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目的探讨女性年龄对体外授精-胚胎移植(In vitro fertilization-embryo transfer,IVF-ET)单胎妊娠周期临床结局的影响。方法本研究纳入本中心2011年1月-2014年6月共807对患者夫妇812个IVF-ET单胎妊娠周期。将研究对象按女性年龄分为3组:<30y、30-34y和≥35y。结果随着女性年龄的增长,平均获卵数、MII卵子数、正常受精卵数、胚胎数和D3优胚数逐渐降低,差异显著(P<0.05)。平均移植胚胎数随着年龄的增加而显著增加(分别为1.70±0.47、1.80±0.45和1.98±0.57,P<0.05)。各年龄组间正常受精率和D3优胚率没有显著差异。囊胚形成率随着年龄的增加呈下降趋势(分别为56.43%、56.43%和47.27%),并且≥35y组显著低于另外两组(P<0.05)。早期流产率(分别为8.94%、14.07%和21.40%)和晚期流产率(分别为1.28%、3.29%和5.35%)随着年龄增加而增加。随着年龄的增加,足月产率呈下降趋势(分别为80.85%、76.95%和63.79%)。此外,≥35y男女性别比显著高于另外两组(分别为1.01、0.93和1.51,P<0.05)。而各年龄组间早产率(分别为8.94%、5.69%和9.47%)、新生儿平均体重(分别为3156±484g、3152±452g和3123±557g)和低体重儿出生率(分别为4.98%、6.98%和8.54%)没有显著差异(P>0.05)。结论 IVF-ET单胎妊娠周期,女性年龄≥35y可能增加早期流产和晚期流产风险,提高新生儿男女性别比的风险,还存在降低囊胚形成率和足月产率的风险。
Objective To investigate the influence of female age on clinical outcomes of singleton pregnancy in vitro fertilization-embryo transfer (IVF-ET). Methods The study included 812 IVF-ET singleton pregnancies in 807 couples between January 2011 and June 2014 in our center. Subjects were divided into three groups by female age: <30y, 30-34y and> 35y. Results With the increase of women’s age, the average number of oocytes retrieved, the number of MII eggs, the number of normal fertilized eggs, the number of embryos and the number of D3 embryos decreased significantly (P <0.05). The average number of embryos transferred increased with age (1.70 ± 0.47, 1.80 ± 0.45 and 1.98 ± 0.57, respectively, P <0.05). There was no significant difference between the normal fertilization rate and D3 excellent embryo rate among all age groups. The blastocyst formation rate decreased with age (56.43%, 56.43% and 47.27%, respectively), and was significantly lower in ≥ 35y group than in the other two groups (P <0.05). Early miscarriage rates (8.94%, 14.07% and 21.40%, respectively) and late miscarriage rates (1.28%, 3.29% and 5.35%, respectively) increased with advancing age. With age, the rate of full-term births is declining (80.85%, 76.95% and 63.79%, respectively). In addition, the sex ratio ≥35y was significantly higher than the other two groups (1.01, 0.93 and 1.51 respectively, P <0.05). The rates of preterm birth (8.94%, 5.69% and 9.47%, respectively), neonatal mean body weight (3156 ± 484g, 3152 ± 452g and 3123 ± 557g, respectively) and low birth weight children (4.98% 6.98% and 8.54%) did not differ significantly (P> 0.05). CONCLUSIONS: IVF-ET singletonic pregnancies with female age> 35y may increase the risk of early miscarriage and late miscarriage, increase the risk of neonatal male-to-female sex ratio, and reduce the risk of blastocyst formation and full-term birth rate.