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无法解释的不孕不育和与年龄有关的不孕不育:无法区分的诊断实体,但不同的试管婴儿预后
Giulia Mattei1, Marco Reschini2, Letizia Li Piani2,3
1Department of Maternal and Child Health and Urology, Sapienza University, Rome, Italy.
Human reproduction (Oxford, England)
|June 21, 2024
概括
试管婴儿 (IVF) 在与年龄有关的不孕症方面提供了有限的好处. 在患有不明原因不孕症的老年女性中,成功率下降得更快,这表明试管婴儿可能无法有效解决与年龄相关的卵细胞衰老问题.
科学领域:
- 生殖医学和内分泌学.
- 不孕症和辅助生殖技术 (ART)
背景情况:
- 无法解释的不孕不育 (UI) 是当标准检查没有发现原因时被诊断出来的.
- 与年龄相关的不孕症 (ARI),特别是在老年妇女中,是UI的重要组成部分.
- 目前的ART可能无法克服与年龄相关的卵细胞能力下降.
研究的目的:
- 评估不解释不育的比例是否会随着女性年龄的增长而增加.
- 为了比较女性的IVF成功率不解释与解释不孕不育,按年龄分层.
- 评估试管婴儿对与年龄相关的不孕症的有用性.
主要方法:
- 对1535名接受试管婴儿 (2014-2021) 的女性 (18-42岁) 的回顾性分析.
- 第1部分:评估了不同年龄组的UI的患病率.
- 第2部分:根据年龄,研究期和不孕症持续时间,将UI的妇女与解释不孕症的妇女匹配1:1,以比较活产率.
主要成果:
- 在35岁以上 (52%) 和35岁以下 (40%) 的女性中,UI的诊断更为频繁.
- 在35岁以上的女性中,UI (27%) 的活产率低于解释不孕症 (34%) (P=0.03).
- 在UI的老年妇女中,活产的调整后几率比为0.63,表明与解释不育的同龄人相比,试管婴儿的有效性减少了37%.
结论:
- 在治疗与年龄相关的不孕症方面,试管婴儿似乎是适度有用的.
- 试管婴儿的有效性会随着年龄的增长而显著降低,而女性患有不明原因的不孕不育.
- 这些发现质疑对老年妇女常规提供IVF,这些老年妇女有不明原因的不孕不育,强调需要生物标志物来诊断ARI.
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