自然週期vs誘導排卵      誘導排卵並不明顯提高胚胎染色體異常率 

自然週期vs誘導排卵      胚胎異常率均隨女性年齡而增加， 

自然週期vs誘導排卵      整倍體囊胚的植入率相同。

誘導排卵對胚胎非整倍體風險或胚胎生殖潛力沒有明顯副作用。

• Embryonic aneuploidy rates are equivalent in natural cycles and gonadotropin-stimulated cycles
• Aneuploidy rates were equivalent in unstimulated and stimulated IVF cycles. 
• The prevalence of aneuploidy in natural cycles increased with the age of the female partner in a manner identical to that seen in stimulated IVF cycles. 
• Implantation rates of euploid blastocysts were equivalent in natural and stimulated IVF cycles.
• No measurable toxic effect of gonadotropin administration on aneuploidy risk or embryonic reproductive potential. 

• The overall sustained implantation rate (SIR) did not differ for patients in the natural cycle group (60.0%) as compared to superovulatory controls (63.8%)
• Patients less than 35 years of age had an SIR of 61.7% in the natural cycle group versus 66.5% in the control group (P=.45). 
• There were no differences in SIR between patients that were 35 to 37 years of age in natural cycle (53.3%) versus gonadotropin control cycle patients (62.9%, P=.52). 
• Patients between the ages of 38 and 40 had SIR of 69.2% and 60.2%, in study and control groups, respectively (P=.65). 
• The SIR similarly did not vary for patients ages 41–42 in the natural cycle group and the superovulatory control group (33.3% vs. 61.4%, P=.33), or greater than 42 years of age (50.0% vs. 50.0%, P>.99). 

在所有年齡層  囊胚持續著床率比較

第5天優質囊胚>第 5 天中等囊胚>5 天差等囊胚>第 6 天胚胎 

第 5 天囊胚著床率與年齡>36歲有輕微負相關

第 6 天囊胚著床率與年齡>36歲有較明顯負相關

質量最佳的整倍體第 5 天胚胎在所有年齡的著床率高達 80%。

質量一般/較差的第 5 天胚胎和第 6 天胚胎的著床率約 50% 

 https://www.sciencedirect.com/science/article/pii/S1472648321002923

There was a clinically significant higher sustained implantation rate at all ages for euploid day 5 good quality embryos compared with day 5 fair, day 5 poor and day 6 embryos.

• For all ages the sustained implantation rates for day 5 good quality blastocysts were higher than for day 5 fair, day 5 poor and day 6 blastocysts. 
• At a maternal age of 36 years the best-fit sustained implantation rates were 86% for day 5 good quality blastocysts, 64% for day 5 fair, 63% for day 5 poor, and 51% for all day 6 blastocysts analysed as one group. 
• The best-fit sustained implantation rates for age 33 compared to age 39 years were 86% versus 80% for day 5 good, 71% versus 62% for day 5 fair, 59% versus 55% for day 5 poor, and 81% versus 46% for all day 6.
• The best quality euploid day 5 embryos had a SIR of 80–90% at all ages. 
• Even fair/poor quality day 5 embryos and day 6 embryos had a SIR of approximately 50% or greater. 
• euploid blastocyst transfers a reasonable performance goal is an overall SIR of 60–65% per embryo and a LBR of 50–60% per embryo. 

 誘導排卵成效與下列有關

• dehydroepiandrosterone DHEA (n = 1,336); 
• testosterone (n = 418); 
• high- vs. low-dose gonadotropin (n = 957); 
• delayed-start protocol with gonadotropin hormone-releasing hormone antagonist (n = 398); 

 誘導排卵成效與下列無關

• letrozole (n = 612); 
• clomiphene citrate (1,113); 
• growth hormone (311); l
• uteal phase stimulation (n = 57); 
• dual triggering (n = 139); dual stimulation (168); 
• luteinizing hormone (979); 
• oestradiol pretreatment (n = 552); 
• corifollitropin alfa (n = 561).

Therapeutic management in women with a diminished ovarian reserve: a systematic review and meta-analysis of randomized controlled trials

https://www.fertstert.org/article/S0015-0282(24)02256-8/fulltext

PGS應用是否能提高累積懷孕率與年齡有關

對於>35歲以上較能提高懷孕率，主因在於囊胚染色體異常率較高

年輕<35歲病患因為囊胚染色體異常率較低 ，PGS對於提高累積懷孕率較無明顯影響

Success rates with preimplantation genetic testing for aneuploidy in good prognosis patients are dependent on age

https://www.fertstert.org/article/S0015-0282(24)02261-1/abstract

To evaluate cumulative live birth after preimplantation genetic testing for aneuploidy (PGT-A) with next generation sequencing (NGS) compared with morphology alone among patients aged 21–40 years undergoing single blastocyst transfer.

• A total of 56,469 retrieval cycles were included in the analysis. Retrieval cycles were stratified based on age (<35, 35–37, and 38–40 years) and exposure to PGT-A with NGS. 
• the use of PGT-A was associated with a slightly lower cumulative live birth in individuals aged <35 years (risk ratio [RR]: 0.96; 95% CI: 0.93–0.99) compared with no PGT, 
• but higher cumulative live birth in ages 35–37 years (RR: 1.04; 95% CI: 1.00–1.08), 
• and 38–40 years (RR: 1.14; 95% CI: 1.07–1.20). 
• PGT-A was associated with higher cumulative live birth in individuals aged ≥35 years 
• was similar to no PGT in individuals aged <35 years. 
• Miscarriage was significantly less likely in individuals aged ≥35 years using PGT-A compared with no PGT-A.

精蟲頭部型態跟下列因素有關

1. acrosome formation頂體形成 
2. proacrosomal vesicles  前頂體囊泡 (PAV) 
3. manchette 
4. perinuclear theca 核週膜 (PT)
5. chromatin condensation染色質凝聚 
6. linker of nucleoskeleton 核骨架連接子
7. cytoskeleton complex細胞骨架 (LINC) 複合物 
8. ‘histone-to-protamine (HTP) transition‘組蛋白到魚精蛋白 (HTP) 轉變

精蟲頭部型態正常與否與ICSI結果有關