Research question

What are the reproductive outcomes of women aged 43 years and older undergoing IVF and intracytoplasmic sperm injection (ICSI) treatment using their own eggs.

Design

Retrospective study of 833 woman aged 43 years or older undergoing their first IVF and ICSI cycle using autologous oocytes at a tertiary referral hospital between January 1995 and December 2019. Live birth rate (LBR) after 24 weeks’ gestation was the primary outcome.

Results

Ninety-five out of 833 (11.4%) had a positive HCG, whereas 59 (62.1% per positive HCG) had a miscarriage before 12 weeks’ gestation and 36 (4.3%) live births were achieved. Analysis by age showed that the number of cumulus–oocyte complexes retrieved was significantly different between the four age groups: 43 years (5 [3–9]); 44 years (5 [2–7]); 45 years (3 [2–8)]); ≥45 years (2.5 [2–6]); P < 0.01; the number of metaphase II oocytes, however, was similar. Positive HCG rates remained low: 43 years (78/580 [13.4%]); 44 years (14/192 [7.3%]); 45 years (1/39 [2.6%]; and ≥46 years (2/22 [9.1%]); P = 0.03, as did LBR: 43 years (28 [4.8%]); 44 (7 [3.6%]); 45 years (0 [0%]); and ≥46 years (1 [4.5%]); P = 0.5. Multivariate regression analysis revealed that only number of metaphase II was significantly associated with LBR, when age was considered as a continuous (OR 1.08, 96% CI 1.004 to 1.16) or categorical variable (OR 1.08, 95% CI 1.005 to 1.16).

Conclusion

The chances of achieving a live birth in patients aged 43 years and older undergoing IVF/ICSI with their own gametes are low, even in cases of patients with a relatively ‘normal’ ovarian reserve for their age.

中文翻译：

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43 岁及以上女性的试管婴儿：20 年的经验

研究问题

使用自己的卵子进行试管婴儿和卵胞浆内单精子注射 (ICSI) 治疗的 43 岁及以上女性的生殖结果是什么？

设计

对 1995 年 1 月至 2019 年 12 月期间在三级转诊医院使用自体卵母细胞进行首次 IVF 和 ICSI 周期的 833 名 43 岁或以上女性的回顾性研究。妊娠 24 周后的活产率 (LBR) 是主要结果。

结果

833 人中有 95 人 (11.4%) 的 HCG 呈阳性，而 59 人（每个阳性 HCG 的人中有 62.1%）在妊娠 12 周前流产，36 人（4.3%）实现了活产。按年龄进行的分析表明，四个年龄组之间检索到的卵丘-卵母细胞复合体的数量存在显着差异：43 岁（5 [3-9]）；44 岁（5 [2-7]）；45 岁 (3 [2–8)])；≥45 岁（2.5 [2–6]）；P < 0.01；然而，中期 II 卵母细胞的数量是相似的。HCG 阳性率仍然很低：43 年（78/580 [13.4%]）；44 岁 (14/192 [7.3%]); 45 岁（1/39 [2.6%]；和 ≥46 岁（2/22 [9.1%]）；P  = 0.03，LBR 也是如此：43 岁（28 [4.8%]）；44（7 [3.6%]） ); 45 岁 (0 [0%]); 和 ≥46 岁 (1 [4.5%]); P = 0.5。多元回归分析显示，当年龄被视为连续变量（OR 1.08，96% CI 1.004 至 1.16）或分类变量（OR 1.08，95% CI 1.005 至 1.16）时，只有中期 II 的数量与 LBR 显着相关。

结论

43 岁及以上接受 IVF/ICSI 的患者使用自己的配子获得活产的机会很低，即使是在其年龄卵巢储备相对“正常”的患者中也是如此。