@article{oai:u-ryukyu.repo.nii.ac.jp:02017766,
 author = {Tong, Lin and Mekaru, Keiko and Yagi, Chiaki and Asato, Kozue and Kinjyo, Tadatsugu and Masamoto, Hitoshi and Xiulan, Zhang and Aoki, Yoichi},
 issue = {3･4},
 journal = {琉球医学会誌 = Ryukyu Medical Journal},
 note = {Purpose: We retrospectively analyzed the clinical outcome of patients over 40 years who received in vitro fertilization-embryo transfer (IVF-ET) or intracytoplasmic sperm injection (ICSI) at a single center, and compared four different ovarian stimulation protocols to determine the most suitable method for use in these women. The aim of the study is to provide valuable information for use in the counseling of prospective IVF patients. Patients and Methods: The clinical records of 272 patients (aged ≥ 41 years) who received IVF-ET/ICSI at our institution between January 2008 and September 2011 were retrospectively analyzed. Four ovarian stimulation protocols were used: Group A received GnRH agonist long protocol with short-acting drugs, Group B received GnRH agonist long protocol with long-acting drugs, Group C received GnRH antagonist protocol, and Group D received microdose GnRH agonist protocol. Results: The mean age was 42.5 years (range, 41-49 years), and the median duration of infertility was 8.2 years (range, 0.5-22 years). The overall pregnancy rate, and live-birth rate per transfer were 20.3%, and 9.1%, respectively, and the abortion rate was 46.8%. The live-birth rate per transfer was decreased as follows: 15.6% at 41 years, 6.4% at 42 years, 6.3% at 43 years, and 4.5% over 44years. A significantly lower live-birth rate per transfer (p = 0.0165) was observed in age group ≥42 years than in 41 years of age. The age ≥42 years and the number of oocyte retrieval (≤4) were found to be an independent unfavorable factor for both pregnancy and live birth by a multivariate analysis. Groups A and B received the highest dosage of HMG injection and the longest HMG treatment, and had the highest oocyte retrieval, whereas group D received the lowest HMG dosage over the shortest period, but had the highest cycle cancelation rate and the fewest oocytes (p < 0.01). Group C had a lower HMG dosage and fewer HMG medication days than Groups A and B (p < 0.01). However, no significant differences were observed in the pregnancy rates among patients among the four groups. Conclusions: Age, in particular ≥42 years, and the less oocyte retrieval are found to be a predictive factor for the treatment failure. For the decreased medication costs and patient discomfort, use of GnRH antagonist or microdose GnRH agonist for ovarian stimulation seem to be better in patients over 40 years., 論文},
 pages = {79--88},
 title = {[原著]Clinical outcome of in vitro fertilization-embryo transfer in patients over 40 years from a single institution in Guangdong, China},
 volume = {32}
}