影响生育力的因素及高龄生育的策略
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摘要
影响生育力的因素非常复杂,年龄增长是生育力下降最不可抗拒的因素,不良遗传、环境、精神心理、生活方式等因素的联合作用也会加速生育力的损害。随着科技的进步,已有多种生育力评估的指标,建议生育期男女尤其是高龄夫妇及时进行生育评估、排除妊娠相关风险,正确对待助孕技术、赠卵及助孕年龄上限。
The factors that affecting fertility are very complex. Age growth is the most irresistible factor for fertility decline.Other factors,including heredity,environment,psychosocial status and lifestyle,also accelerate the damage of fertility.With the progress of science and technology,many indicators were employed for fertility assessment. It is suggested that men and women at childbearing age,especially elderly couples,should timely accept fertility assessment to eliminate pregnancy-related risks,and correctly choose assisted reproductive technology or egg donation,and understand the upper limit of ART age.
The factors that affecting fertility are very complex. Age growth is the most irresistible factor for fertility decline.Other factors,including heredity,environment,psychosocial status and lifestyle,also accelerate the damage of fertility.With the progress of science and technology,many indicators were employed for fertility assessment. It is suggested that men and women at childbearing age,especially elderly couples,should timely accept fertility assessment to eliminate pregnancy-related risks,and correctly choose assisted reproductive technology or egg donation,and understand the upper limit of ART age.
引文
[1]Gill SK,Broussard C,Devine O,et al. Association be-tween maternal age and birth defects of unknown etiology:United States,1997-2007[J]. Birth Defects Res Part AClin Mol Teratol,2012,94(12):1010-1018.
[2] Sharma R,Agarwal A,Rohra VK,et al. Effects of in-creased paternal age on sperm quality,reproductive out-come and associated epigenetic risks to offspring[J]. Re-prod Biol Endocrinol, 2015, 13:35. doi:10. 1186/s12958-015-0028-x.
[3] de La Rochebrochard E,de Mouzon J,Thépot F,et al.Fathers over 40 and increased failure to conceive:the les-sons of in vitro fertilization in France[J]. Fertil Steril,2006,85(5):1420-1424.
[4]Steiner AZ,Jukic AM. Impact of female age and nulligra-vidity on fecundity in an older reproductive age cohort[J].Fertil Steril,2016,105(6):1584-1588.
[5]De Vos M,Devroey P,Fauser BC. Primary ovarian insuffi-ciency[J]. Lancet,2010,376(9744):911-921.
[6]Franasiak JM,Forman EJ,Hong KH,et al. The nature ofaneuploidy with increasing age of the female partner:a re-view of 15,169 consecutive trophectoderm biopsies evalua-ted with comprehensive chromosomal screening[J]. FertilSteril,2014,101(3):656-663.
[7]Revel A. Defective endometrial receptivity[J]. Fertil Ster-il,2012,97(5):1028-1032.
[8]Stone BA,Alex A,Werlin LB,et al. Age thresholds forchanges in semen parameters in men[J]. Fertil Steril,2013,100(4):952-958.
[9]Feldman HA,Longcope C,Derby CA,et al. Age trends inthe level of serum testosterone and other hormones in mid-dle-aged men:longitudinal results from the Massachusettsmale aging study[J]. J Clin Endocrinol Metab,2002,87(2):589-598.
[10]Broer L,Codd V,Nyholt DR,et al. Meta-analysis of te-lomere length in 19,713 subjects reveals high heritability,stronger maternal inheritance and a paternal age effect[J]. Eur J Hum Genet,2013,21(10):1163-1168.
[11]Moskovtsev SI,Willis J,Mullen JB. Age-related declinein sperm deoxyribonucleic acid integrity in patients evalu-ated for male infertility[J]. Fertil Steril,2006,85(2):496-499.
[12]Curley JP,Mashoodh R,Champagne FA. Epigenetics andthe origins of paternal effects[J]. Horm Behav,2011,59(3):306-314.
[13]Schimmel MS,Bromiker R,Hammerman C,et al. Theeffects of maternal age and parity on maternal and neonataloutcome[J]. Arch Gynecol Obstet,2015,291(4):793-798.
[14]Wennberg AL,Opdahl S,Bergh C,et al. Effect of mater-nal age on maternal and neonatal outcomes after assistedreproductive technology[J]. Fertil Steril,2016,106(5):1142-1149.
[15]Morris JK,Wald NJ,Mutton DE,et al. Comparison ofmodels of maternal age-specific risk for Down syndromelive births[J]. Prenat Diagn,2003,23(3):252-258.
[16]章小维,郭明彩,杨慧霞.高龄初产对妊娠结局的影响[J].中国实用妇科与产科杂志,2005,21(2):111-112.ZHANG Xiaowei, GUO Mingcai, YANG Huixia. Theeffects of first pregnancy in elder age on the prognosis[J]. Chinese Journal of Practical Gynecology and Obstet-rics,2005,21(2):111-112.
[17]Nybo Andersen AM,Urhoj SK. Is advanced paternal agea health risk for the offspring?[J] Fertil Steril,2017,107(2):312-318.
[18]Chapman C,Cree L,Shelling AN. The genetics of pre-mature ovarian failure:current perspectives[J]. Int JWomens Health, 2015, 7:799-810. doi:10. 2147/IJWH. S64024.
[19]姜辉,田杨,黄锦,等.重视染色体基因缺陷对男性生育的影响[J].北京大学学报(医学版),2012,44(4):504-506.
[20] Ramlau-Hansen CH,Thulstrup AM,Nohr EA,et al.Subfecundity in overweight and obese couples[J]. HumReprod,2007,22(6):1634-1637.
[21]Chavarro JE,Rich-Edwards JW,Rosner BA,et al. Diet-ary fatty acid intakes and the risk of ovulatory infertility[J]. Am J Clin Nutr,2007,85(1):231-237.
[22]Qiao J,Feng HL. Extra-and intra-ovarian factors in poly-cystic ovary syndrome:impact on oocyte maturation andembryo developmental competence[J]. Hum Reprod Up-date,2011,17(1):17-33.
[23]卓胜楠,张印峰,张帅,等.不孕症女性体质量指数对IVF/ICSI-ET治疗结局的影响[J].生殖与避孕,2013,33(8):534-540.ZHUO Shengnan,ZHANG Yinfeng,ZHANG Shuai,etal. Influence of body mass index on IVF/ICSI-ET treat-ment outcome among infertility women[J]. Reproductionand Contraception,2013,33(8):534-540.
[24]杨青萍.卵巢储备功能与生育力减退影响因素的研究进展[J].医学综述,2016,22(11):2158-2161.YANG Qingping. Research progress in the influence fac-tors of ovarian reserve and fertility diminishment[J].Medical Recapitulate,2016,22(11):2158-2161.
[25]白双勇,王剑松.肥胖对男性精液影响的研究进展[J].医学综述,2015,21(17):3087-3089.BAI Shuangyong,WANG Jiansong. Research progress inthe effects of obesity on male semen[J]. Medical Reca-pitulate,2015,21(17):3087-3089.
[26] Spandorfer SD,Kump L,Goldschlag D,et al. Obesityand in vitro fertilization:negative influences on outcome[J]. J Reprod Med,2004,49(12):973-977.
[27]Zhang D,Zhu YM,Gao HJ,et al. Overweight and obesi-ty negatively affect the outcomes of ovarian stimulation andin vitro fertilisation:a cohort study of 2628 Chinesewomen[J]. Gynecol Endocrinol,2010,26(5):325-332.
[28]Colaci DS,Afeiche M,Gaskins AJ,et al. Men's bodymass index in relation to embryo quality and clinical out-comes in couples undergoing in vitro fertilization[J]. Fer-til Steril,2012,98(5):1193-1199.
[29]PetríkováJ,LazúrováI. Ovarian failure and polycystic o-vary syndrome[J]. Autoimmun Rev,2012,11(6-7):A471-478.
[30]La Marca A,Brozzetti A,Sighinolfi G,et al. Primary o-varian insufficiency:autoimmune causes[J]. Curr OpinObstet Gynecol,2010,22(4):277-282.
[31]Toufexis D,Rivarola MA,Lara H,et al. Stress and thereproductive axis[J]. J Neuroendocrinol,2014,26(9):573-586.
[32]Pal L,Bevilacqua K,Santoro NF. Chronic psychosocialstressors are detrimental to ovarian reserve:a study of in-fertile women[J]. J Psychosom Obstet Gynaecol,2010,31(3):130-139.
[33]倪少凯,吴柱国,黄建初,等.东莞市不孕不育影响因素的调查与分析[J].广东医学院学报,2010,28(4):364-367.NI Shaokai,WU Zhuguo,HUANG Jianchu,et al. Influ-encing factors of infertility in Dongguan City[J]. Journalof Guangdong Medical College,2010,28(4):364-367.
[34]Han Y,Xia YK,Zhu PF,et al. Reproductive hormonesin relation to polycyclic aromatic hydrocarbon(PAH)me-tabolites among non-occupational exposure of males[J].Sci Total Environ,2010,408(4):768-773.
[35] Cohn BA,Cirillo PM,Sholtz RI,et al. Polychlorinatedbiphenyl(PCB)exposure in mothers and time to pregnan-cy in daughters[J]. Reprod Toxicol,2011,31(3):290-296.
[36]Eskenazi B,Warner M,Marks AR,et al. Serum dioxinconcentrations and time to pregnancy[J]. Epidemiology,2010,21(2):224-231.
[37] Axmon A,Thulstrup AM,Rignell-Hydbom A,et al.Time to pregnancy as a function of male and female serumconcentrations of 2,2'4,4'5,5'-hexachlorobiphenyl(CB-153)and 1,1-dichloro-2,2-bis(p-chlorophenyl)-ethyl-ene(p,p'-DDE)[J]. Hum Reprod,2006,21(3):657-665.
[38] Li DK,Zhou ZJ,Miao MH,et al. Urine bisphenol-A(BPA)level in relation to semen quality[J]. Fertil Ster-il,2011,95(2):625-630.
[39]Wirth JJ,Rossano MG,Potter R,et al. A pilot study as-sociating urinary concentrations of phthalate metabolitesand semen quality[J]. Syst Biol Reprod Med,2008,54(3):143-154.
[40]Herr C,zur Nieden A,Koch HM,et al. Urinary di(2-ethylhexyl)phthalate(DEHP):metabolites and male hu-man markers of reproductive function[J]. Int J Hyg Envi-ron Health,2009,212(6):648-653.
[41] Lin CM,Chang WP,Doyle P,et al. Prolonged time topregnancy in residents exposed to ionising radiation in co-balt-60-contaminated buildings[J]. Occup Environ Med,2010,67(3):187-195.
[42]Kesari KK,Agarwal A,Henkel R. Radiations and malefertility[J]. Reprod Biol Endocrinol,2018,16(1):118.
[43]Hjollund NH,Storgaard L,Ernst E,et al. Impact of di-urnal scrotal temperature on semen quality[J]. ReprodToxicol,2002,16(3):215-221.
[44]白婷,肖红梅,卢光琇.不孕症患者病因调查分析[J].生命科学研究,2008,12(3):267-271.BAI Ting,XIAO Hongmei,LU Guangxiu. Investigationon etiological factors of infertile couples[J]. Life ScienceResearch,2008,12(3):267-271.
[45] Li Y,Lin H,Li YF,et al. Association between socio-psycho-behavioral factors and male semen quality:sys-tematic review and meta-analyses[J]. Fertil Steril,2011,95(1):116-123.
[46]Anifandis G,Bounartzi T,Messini CI,et al. The impactof cigarette smoking and alcohol consumption on spermparameters and sperm DNA fragmentation(SDF)meas-ured by Halosperm()[J]. Arch Gynecol Obstet,2014,290(4):777-782.
[47] Lalinde-Acevedo PC,Mayorga-Torres BJM,Agarwal A,et al. Physically active men show better semen parametersthan their sedentary counterparts[J]. Int J Fertil Steril,2017,11(3):156-165.
[48]高商,袁聚祥,韩宝生.女性不孕相关危险因素的病例对照研究[J].中国妇幼保健,2015,30(18):3014-3016.GAO Shang,YUAN Juxiang,HAN Baosheng. A case-control study on related risk factors of female infertility[J]. Maternal&Child Health Care of China,2015,30(18):3014-3016.
[49]李亚宁.人工流产后不孕妇女的免疫学检查结果分析[J].医学与临床,2011,8(8):970-971.
[50]李晓梅.高龄妇女再生育能力的孕前评估及干预措施[J].中国当代医药,2018,25(17):29-32.LI Xiaomei. Pre-pregnancy assessment and interventionmeasures for the reproductive ability of elderly women[J]. China Modern Medicine,2018,25(17):29-32.
[51]孙瑜,朱依敏.高龄不育夫妇,现代辅助生殖技术之惑[J].中国计划生育和妇产科,2014,6(8):1-3.
[52]American College of Obstetricians and Gynecologists Com-mittee on Gynecologic Practice and Practice Committee.Female age-related fertility decline. Committee OpinionNo. 589[J]. Fertil Steril,2014,101(3):633-634.
[53]Goldman MB,Thornton KL,Ryley D,et al. A random-ized clinical trial to determine optimal infertility treatmentin older couples:the Forty and Over Treatment Trial(FORT-T)[J]. Fertil Steril,2014,101(6):1574-1581.
[54]Qiao J,Wang ZB,Feng HL,et al. The root of reducedfertility in aged women and possible therapentic options:current status and future perspects[J]. Mol Aspects Med,2014,38:54-85. doi:10. 1016/j. mam. 2013. 06. 001.
[55]Ethics Committee of the American Society for ReproductiveMedicine. Oocyte or embryo donation to women of ad-vanced reproductive age:an Ethics Committee opinion[J]. Fertil Steril,2016,106(5):e3-e7. doi:10. 1016/j. Fertnstert. 2016. 07. 002.
[2] Sharma R,Agarwal A,Rohra VK,et al. Effects of in-creased paternal age on sperm quality,reproductive out-come and associated epigenetic risks to offspring[J]. Re-prod Biol Endocrinol, 2015, 13:35. doi:10. 1186/s12958-015-0028-x.
[3] de La Rochebrochard E,de Mouzon J,Thépot F,et al.Fathers over 40 and increased failure to conceive:the les-sons of in vitro fertilization in France[J]. Fertil Steril,2006,85(5):1420-1424.
[4]Steiner AZ,Jukic AM. Impact of female age and nulligra-vidity on fecundity in an older reproductive age cohort[J].Fertil Steril,2016,105(6):1584-1588.
[5]De Vos M,Devroey P,Fauser BC. Primary ovarian insuffi-ciency[J]. Lancet,2010,376(9744):911-921.
[6]Franasiak JM,Forman EJ,Hong KH,et al. The nature ofaneuploidy with increasing age of the female partner:a re-view of 15,169 consecutive trophectoderm biopsies evalua-ted with comprehensive chromosomal screening[J]. FertilSteril,2014,101(3):656-663.
[7]Revel A. Defective endometrial receptivity[J]. Fertil Ster-il,2012,97(5):1028-1032.
[8]Stone BA,Alex A,Werlin LB,et al. Age thresholds forchanges in semen parameters in men[J]. Fertil Steril,2013,100(4):952-958.
[9]Feldman HA,Longcope C,Derby CA,et al. Age trends inthe level of serum testosterone and other hormones in mid-dle-aged men:longitudinal results from the Massachusettsmale aging study[J]. J Clin Endocrinol Metab,2002,87(2):589-598.
[10]Broer L,Codd V,Nyholt DR,et al. Meta-analysis of te-lomere length in 19,713 subjects reveals high heritability,stronger maternal inheritance and a paternal age effect[J]. Eur J Hum Genet,2013,21(10):1163-1168.
[11]Moskovtsev SI,Willis J,Mullen JB. Age-related declinein sperm deoxyribonucleic acid integrity in patients evalu-ated for male infertility[J]. Fertil Steril,2006,85(2):496-499.
[12]Curley JP,Mashoodh R,Champagne FA. Epigenetics andthe origins of paternal effects[J]. Horm Behav,2011,59(3):306-314.
[13]Schimmel MS,Bromiker R,Hammerman C,et al. Theeffects of maternal age and parity on maternal and neonataloutcome[J]. Arch Gynecol Obstet,2015,291(4):793-798.
[14]Wennberg AL,Opdahl S,Bergh C,et al. Effect of mater-nal age on maternal and neonatal outcomes after assistedreproductive technology[J]. Fertil Steril,2016,106(5):1142-1149.
[15]Morris JK,Wald NJ,Mutton DE,et al. Comparison ofmodels of maternal age-specific risk for Down syndromelive births[J]. Prenat Diagn,2003,23(3):252-258.
[16]章小维,郭明彩,杨慧霞.高龄初产对妊娠结局的影响[J].中国实用妇科与产科杂志,2005,21(2):111-112.ZHANG Xiaowei, GUO Mingcai, YANG Huixia. Theeffects of first pregnancy in elder age on the prognosis[J]. Chinese Journal of Practical Gynecology and Obstet-rics,2005,21(2):111-112.
[17]Nybo Andersen AM,Urhoj SK. Is advanced paternal agea health risk for the offspring?[J] Fertil Steril,2017,107(2):312-318.
[18]Chapman C,Cree L,Shelling AN. The genetics of pre-mature ovarian failure:current perspectives[J]. Int JWomens Health, 2015, 7:799-810. doi:10. 2147/IJWH. S64024.
[19]姜辉,田杨,黄锦,等.重视染色体基因缺陷对男性生育的影响[J].北京大学学报(医学版),2012,44(4):504-506.
[20] Ramlau-Hansen CH,Thulstrup AM,Nohr EA,et al.Subfecundity in overweight and obese couples[J]. HumReprod,2007,22(6):1634-1637.
[21]Chavarro JE,Rich-Edwards JW,Rosner BA,et al. Diet-ary fatty acid intakes and the risk of ovulatory infertility[J]. Am J Clin Nutr,2007,85(1):231-237.
[22]Qiao J,Feng HL. Extra-and intra-ovarian factors in poly-cystic ovary syndrome:impact on oocyte maturation andembryo developmental competence[J]. Hum Reprod Up-date,2011,17(1):17-33.
[23]卓胜楠,张印峰,张帅,等.不孕症女性体质量指数对IVF/ICSI-ET治疗结局的影响[J].生殖与避孕,2013,33(8):534-540.ZHUO Shengnan,ZHANG Yinfeng,ZHANG Shuai,etal. Influence of body mass index on IVF/ICSI-ET treat-ment outcome among infertility women[J]. Reproductionand Contraception,2013,33(8):534-540.
[24]杨青萍.卵巢储备功能与生育力减退影响因素的研究进展[J].医学综述,2016,22(11):2158-2161.YANG Qingping. Research progress in the influence fac-tors of ovarian reserve and fertility diminishment[J].Medical Recapitulate,2016,22(11):2158-2161.
[25]白双勇,王剑松.肥胖对男性精液影响的研究进展[J].医学综述,2015,21(17):3087-3089.BAI Shuangyong,WANG Jiansong. Research progress inthe effects of obesity on male semen[J]. Medical Reca-pitulate,2015,21(17):3087-3089.
[26] Spandorfer SD,Kump L,Goldschlag D,et al. Obesityand in vitro fertilization:negative influences on outcome[J]. J Reprod Med,2004,49(12):973-977.
[27]Zhang D,Zhu YM,Gao HJ,et al. Overweight and obesi-ty negatively affect the outcomes of ovarian stimulation andin vitro fertilisation:a cohort study of 2628 Chinesewomen[J]. Gynecol Endocrinol,2010,26(5):325-332.
[28]Colaci DS,Afeiche M,Gaskins AJ,et al. Men's bodymass index in relation to embryo quality and clinical out-comes in couples undergoing in vitro fertilization[J]. Fer-til Steril,2012,98(5):1193-1199.
[29]PetríkováJ,LazúrováI. Ovarian failure and polycystic o-vary syndrome[J]. Autoimmun Rev,2012,11(6-7):A471-478.
[30]La Marca A,Brozzetti A,Sighinolfi G,et al. Primary o-varian insufficiency:autoimmune causes[J]. Curr OpinObstet Gynecol,2010,22(4):277-282.
[31]Toufexis D,Rivarola MA,Lara H,et al. Stress and thereproductive axis[J]. J Neuroendocrinol,2014,26(9):573-586.
[32]Pal L,Bevilacqua K,Santoro NF. Chronic psychosocialstressors are detrimental to ovarian reserve:a study of in-fertile women[J]. J Psychosom Obstet Gynaecol,2010,31(3):130-139.
[33]倪少凯,吴柱国,黄建初,等.东莞市不孕不育影响因素的调查与分析[J].广东医学院学报,2010,28(4):364-367.NI Shaokai,WU Zhuguo,HUANG Jianchu,et al. Influ-encing factors of infertility in Dongguan City[J]. Journalof Guangdong Medical College,2010,28(4):364-367.
[34]Han Y,Xia YK,Zhu PF,et al. Reproductive hormonesin relation to polycyclic aromatic hydrocarbon(PAH)me-tabolites among non-occupational exposure of males[J].Sci Total Environ,2010,408(4):768-773.
[35] Cohn BA,Cirillo PM,Sholtz RI,et al. Polychlorinatedbiphenyl(PCB)exposure in mothers and time to pregnan-cy in daughters[J]. Reprod Toxicol,2011,31(3):290-296.
[36]Eskenazi B,Warner M,Marks AR,et al. Serum dioxinconcentrations and time to pregnancy[J]. Epidemiology,2010,21(2):224-231.
[37] Axmon A,Thulstrup AM,Rignell-Hydbom A,et al.Time to pregnancy as a function of male and female serumconcentrations of 2,2'4,4'5,5'-hexachlorobiphenyl(CB-153)and 1,1-dichloro-2,2-bis(p-chlorophenyl)-ethyl-ene(p,p'-DDE)[J]. Hum Reprod,2006,21(3):657-665.
[38] Li DK,Zhou ZJ,Miao MH,et al. Urine bisphenol-A(BPA)level in relation to semen quality[J]. Fertil Ster-il,2011,95(2):625-630.
[39]Wirth JJ,Rossano MG,Potter R,et al. A pilot study as-sociating urinary concentrations of phthalate metabolitesand semen quality[J]. Syst Biol Reprod Med,2008,54(3):143-154.
[40]Herr C,zur Nieden A,Koch HM,et al. Urinary di(2-ethylhexyl)phthalate(DEHP):metabolites and male hu-man markers of reproductive function[J]. Int J Hyg Envi-ron Health,2009,212(6):648-653.
[41] Lin CM,Chang WP,Doyle P,et al. Prolonged time topregnancy in residents exposed to ionising radiation in co-balt-60-contaminated buildings[J]. Occup Environ Med,2010,67(3):187-195.
[42]Kesari KK,Agarwal A,Henkel R. Radiations and malefertility[J]. Reprod Biol Endocrinol,2018,16(1):118.
[43]Hjollund NH,Storgaard L,Ernst E,et al. Impact of di-urnal scrotal temperature on semen quality[J]. ReprodToxicol,2002,16(3):215-221.
[44]白婷,肖红梅,卢光琇.不孕症患者病因调查分析[J].生命科学研究,2008,12(3):267-271.BAI Ting,XIAO Hongmei,LU Guangxiu. Investigationon etiological factors of infertile couples[J]. Life ScienceResearch,2008,12(3):267-271.
[45] Li Y,Lin H,Li YF,et al. Association between socio-psycho-behavioral factors and male semen quality:sys-tematic review and meta-analyses[J]. Fertil Steril,2011,95(1):116-123.
[46]Anifandis G,Bounartzi T,Messini CI,et al. The impactof cigarette smoking and alcohol consumption on spermparameters and sperm DNA fragmentation(SDF)meas-ured by Halosperm()[J]. Arch Gynecol Obstet,2014,290(4):777-782.
[47] Lalinde-Acevedo PC,Mayorga-Torres BJM,Agarwal A,et al. Physically active men show better semen parametersthan their sedentary counterparts[J]. Int J Fertil Steril,2017,11(3):156-165.
[48]高商,袁聚祥,韩宝生.女性不孕相关危险因素的病例对照研究[J].中国妇幼保健,2015,30(18):3014-3016.GAO Shang,YUAN Juxiang,HAN Baosheng. A case-control study on related risk factors of female infertility[J]. Maternal&Child Health Care of China,2015,30(18):3014-3016.
[49]李亚宁.人工流产后不孕妇女的免疫学检查结果分析[J].医学与临床,2011,8(8):970-971.
[50]李晓梅.高龄妇女再生育能力的孕前评估及干预措施[J].中国当代医药,2018,25(17):29-32.LI Xiaomei. Pre-pregnancy assessment and interventionmeasures for the reproductive ability of elderly women[J]. China Modern Medicine,2018,25(17):29-32.
[51]孙瑜,朱依敏.高龄不育夫妇,现代辅助生殖技术之惑[J].中国计划生育和妇产科,2014,6(8):1-3.
[52]American College of Obstetricians and Gynecologists Com-mittee on Gynecologic Practice and Practice Committee.Female age-related fertility decline. Committee OpinionNo. 589[J]. Fertil Steril,2014,101(3):633-634.
[53]Goldman MB,Thornton KL,Ryley D,et al. A random-ized clinical trial to determine optimal infertility treatmentin older couples:the Forty and Over Treatment Trial(FORT-T)[J]. Fertil Steril,2014,101(6):1574-1581.
[54]Qiao J,Wang ZB,Feng HL,et al. The root of reducedfertility in aged women and possible therapentic options:current status and future perspects[J]. Mol Aspects Med,2014,38:54-85. doi:10. 1016/j. mam. 2013. 06. 001.
[55]Ethics Committee of the American Society for ReproductiveMedicine. Oocyte or embryo donation to women of ad-vanced reproductive age:an Ethics Committee opinion[J]. Fertil Steril,2016,106(5):e3-e7. doi:10. 1016/j. Fertnstert. 2016. 07. 002.