高龄女性不孕诊治指南

发布时间：2018-05-07 21:02

本文选题：高龄 + 不孕症　；参考：《中华生殖与避孕杂志》2017年02期

【摘要】：随着越来越多的育龄夫妇推迟其生育计划,以及我国“二孩政策”全面放开,高龄希望生育父母的比例逐渐增加。然而,随着女性年龄增加,卵巢功能逐渐下降,且子宫肌瘤、瘢痕子宫、盆腔炎症等发生率显著增加,不孕症的发生率逐渐增加。高龄女性即使通过辅助生殖技术(ART)获得成功妊娠,妊娠并发症风险和内、外科合并症的发生风险亦会随年龄增大而增加,如流产、胎死宫内、低出生体质量、早产以及妊娠期糖尿病和高血压疾病等。对于高龄不孕患者的诊治策略目前尚缺乏一致性,患者的诊治疗效更是参差不齐。基于以上情况,中国医师协会生殖医学专业委员会组织生殖内分泌及ART专家编写了本“高龄女性不孕诊治指南”,希望本指南可以规范我国高龄不孕女性患者的诊治流程。本指南从高龄女性的生育状况、需要进行的相关生育力评估及指标解读以及高龄女性孕前身体和营养准备、咨询、相关妊娠风险评估等入手进行深入探讨,分析了目前临床、实验室的热点问题:高龄女性子代遗传学特征及评估、咨询以及相应的实验室筛查、诊断方法和操作规范。另外,对于高龄女性妇产科及内外科合并症发生率高的状况,针对不同合并症状况探讨了相应的诊疗规范。最后,综合各方面情况制定了高龄女性不孕症的助孕策略,为高龄不孕女性的诊治提供依据和指导。
[Abstract]:With more and more couples of childbearing age postponing their fertility plans and the "two-child policy" being fully liberalized in China, the proportion of senior citizens who wish to have parents increases gradually. However, with the increase of female age, ovarian function gradually decreased, and the incidence of uterine fibroids, scar uterus, pelvic inflammation and so on increased significantly, and the incidence of infertility increased gradually. Even if successful pregnancy is achieved through assisted reproductive technology (ART), the risk of complications and internal complications of pregnancy and surgical complications also increase with age, such as abortion, intrauterine fetal death, low birth weight. Premature delivery and gestational diabetes mellitus and hypertension, and so on. At present, the diagnosis and treatment strategy for the elderly infertility is still lack of consistency, and the curative effect of diagnosis and treatment is even more uneven. Based on the above situation, the expert on reproductive endocrinology and ART of the professional committee of reproductive medicine of the Chinese Medical Association has compiled the guide for the diagnosis and treatment of infertility in the elderly women, hoping that this guide can standardize the diagnosis and treatment process of the elderly infertile women in China. This guide explores the fertility status of older women, the related fertility assessments and indicators that need to be evaluated, and the physical and nutritional preparation, counseling, and risk assessment of pregnancy for older women before pregnancy, and analyzes the current clinical features. Hot issues in the laboratory: genetic characteristics and evaluation, counseling and corresponding laboratory screening, diagnostic methods and operational specifications for the offspring of older women. In addition, for the elderly women with high incidence of gynecology and obstetrics and internal and surgical complications, the diagnosis and treatment of different complications were discussed. Finally, the strategy of assisted pregnancy for the elderly women with infertility is formulated in order to provide the basis and guidance for the diagnosis and treatment of the elderly infertile women.
【作者单位】：中国医师协会生殖医学专业委员会;

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