocyte donation group,oocyte recipient group and control groups:The average age（years）of the women in the oocyte donation group,oocyte recipient group and control groups were 29.26±3.18,41.04±5.95 and36.48±5.22,respectively.The oocyte recipient group was higher than the control group and the oocyte donation group（P<0.05）;The average age（years）of the man were 32.29±4.35,42.51±6.90 and 38.41±5.96.The oocyte recipient group was higher than the control group and the oocyte donation group（P<0.05）;The average basic FSH（m IU/ml）were 7.34±1.81,33.37±35.05 and 8.47±3.04（P<0.05）,respectively;The average basic E2（pg/ml）were 54.93±36.01,59.97±64.50 and 50.45±29.25（P<0.05）;The average AMH（ng/ml）were 3.88±2.03,1.54±3.69 and 3.44±3.68,respectively,The oocyte donation group was higher than the oocyte recipient group（P>0.05）,and the control group was higher than the oocyte recipient group（P<0.05）;The average AFC were 16.70±.4.56,7.66±5.45 and 10.08±5.59（P<0.05）.3.In vitro fertilization and embryos situation in the oocyte donation group,oocyte recipient group and control groups:The average number of oocytes retrieved27.28±6.65,3.53±0.84 and 11.63±8.45（P<0.05）;The average number of MⅡoocytes were 22.14±6.21,3.50±0.83 and 9.33±7.00（P<0.05）;The average total number of embryo were 15.01±5.41,3.06±0.90 and 8.46±6.42（P<0.05）;The IVF 2PN rates were 53.62%,83.45%and 69.91%（P<0.05）;The ICSI 2PN rate were 75.62%,88.27%and 72.1%（P<0.05）;The IVF high-quality embryo rate were 43.73%,38.71%and 45.79%（P<0.05）;The ICSI high-quality embryo rate were 37.38%,34.06%and42.99%（P<0.05）,respectively.4.Clinical outcome of the oocyte donation group,oocyte recipient group and control groups:The number of embryos transferred per transfer cycle in the oocyte donation group,oocyte recipient group and control groups were 2.02±0.33,2.32±0.65and 2.18±0.62（P<0.05）,respectively;The number of excellent embryos transferred per transplant cycle were 1.63±0.65,0.97±0.97 and 1.35±1.26（P<0.05）;The h CG day/transformation day endometrial thickness were 10.78±2.48,9.26±1.79 and10.05±2.27（P<0.05）;The embryo implantation rate were 26.22%,23.97%and16.06%,respectively,the oocyte donation group was higher than the oocyte recipient group（P>0.05）,the oocyte recipient group was higher than the control group（P<0.05）;The embryo implantation rate of the oocyte recipient group was consistent with the oocyte donation group,while the embryo implantation rate of the control group decreased with age from 24.02%before 29 years old to 6.71%at 42～43 years old.The clinical pregnancy rate were 39.19%,40.49%and 27.09%,respectively.The oocyte recipient group was higher than the oocyte donation group（P>0.05）,and the oocyte recipient group was higher than the control group（P<0.05）;The clinical pregnancy rate of the oocyte recipient group was consistent with the oocyte donation group,while the clinical pregnancy rate of the control group decreased from 38.53%before 29 years old to 11.27%at 42～43 years old.The singleton pregnancy rates（%）were 67.48%,67.34%,and 72.66%,respectively.The control group was higher than the oocyte donation group than the oocyte recipient group（P>0.05）;The multiple pregnancy rates（%）were 32.52%,32.66%,and 27.34%,the oocyte recipient group was higher than the oocyte donation group than the control group（P>0.05）;The taking baby home rate（%）were 31.13%,28.98%and 18.46%,respectively,and the oocyte donation group was higher than the oocyte recipient group（P>0.05）,the oocyte recipient group was higher than the control group（P<0.05）.The taking baby home rate in the oocyte recipient group was consistent with the oocyte donation group,while the taking baby home rate of the control group dropped from 31.19%before 29 years old to 4.31%at 42～43years old.5.Endometrial estrogen preparation,endometrial ultrasound imaging and clinical outcome in the oocyte recipient group:The P value of the total number of days and total dose of estrogen used to prepare the endometrium in the oocyte recipient group was 0.964 and 0.548,respectively;The embryo implantation rate of the A-type endometrium group and the non-A-type endometrium group were 23.20%and26.01%（P>0.05）,respectively;The embryo implantation rates of the endometrium thickness<8mm group,8mm～12mm group and>12mm group were 22.02%,25.13%and 16.67%,respectively.The 8mm～12mm group was higher than the<8mm group（P>0.05）;The 8mm～12mm group was higher than the>12mm group,and the<8mm group was higher than the>12mm group（P<0.05）.【Conclusion】（1）The female endometrial receptivity did not decrease significantly within the observation range of this study（before 50 years old）,and the decrease in reproductive ability was mainly due to the decrease in the quality of oocytes.（2）The endometrial thickness affects the embryo implantation rate,and the embryo implantation rate is the highest when the endometrial thickness is between8mm and 12mm on h CG day/transformation day. |
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