Guideline for diagnosis and treatment of infertility in advanced age women (revised edition)

Abstract

As more and more couples postpone their childbearing plan, and Chinese two-child policy is fully liberalized, the proportion of advanced-age parents gradually increases. However, ovarian function gradually descends with age, and the incidences of uterine fibroids, scarred uterus, and pelvic inflammation disease significantly increase, which increases the risk of infertility. Even though the advanced-age women successfully get pregnant through assisted reproductive technology (ART), the risks of pregnancy complications and medical and surgical complications (such as miscarriage, gestational diabetes, gestational hypertension, intrauterine fetal death, low birth weight of newborn, or premature birth) will increase with age. Currently, the consistency of diagnosis and treatment strategies on elderly patients with infertility is still lacking, and the efficacy of the diagnosis and treatment is even worse. In light of the above situations, the specialized committee organized experts of reproductive endocrinology and ART to compose this guideline, aiming for standardizing the process of diagnosis and treatment on advanced-age infertile women. This guideline interprets reproductive status and related fertility evaluation on advanced-age infertile women, and discusses prepregnancy preparation of body and nutrition and consultation, as well as related risk assessment of pregnancy. It also analyzes the current clinical and laboratory hot issues: the genetic characteristics of advanced-age women, evaluation, counseling, and corresponding laboratory screening, diagnostic methods, and operational norms. In addition, for the advanced-age women with high incidence of medical and surgical complications, this guideline gives us norms of diagnosis and treatment on different complications. Finally, strategies of ART are made for the advanced-age infertile women, which can provide basis and guidance for their diagnosis and treatment.