Assisted Reproductive Technology and Relates Clinical Factors

As a widely-applied clinical therapy for infertility and sterility, ART has its own merits compared to other techniques and operations; however, the outcome of ART is influenced by various factors ranging from age, endometrial receptivity, reproductive system condition (e.g. uterus, fallopian tube and pelvic factors, etc.), immune system and so on. From our clinical experience and the literatures reviewd, it is strongly recommended that the situation of every infertile couple be evaluated thoroughly before applying therapy.AgeMore and more attention was paid to the relationship between advanced female reproductive age (or old age) and ART. The decrease of female fecundity began in the 30’s, becoming more pronounced after 40. There is an approximately 50% decrease in the fecundity rate of woman attempting pregnancy at the age of 40 or over compared with younger women, and a twofold to threefold increase in the rate of spontaneous abortions. In addition to the pelvic organ diseases and endocrine disorders, the main cause of ART failure is the aging of oocyte and granulosa cell, and then is the reduction of endometrium receptivity, which may be related to the blood flow of uterus. Ovarian reserve tests, e.g. the basal level of FSH, E2, and inhibin, FSH/LH ratio and real-time stimulation test (e.g. CC, GnH or GnRH test), should be done in women who are more than 35 years old; and transvaginal sonography (TVS) should also be done to evaluate the ovarian volume, follicular development, blood flow, etc. Some authors suggest that the basal level of FSH is more effective in prospecting the rate of cycle canceling and pregnancy in IVF program than age.Increasing age of patient is associated with poor ovarian response, as represented by smaller ovarian volume, lower antral follicle count, and poor stromal vascularity. Three-dimensional power Doppler ultrasonography can help to individualize IVF in patients regardless of age.