目的:当考虑女性伴侣的年龄时,高级男性伴侣的年龄是否会影响IVF治疗中的活产率(LBRs)?
结论:在新的IVF周期中,当女性伴侣年龄在35-39岁时,LBRs随着男性伴侣年龄≥40岁而下降,无论是否存在男性因素;但当女性伴侣年龄<35岁或≥40岁时不存在;在ICSI周期中未观察到这种下降。
背景:父系高龄与精子参数下降有关,胚胎发育受损,怀孕结局受损,以及IVF/ICSI周期中后代的异常。然而,关于母体和父亲年龄对IVF结局的交互作用的数据非常有限且不一致.在供体卵母细胞周期中,男性伴侣的年龄对妊娠结局没有显著影响。
方法:回顾性分析所有符合条件的自体IVF/ICSI周期,并从英国国家匿名注册中心获取卵母细胞和预期的新鲜胚胎移植(ET),由人类受精和胚胎学管理局(HFEA)在线发布。在研究期间有59951个周期符合纳入标准:2017年1月1日至2018年12月31日。
方法:夫妇接受试管婴儿(n=27226)或ICSI(n=32725)治疗伴侣的精子,然后是新鲜ET,原因不明(n=31846),输卵管(n=6605),或男性不育(n=22905)。子宫内膜异位症的治疗周期(n=5563),排卵障碍(n=9970),女性伴侣年龄>44岁(n=636),和PGT(n=280)被排除。女性在以下组中按年龄分层:<35、35-39、40-42和43-44岁;男性伴侣的年龄<35(参考组),35-37、38-39、40-42、43-44、45-50、51-55、55-60和>55年,如HFEA所述。在分析中合并了一些年龄组以增加人口规模。卡方检验用于比较双项数据;和多元逻辑回归,以发现男性和女性年龄组在活产方面的任何关联,以校正对该结果有重大影响的其他混杂因素。
结果:当女性伴侣年龄<35岁或年龄在40至44岁之间时,男性伴侣的每个卵母细胞提取以及每个ET的LBRs没有差异,男性因素不育症是否被纳入或排除,是否为IVF或ICSI周期.然而,当体外受精是女性伴侣35-39岁年龄组的授精方法时,每次取卵的LBRs从<35岁男性年龄组(参照组)的27.0%显著下降到22.9%(P=0.002),22.0%(P=0.006),在40-44岁、45-50岁和>50岁年龄组中占18.8%(P=0.004),分别在包括男性因素不育症的人群中。同样,每次检索的LBR从35岁年龄组的27.6%下降到40-44岁及以上年龄组的23.5%(P=0.002)和22.2%(P=002),分别在无男性不育的周期中。然而,在有或没有男性不育症的情况下进行ICSI时,男性年龄对任何女性伴侣年龄组的LBR均无影响.在结合IVF和ICSI周期的分析中,在35-39岁的女性年龄组中观察到每次检索和每次ET的LBR类似下降。当仅包括第一个治疗周期(每个患者分析)或分析单个囊胚移植周期时,推断保持不变。消除胚胎移植数量和阶段的影响。在调整了包括男性年龄在内的混杂因素后,女性年龄,以前的治疗周期数,以前的活产,授精方法(IVF或ICSI),移植的胚胎数量,和ET的日期(阶段),在35-39岁的女性年龄组中,男性伴侣的年龄与LBR仍然显着相关,但当女性年龄小于35岁或40至44岁时,在人口中,包括和不包括男性不育。只有当男性超过55岁,女性伴侣年龄<40岁时,IVF和ICSI周期中每一次ET的流产率才有上升趋势(非显著)。特别是当男性不育症被排除在外时。
结论:没有关于卵巢储备和刺激方案的信息。这可能影响不大,考虑到所研究的人口众多。女性和男性伴侣的年龄分组,需要将其作为回归分析中的序数变量。无法确定累积LBR,因为无法追踪后续冻融ET周期的信息,并且HFEA数据库中不存在异常精液参数的严重程度或原因。合并一些患者数量少的年龄组以获得可靠的结果。
结论:这是支持年轻女性卵母细胞逆转年龄相关精子质量恶化能力的实验室证据的最大临床数据。随着衰老的卵母细胞失去这种分离机制,老化的精子对LBR产生有害影响。这项研究的信息对于患者咨询和计划治疗很重要。对男性和女性年龄之间的相互作用的进一步研究将增加我们对这一问题的理解,并有助于确定ICSI程序是否更适合老年男性伴侣,即使没有明显的精液异常。
背景:不需要资金。没有竞争的利益。
背景:不适用(回顾性分析)。
OBJECTIVE: Does advanced male partner\'s age impact live birth rates (LBRs) in IVF treatment when female partner\'s age is factored in?
CONCLUSIONS: In fresh IVF cycles LBRs decline with male partner\'s age ≥40 years when the female partner is aged 35-39 years, irrespective of the presence or absence of male factor; but not when the female partner is <35 years or ≥40 years of age; this decline is not observed in ICSI cycles.
BACKGROUND: Advanced paternal age is associated with declining sperm parameters, impaired embryo development, compromised pregnancy outcomes, and abnormalities in the offspring in IVF/ICSI cycles. However, data on the interaction between maternal and paternal age on IVF outcomes are very limited and inconsistent. No significant effect of male partner\'s age on pregnancy outcomes has been noted in donor oocyte cycles.
METHODS: Retrospective analysis of all eligible autologous IVF/ICSI cycles with oocyte retrieval and intended fresh embryo transfer (ET) from the UK\'s national anonymized registry, published online by the Human Fertilisation and Embryology Authority (HFEA). There were 59 951 cycles that qualified the inclusion criteria in the study period: 1 January 2017 to 31 December 2018.
METHODS: Couples underwent IVF (n = 27 226) or ICSI (n = 32 725) treatment with partner\'s sperm followed by fresh ET due to unexplained (n = 31 846), tubal (n = 6605), or male infertility (n = 22 905). Treatment cycles with endometriosis (n = 5563), ovulatory disorders (n = 9970), female partner aged >44 years (n = 636), and PGT (n = 280) were excluded. Women were stratified by age in the following groups: <35, 35-39, 40-42, and 43-44 years; male partner\'s age as <35 (reference group), 35-37, 38-39, 40-42, 43-44, 45-50, 51-55, 55-60, and >55 years as presented by the HFEA. Some age-groups were merged in the analysis to increase the population size. Chi-square test was used to compare binominal data; and multiple logistic regression to find any association between male and female age-groups on live birth adjusting for other confounders that had a significant effect on this outcome.
RESULTS: LBRs per oocyte retrieval as well as per ET were no different across the male partners\' age-groups when the female partners were aged <35 years or in 40- to 44-year age-group, whether male-factor infertility was included or excluded and whether it was IVF or ICSI cycle. However, when IVF was the method of insemination in the female partner\'s age-group of 35-39 years, LBRs per oocyte retrieval dropped significantly from 27.0% in the male age-group of <35 years (reference group) to 22.9% (P = 0.002), 22.0% (P = 0.006), and 18.8% (P = 0.004) in 40-44, 45-50, and >50 years age-group, respectively in population that included male-factor infertility. Likewise, LBR per retrieval declined from 27.6% in 35 years age-group to 23.5% (P = 0.002) and 22.2% (P = 002) in 40-44 years and older groups, respectively in cycles without male infertility. However, there was no impact of male age on LBR in any female partner\'s age-group when ICSI was performed in either the presence or the absence of male infertility. A similar decline in the LBR per retrieval and per ET was observed in female age-group of 35-39 years in the analyses with IVF and ICSI cycles combined. The inference remained unchanged when only the first treatment cycle was included (per patient analysis) or when single blastocyst transfer cycles were analysed, eliminating the impact of the number and stage of embryo transferred. After adjusting for confounders including male age, female age, number of previous treatment cycles, previous live birth, insemination method (IVF or ICSI), number of embryos transferred, and day (stage) of ET, male partner\'s age remained significantly associated with LBR in the female age-group of 35-39 years, but not when women were in <35 years or 40- to 44-year age-group, in population including as well as excluding male infertility. Miscarriage rates per single ET trended to rise (non-significantly) in IVF as well as ICSI cycle only when men were over 55 years and female partners aged <40 years, particularly when male infertility was excluded.
CONCLUSIONS: Information on ovarian reserve and stimulation protocols was not available. This probably would have had little impact, given the large size of the population studied. The ages of female and male partners were given in groups necessitating taking them as ordinal variable in the regression analysis. Cumulative LBRs could not be determined as the information on subsequent frozen-thawed ET cycles could not be traced and the severity or cause of abnormal semen parameters were not present in the HFEA database. Some age-groups with small number of patients were merged to obtain a reliable result.
CONCLUSIONS: This is the largest clinical data to support the laboratory evidence of the ability of oocytes from young women to reverse the age-related deterioration of sperm quality. As the ageing oocytes lose this reparatory mechanism, the ageing sperm exert a detrimental effect on the LBR. The message of this study is important in counselling of patients and planning out treatment. Further research on interaction between male and female age will increase our understanding of this matter and help to establish whether ICSI procedure is more appropriate for older male partners even when there is no apparent semen abnormality.
BACKGROUND: No funding was required. There is no competing interest.
BACKGROUND: N/A (retrospective analysis).