40岁及以上的高龄不孕症患者体外受精多周期累积活产率及相关影响因素

Objective: To investigate the cumulative live birth rates (CLBRs) and related influencing factors in women aged ≥40 years who underwent multi-cycle in vitro fertilization (IVF). Methods: This was a retrospective study. A total of 603 patients aged ≥40 years who underwent their first IVF cycle in the Center of Assisted Reproductive Technology of Northwest Women and Children's Hospital enrolled from April 2014 to September 2016. Patients were categorized into four groups according to age: group A (40-41 years), group B (42-43 years), group C (44-45 years); and group D (≥46 years). The differences in antral follicle count (AFC), etiology of infertility and CLBR among the four groups were detailed compared. Some influencing factors related to CLBRs, such as age and parity, were also analyzed by logistic multivariate methods. Results: The pregnancy rate per cycle, the live birth rates per cycle and the cumulative live birth rates were significantly higher in group A than those in other group, and the differences between the groups were statistically significant (P<0.05). However, the number of patients with at least one cycle with no retrieval oocytes significantly enhanced (P<0.001). After three IVF cycles, 122 patients achieved a live birth, which comprised 97.6% of the total live births. Compared with group A, CLBR significantly declined from group B to group D. The OR values of groups (B, C to D) were 0.416 (95% CI=0.259-0.668), 0.227 (95% CI=0.114-0.453) and 0.121 (95% CI=0.036-0.410), respectively. Conclusion: CLBR significantly declined with age. After three cycles of treatment, the accrual in the CLBR becomes less pronounced for all the four age groups.