Бесплодие у женщин старшего репродуктивного возраста: причины, тактика ведения, перспективы использования преимплантационного генетического скрининга (обзор литературы)
Бесплодие у женщин старшего репродуктивного возраста: причины, тактика ведения, перспективы использования преимплантационного генетического скрининга (обзор литературы)
Сыркашева А.Г., Ильина Е.О., Долгушина Н.В. Бесплодие у женщин старшего репродуктивного возраста: причины, тактика ведения, перспективы использования преимплантационного генетического скрининга (обзор литературы). Гинекология. 2016; 18 (3): 40–43.
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Syrkasheva A.G., Ilina E.O., Dolgushina N.V. Infertility in women of advanced age: etiology, management, application of preimplantation genetic screening. Gynecology. 2016; 18 (3): 40–43.
Бесплодие у женщин старшего репродуктивного возраста: причины, тактика ведения, перспективы использования преимплантационного генетического скрининга (обзор литературы)
Сыркашева А.Г., Ильина Е.О., Долгушина Н.В. Бесплодие у женщин старшего репродуктивного возраста: причины, тактика ведения, перспективы использования преимплантационного генетического скрининга (обзор литературы). Гинекология. 2016; 18 (3): 40–43.
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Syrkasheva A.G., Ilina E.O., Dolgushina N.V. Infertility in women of advanced age: etiology, management, application of preimplantation genetic screening. Gynecology. 2016; 18 (3): 40–43.
В настоящее время проблема восстановления фертильности у женщин старшего репродуктивного возраста находится в эпицентре внимания врачей во всем мире. Процент женщин старшего репродуктивного возраста с бесплодием неуклонно увеличивается, при этом эффективность преодоления бесплодия, даже с применением методов вспомогательной репродукции, остается низкой. Бесплодие, связанное с возрастом, обусловлено различным спектром причин. Женщины старшего репродуктивного возраста имеют более высокую соматическую и гинекологическую заболеваемость, более высокий риск наличия хромосомных аномалий ооцитов (а значит, и эмбрионов), тенденцию к снижению овариального резерва. В данном обзоре литературы рассмотрены основные причины снижения фертильности у женщины старшего репродуктивного возраста, влияние возраста на качество ооцитов и исходы программ вспомогательных репродуктивных технологий, а также современные возможности преимплантационного генетического скрининга в повышении эффективности лечения бесплодия у данной группы пациенток. Ключевые слова: экстракорпоральное оплодотворение, преимплантационный генетический скрининг, бесплодие, старший репродуктивный возраст, качество ооцитов.
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The problem ofdecreased fertility in women of advanced reproductive age is important today. The number of women of advanced age with infertility is increasing constantly, however efficiency of infertility treatment (even with the use of artificial reproductive technologies) remains low. There are many biological and other causes ofage-associated infertility. Women of advanced reproductive age have high incidence of somatic and gynecological diseases, high risk of chromosomal abnormalities of oocytes and embryos and diminished ovarian reserve. This paper considers the main causes of decreased fertility in women of advanced age, impact of aging on oocyte quality and in vitro fertilization outcomes, and possibilities of application of preimplantation genetic screening in this group of women. Key words: in vitro fertilization, preimplantation genetic screening, infertility, advanced maternal age, oocyte quality.
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7. Hansen KR, Knowlton NS, Thyer AC et al. A new model of reproductive aging: The decline in ovarian non-growing follicle number from birth to menopause. Hum Reprod 2008; 23 (3): 699–708.
8. Johnson NP, Bagrie EM, Coomarasamy A et al. Ovarian reserve tests for predicting fertility outcomes for assisted reproductive technology: The International Systematic Collaboration of Ovarian Reserve Evaluation protocol for a systematic review of ovarian reserve test accuracy. BJOG An Int J Obstet Gynaecol 2006; 113 (12): 1472–80.
9. Velde ER, Pearson PL. The variability of female reproductive aging. Hum Reprod Update 2002; 8 (2): 141–54.
10. Klein N, Battaglia D, Fujimoto V et al. Reproductive aging: accelerated ovarian follicular development associated with a monotropic follicle-stimulating hormone rise in normal older women. J Clin Endocrinol Metab 1996; 81: 1038–45.
11. Broekmans FJ, Soules MR, Fauser BC. Ovarian aging: Mechanisms and clinical consequences. Endocr Rev 2009; 30 (5): 465–93.
12. Laven JSE. Genetics of Early and Normal Menopause. Semin Reprod Med 2015; 33 (6): 377–83.
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14. Nesbitt-Hawes EM, Ledger W. Endometriosis and infertility. Reprod Surg Assist Concept 2015; 29–35.
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21. Bokemeyer C, Schmoll H, van Rhee J et al. Long-term gonadal toxicity after therapy for Hodgkin’s and non-Hodgkin’s lymphoma. Ann Hemat 1994; 68 (3): 105–10.
22. Sharara FI, Beatse SN, Leonardi MR et al. Cigarette smoking accelerates the development of diminished ovarian reserve as evidenced by the clomiphene citrate challenge test. Fertil Steril 1994; 62 (2): 257–62.
23. Bukulmez O, Arici A. Assessment of ovarian reserve. Curr Opin Obs Gynecol 2004; 16 (3): 231–7.
24. Hardarson T, Hanson C, Lundin K et al. Preimplantation genetic screening in women of advanced maternal age caused a decrease in clinical pregnancy rate: a randomized controlled trial. Hum Reprod 2008; 23 (12): 2806–12.
25. Magli MC, Montag M, Kster M et al. Polar body array CGH for prediction of the status of the corresponding oocyte. Part II: Technical aspects. Hum Reprod 2011; 26: 3181–5.
26 Gianaroli L, Magli MC, Ferraretti AP et al. The role of preimplantation diagnosis for aneuploidies. Reprod BioMed Online 2002; 4 (3): 31–6.
27. Pellestor F, Andréo B, Arnal F et al. Maternal aging and chromosomal abnormalities: new data drawn from in vitro unfertilized human oocytes. Hum Genet 2003; 112 (2): 195–203.
28. Qi S-T, Liang L-F, Xian Y-X et al. Arrested human embryos are more likely to have abnormal chromosomes than developing embryos from women of advanced maternal age. J Ovarian Res 2014; 7 (1): 65.
29. Barbash-Hazan S, Frumkin T, Malcov M et al. Preimplantation aneuploid embryos undergo self-correction in correlation with their developmental potential. Fertil Steril 2009; 92 (3): 890–6. Available from: http://dx.doi.org/10.1016/j.fertnstert.2008.07.1761
30. Mersereau JE, Plunkett BA, Cedars MI. Preimplantation genetic screening in older women: a cost-effectiveness analysis. Fertil Steril 2008; 90 (3): 592–8.
31. Lee H, Mcculloh DH, Hodes-wertz B et al. In vitro fertilization with preimplantation genetic screening improves implantation and live birth in women age 40 through 43. 2015; 435–44.
________________________________________________
1. Zegers-Hochschild F, Adamson GD, de Mouzon J et al. International Committee for Monitoring Assisted Reproductive Technology (ICMART) and the World Health Organization (WHO) revised glossary of ART terminology, 2009. Fertil Sterild 2009; 92 (5): 1520–4.
2. Liu K, Case A. Advanced reproductive age and fertility. J Obs Gynaecol Can 2011; 33 (11): 1165–75.
3. Denson V. Diagnosis and Management of Infertility. J Nurse Pract 2006; 2 (6): 380–6.
4. Mishieva N.G. Besplodie u zhenshchin pozdnego reproduktivnogo vozrasta: printsipy diagnostiki i lecheniia v zavisimosti ot ovarial'nogo rezerva. Dis. … d-ra med. nauk. M., 2008. [in Russian]
5. Boiarskii K.Iu., Gaidukov S.N., Chkuaseli A.S. Faktory, opredeliaiushchie ovarial'nyi rezerv zhenshchiny. Zhurn. akush. i zhenskikh boleznei. 2009; 58 (2): 65–71. [in Russian]
6. Gougeon A, Ecochard R, Thalabard JC. Age-related changes of the population of human ovarian follicles: increase in the disappearance rate of non-growing and early-growing follicles in aging women. Biol Reprod 1994; 50 (3): 653–63.
7. Hansen KR, Knowlton NS, Thyer AC et al. A new model of reproductive aging: The decline in ovarian non-growing follicle number from birth to menopause. Hum Reprod 2008; 23 (3): 699–708.
8. Johnson NP, Bagrie EM, Coomarasamy A et al. Ovarian reserve tests for predicting fertility outcomes for assisted reproductive technology: The International Systematic Collaboration of Ovarian Reserve Evaluation protocol for a systematic review of ovarian reserve test accuracy. BJOG An Int J Obstet Gynaecol 2006; 113 (12): 1472–80.
9. Velde ER, Pearson PL. The variability of female reproductive aging. Hum Reprod Update 2002; 8 (2): 141–54.
10. Klein N, Battaglia D, Fujimoto V et al. Reproductive aging: accelerated ovarian follicular development associated with a monotropic follicle-stimulating hormone rise in normal older women. J Clin Endocrinol Metab 1996; 81: 1038–45.
11. Broekmans FJ, Soules MR, Fauser BC. Ovarian aging: Mechanisms and clinical consequences. Endocr Rev 2009; 30 (5): 465–93.
12. Laven JSE. Genetics of Early and Normal Menopause. Semin Reprod Med 2015; 33 (6): 377–83.
13. Pelosi E, Forabosco A, Schlessinger D. Genetics of the ovarian reserve. Front Genet 2015; 6: 1–20.
14. Nesbitt-Hawes EM, Ledger W. Endometriosis and infertility. Reprod Surg Assist Concept 2015; 29–35.
15. Shebl O, Ebner T, Sommergruber M et al. Anti muellerian hormone serum levels in women with endometriosis: a case-control study. Gynecol Endocrinol 2009; 25 (11): 713–6.
16. Korsak V.S., Parusov V.N., Kirsanov A.A., Isakova E.V. Vliianie rezektsii iaichnikov na ikh funktsional'nyi rezerv. Probl. reprod. 1996; 2 (4): 63–7. [in Russian]
17. Nargund G, Cheng WC, Parsons J. The impact of ovarian cystectomy on ovarian response to stimulation during in-vitro fertilization cycles. Hum Reprod 1996; 11 (1): 81–3.
18. Shulman A, Marom H, Oelsner G et al. The effect of adnexal surgery on the ovarian response to stimulation in in vitro fertilization. Eur J Obs Gynecol Reprod Bio 2002; 103 (2): 158–62.
19. Belialova N.S., Belialov F.I. Faktory riska i profilaktika raka. Klin. med. 2005; 11 (1): 17–21. [in Russian]
20. Lushbaugh C, Carasett C. The effects of gonadal irradiation in clinical radiation therapy: a review. Cancer 1976; 37: 1111–20.
21. Bokemeyer C, Schmoll H, van Rhee J et al. Long-term gonadal toxicity after therapy for Hodgkin’s and non-Hodgkin’s lymphoma. Ann Hemat 1994; 68 (3): 105–10.
22. Sharara FI, Beatse SN, Leonardi MR et al. Cigarette smoking accelerates the development of diminished ovarian reserve as evidenced by the clomiphene citrate challenge test. Fertil Steril 1994; 62 (2): 257–62.
23. Bukulmez O, Arici A. Assessment of ovarian reserve. Curr Opin Obs Gynecol 2004; 16 (3): 231–7.
24. Hardarson T, Hanson C, Lundin K et al. Preimplantation genetic screening in women of advanced maternal age caused a decrease in clinical pregnancy rate: a randomized controlled trial. Hum Reprod 2008; 23 (12): 2806–12.
25. Magli MC, Montag M, Kster M et al. Polar body array CGH for prediction of the status of the corresponding oocyte. Part II: Technical aspects. Hum Reprod 2011; 26: 3181–5.
26 Gianaroli L, Magli MC, Ferraretti AP et al. The role of preimplantation diagnosis for aneuploidies. Reprod BioMed Online 2002; 4 (3): 31–6.
27. Pellestor F, Andréo B, Arnal F et al. Maternal aging and chromosomal abnormalities: new data drawn from in vitro unfertilized human oocytes. Hum Genet 2003; 112 (2): 195–203.
28. Qi S-T, Liang L-F, Xian Y-X et al. Arrested human embryos are more likely to have abnormal chromosomes than developing embryos from women of advanced maternal age. J Ovarian Res 2014; 7 (1): 65.
29. Barbash-Hazan S, Frumkin T, Malcov M et al. Preimplantation aneuploid embryos undergo self-correction in correlation with their developmental potential. Fertil Steril 2009; 92 (3): 890–6. Available from: http://dx.doi.org/10.1016/j.fertnstert.2008.07.1761
30. Mersereau JE, Plunkett BA, Cedars MI. Preimplantation genetic screening in older women: a cost-effectiveness analysis. Fertil Steril 2008; 90 (3): 592–8.
31. Lee H, Mcculloh DH, Hodes-wertz B et al. In vitro fertilization with preimplantation genetic screening improves implantation and live birth in women age 40 through 43. 2015; 435–44.
Авторы
А.Г.Сыркашева*1, Е.О.Ильина2, Н.В.Долгушина1
1. ФГБУ Научный центр акушерства, гинекологии и перинатологии им. акад. В.И.Кулакова Минздрава России. 117997, Россия, Москва, ул. Академика Опарина, д. 4;
2. ФГБОУ ВО Московский государственный университет им. М.В.Ломоносова. 119192, Россия, Москва, Ломоносовский пр., д. 31, корп. 5
*anast.syrkasheva@gmail.com
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A.G.Syrkasheva*1, E.O.Ilina2, N.V.Dolgushina1
1. V.I.Kulakov Research Center for Obstetrics, Gynecology and Perinatology of the Ministry of Health of the Russian Federation. 117997,
Russian Federation, Moscow, ul. Akademika Oparina, d. 4;
2. M.V.Lomonosov Moscow State University. 119192, Russian Federation, Moscow, Lomonosovskii pr., d. 31, korp. 5
*anast.syrkasheva@gmail.com