Debating Elective Single Embryo Transfer after in vitro Fertilization: A Plea for a Context-Sensitive Approach.
Debating Elective Single Embryo Transfer after in vitro Fertilization: A Plea for a Context-Sensitive Approach.
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DOI：
10.4103/2141-9248.149761
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发表时间：
2015-01
影响因子：
--
通讯作者：
der Burg SV
中科院分区：
文献类型：
--
作者：
Ezugwu E;der Burg SV
体外受精（IVF）后移植的胚胎数量是十多年来争论的话题。由于与多胎妊娠相关的风险，全球一直在努力将多胎妊娠率降至最低，同时保持可接受的成功IVF妊娠率水平。选择性单胚胎移植（eSET）在大多数欧洲国家都是提倡的。在比利时和瑞典，对于预后良好的夫妇，eSET是强制性的。然而，尽管有临床建议和政策声明，但临床实践中的患者经常要求移植多个胚胎以获得双胞胎。这样的要求与政策准则相冲突，给医生带来了伦理困境：医生应该按照夫妇的要求去做，并尊重病人的自主权，还是坚持以母亲和孩子的健康为核心的医疗政策？本文提供了一个探索的参数中发现的文献，在这个话题的讨论中发挥了作用，并最终认为，医生应该做什么取决于具体的情况下，患者和医生都牵连。这些背景问题可以考虑在一个共同的决策过程中，这使得病人和医生的反思和责任，参加有关辅助生殖的决定。
The number of embryos transferred after in vitro fertilization (IVF) have been a topic of debate for over a decade now. Due to the risk associated with multiple pregnancy, there has been a global effort at reducing the multiple pregnancy rates to a minimum while maintaining an acceptable level of successful IVF pregnancy rate. Elective single embryo transfer (eSET) is advocated in most European countries. In Belgium and Sweden, eSET is mandatory for couples with a good prognosis. However, despite clinical recommendations and policy statements, patients in clinical practice frequently do request for the transfer of multiple embryos in order to have twins. Such requests conflict with policy guidelines and create an ethical dilemma for physicians: Should the physician do as the couple requests, and there with respect the autonomy of patients, or adhere to medical policy that takes the health of the mother and children at heart? This article provides an exploration of the arguments found in the literature that plays a role in the discussion on this topic and eventually argues that what a physician should do depends on the specificities of the context in which patients and physicians are implicated. These contextual issues can be taken into account in a shared decision-making procedure, which allows reflections and the responsibilities of both patients and physicians to be attended in decision about assisted reproduction.