Assisted Reproductive Technology and Newborn Size in Singletons Resulting from Fresh and Cryopreserved Embryos Transfer
Assisted Reproductive Technology and Newborn Size in Singletons Resulting from Fresh and Cryopreserved Embryos Transfer
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DOI：
10.1371/journal.pone.0169869
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发表时间：
2017-01-23
期刊：
影响因子：
3.7
通讯作者：
Diamond, Michael P.
中科院分区：
文献类型：
--
作者：
Dunietz, Galit Levi;Holzman, Claudia;Diamond, Michael P.
目的和研究设计本研究的目的有两个方面：采用标准化的测量方法，探讨辅助生殖技术（ART）与新生儿小体型的关系；并检查新鲜和冷冻胚胎移植的分层内，这种关联是否受到父母不育诊断的影响。我们使用了来自密歇根州（2000-2009年）、佛罗里达州和马萨诸塞州（2000-2010年）的基于人群的回顾性队列。我们的样本包括28,946例非供体卵母细胞妊娠的ART单胎和4,263,846例非ART单胎。方法采用回归模型对4个相互排斥的不育组（仅女性不孕症、仅男性不孕症、男女合并不孕症和不明原因不孕症）中ART与新生儿尺寸（以小胎龄（SGA）和出生体重z-score衡量）的相关性进行研究，并按新鲜和冷冻胚胎移植分层。结果我们发现新鲜胚胎移植的ART单胎与非ART单胎相比，SGA的发生率增加，不孕来源差异不大[仅女性不孕患者SGA的调整比值：1.18 (95% CI 1.10, 1.26)，仅男性不孕：1.20 (95% CI 1.10, 1.32)，男性和女性不孕：1.18 （95% CI 1.06, 1.31）和不明原因不孕：1.24 (95% CI 1.10, 1.38)]。相反，冷冻保存胚胎移植后出生的ART单胎与非ART单胎相比，SGA的发生率较低，不孕来源差异不大[仅女性不孕患者SGA的调整比值：0.56 (95% CI 0.45, 0.71)，仅男性不孕：0.64 (95% CI 0.47, 0.86)，男性和女性不孕：0.52 （95% CI 0.36, 0.77）和不明原因不孕：0.71 (95% CI 0.47, 1.06)]。无论不孕诊断如何，新鲜胚胎移植后出生的ART单胎的出生体重z评分明显低于非ART单胎。
Objectives and Study DesignThe aim of this study was two-fold: to investigate the association of Assisted Reproductive Technology (ART) and small newborn size, using standardized measures; and to examine within strata of fresh and cryopreserved embryos transfer, whether this association is influenced by parental infertility diagnoses. We used a population-based retrospective cohort from Michigan (2000-2009), Florida and Massachusetts (2000-2010). Our sample included 28,946 ART singletons conceived with non-donor oocytes and 4,263,846 non-ART singletons.MethodsRegression models were used to examine the association of ART and newborn size, measured as small for gestational age (SGA) and birth-weight-z-score, among four mutually exclusive infertility groups: female infertility only, male infertility only, combined female and male infertility, and unexplained infertility, stratified by fresh and cryopreserved embryos transfer.ResultsWe found increased SGA odds among ART singletons from fresh embryos transfer compared with non-ART singletons, with little difference by infertility source [adjusted odds-ratio for SGA among female infertility only: 1.18 (95% CI 1.10, 1.26), male infertility only: 1.20 (95% CI 1.10, 1.32), male and female infertility: 1.18 (95% CI 1.06, 1.31) and unexplained infertility: 1.24 (95% CI 1.10, 1.38)]. Conversely, ART singletons, born following cryopreserved embryos transfer, had lower SGA odds compared with non-ART singletons, with mild variation by infertility source [adjusted odds-ratio for SGA among female infertility only: 0.56 (95% CI 0.45, 0.71), male infertility only: 0.64 (95% CI 0.47, 0.86), male and female infertility: 0.52 (95% CI 0.36, 0.77) and unexplained infertility: 0.71 (95% CI 0.47, 1.06)]. Birth-weight-z-score was significantly lower for ART singletons born following fresh embryos transfer than non-ART singletons, regardless of infertility diagnoses.