A prognosis-based approach to infertility: understanding the role of time

被引：39

作者：

Albertini, D. F. ^{[1
]}

Anderson, R. ^{[2
]}

Bhattacharya, S. ^{[3
,4
,5
]}

Evers, J. L. H. ^{[6
]}

Mclernon, D. J. ^{[7
]}

Repping, S. ^{[8
]}

Somigliana, E. ^{[9
]}

Baird, D. T. ^{[10
]}

Crosignani, P. G. ^{[11
]}

Diedrich, K. ^{[12
]}

Farquharson, R. G. ^{[13
]}

Lundin, K. ^{[14
]}

Tapanainen, J. S. ^{[15
]}

Van Steirteghem, A. ^{[16
]}

机构：

[1] Ctr Human Reprod, Div Labs, New York, NY USA

[2] Univ Edinburgh, Obstet & Gynaecol, Edinburgh, Midlothian, Scotland

[3] Univ Aberdeen, Aberdeen Matern Hosp, Sch Med & Dent, Reprod Med, Aberdeen, Scotland

[4] Univ Aberdeen, Aberdeen Matern Hosp, Sch Med & Dent, Div Appl Hlth Sci, Aberdeen, Scotland

[5] Univ Aberdeen, Aberdeen Matern Hosp, Sch Med & Dent, Inst Appl Hlth Sci, Aberdeen, Scotland

[6] Maastricht Univ, Med Ctr, Dept Obstet & Gynecol, Maastricht, Netherlands

[7] Univ Aberdeen, Div Appl Hlth Sci, Med Stat Team, Aberdeen, Scotland

[8] Univ Amsterdam, Acad Med Ctr, Ctr Voortplantingsgeneeskunde, Amsterdam, Netherlands

[9] Maggiore Policlin Hosp, IRCCS Ca Granda Fdn, Clin Ostet & Ginecol, Milan, Italy

[10] Univ Edinburgh, Ctr Reprod Biol, Edinburgh, Midlothian, Scotland

[11] Maggiore Policlin Hosp, IRCCS Ca Granda Fdn, Via M Fanti 6, I-20122 Milan, Italy

[12] Univ Klinikum Schleswig Holstein, Klin Frauenheilkunde & Geburtshilfe, Campus Lubeck, Lubeck, Germany

[13] Liverpool Womens Hosp, Dept OB GYN, Liverpool, Merseyside, England

[14] Sahlgrens Univ Hosp, Reprod Med, Gothenburg, Sweden

[15] Univ Helsinki, Helsinki Univ Hosp, Dept Obstet & Gynaecol, Helsinki, Finland

[16] Vrije Univ Brussel, Univ Ziekenhuis, Ctr Reprod Med, Brussels, Belgium

来源：

HUMAN REPRODUCTION | 2017年 / 32卷 / 08期

关键词：

aging; subfertility; infertility; fecundity; age-related infertility; unexplained infertility; SUBFERTILE COUPLES; PREDICTION MODELS; LIVE BIRTH; AGE; MEDICINE;

D O I：

10.1093/humrep/dex214

中图分类号：

R71 [妇产科学];

学科分类号：

100211 ;

摘要：

The current definition of infertility acknowledges the importance of duration of pregnancy seeking but fails to recognize the prevalent negative impact of female age. In fact, the diagnosis of unexplained infertility increases with women's age because of our incapacity to discern between age-related infertility and real unexplained infertility. Physicians' response to the pressures of increased female age has been to take prompt refuge in assisted reproduction despite the lack of robust evidence and the inherent risks and costs of these procedures. Moreover, the prioritization of immediate health gains over those in the future, preference for accessing active treatment rapidly and reluctance to wait for spontaneous pregnancy expose patients to additional risks of overtreatment. Solutions are not simple to find but an alternative and innovative vision of infertility based on prognosis may be a valid solution. The availability of validated dynamic models based on real-life data that could predict both natural and ART-mediated conceptions may be of benefit. They could facilitate patients' counselling and could optimize the chances of success without exposing patients to unnecessary, expensive and demanding treatments.

引用

页码：1556 / 1559

页数：4

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