Assisted reproductive technology surveillance--United States, 2005.
Assisted reproductive technology surveillance--United States, 2005.
复制标题
辅助生殖技术监测——美国，2005年。
DOI：
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发表时间：
2008
期刊：
影响因子：
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通讯作者：
M. Macaluso
中科院分区：
文献类型：
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作者：
V. Wright;Jeani Chang;Gary Jeng;M. Macaluso
问题/状况
辅助生殖技术 (ART) 包括在实验室处理卵子和精子的生育治疗（即体外受精和相关程序）。接受 ART 手术的患者比自然受孕的女性更有可能生出多胎婴儿。多胞胎与母亲和婴儿的风险增加有关（例如妊娠并发症、早产、低出生体重婴儿和婴儿长期残疾）。本报告介绍了最新的国家数据和各州的具体结果。
报告期涵盖范围
2005年。
系统描述
1996 年，CDC 根据 1992 年生育诊所成功率和认证法案 (FCSRCA)（公法 102-493 [1992 年 10 月 24 日]）的规定，开始收集有关在美国进行的 ART 程序的数据。从2004年开始，CDC与统计调查研究机构Westat, Inc.签订合同，从美国的ART医疗中心获取数据。 Westat, Inc. 维护 CDC 的基于网络的数据收集系统，称为国家 ART 监视系统 (NASS)。
结果
2005 年，总共向 CDC 报告了 134,260 例 ART 手术。这些手术导致 38,910 例活产分娩和 52,041 名婴儿。在全国范围内，73%的ART手术使用来自患者卵子的新鲜受精胚胎，15%使用来自患者卵子的解冻胚胎，8%使用来自捐赠卵子的新鲜受精胚胎，4%使用来自捐赠卵子的解冻胚胎。总体而言，42% 的 ART 移植手术导致怀孕，35% 导致活产（产下一名或多名活产婴儿）。在使用来自捐赠卵子的新鲜受精胚胎的 ART 手术中观察到最高的活产率 (52%)。接受 ART 手术次数最多的是加利福尼亚州（18,655 例）、纽约州（12,032 例）、伊利诺伊州（9,449 例）、新泽西州（9,325 例）和马萨诸塞州（8,571 例）的居民。这五个州的活产分娩数量也最高。在 52,041 名通过 ART 出生的婴儿中，49% 是多胎分娩。对于接受 ART 移植手术（使用来自捐赠卵子（41%）或自己卵子（32%）的新鲜受精胚胎）的女性来说，多胞胎风险最高。 2005 年出生的美国婴儿中约有 1% 是通过 ART 受孕的。这些婴儿占全国多胞胎的17%。大约 9% 的 ART 单胞胎、57% 的 ART 双胞胎和 95% 的 ART 三胞胎或多胞胎出生体重较低。同样，15% 的 ART 单胞胎、66% 的 ART 双胞胎和 97% 的 ART 三胞胎或多胞胎早产。
口译
ART 手术是否会导致妊娠和活产取决于不同的患者和治疗因素。 ART 造成多胎分娩的重大风险，并与不良的孕产妇和婴儿结局（例如早产、低出生体重和婴儿死亡率）相关。这种风险根据患者的年龄、所进行的 ART 手术类型、可移植到子宫的胚胎数量、实际移植的数量以及移植日期（第 3 天或第 5 天）而有所不同。
公共卫生行动
与 ART 相关的多胞胎在全国和某些州的所有多胞胎中占相当大的比例。为了尽量减少多胎妊娠对母婴健康的不利影响，应继续并加强限制每次 ART 程序中移植胚胎数量的努力。在为考虑 ART 的患者提供咨询时，应充分解释与 ART 治疗选择相关的不良母婴结局（例如低出生体重和早产）。
PROBLEM/CONDITION
Assisted reproductive technology (ART) includes fertility treatments in which both eggs and sperm are handled in the laboratory (i.e., in vitro fertilization and related procedures). Patients who undergo ART procedures are more likely to deliver multiple-birth infants than women who conceive naturally. Multiple births are associated with increased risk for mothers and infants (e.g., pregnancy complications, premature delivery, low-birthweight infants, and long-term disability among infants). This report presents the most recent national data and state-specific results.
REPORTING PERIOD COVERED
2005.
DESCRIPTION OF SYSTEM
In 1996, CDC initiated data collection regarding ART procedures performed in the United States, as mandated by the Fertility Clinic Success Rate and Certification Act of 1992 (FCSRCA) (Public Law 102-493 [October 24, 1992]). Beginning with 2004, CDC has contracted with a statistical survey research organization, Westat, Inc., to obtain data from ART medical centers in the United States. Westat, Inc., maintains CDC's web-based data collection system called the National ART Surveillance System (NASS).
RESULTS
In 2005, a total of 134,260 ART procedures were reported to CDC. These procedures resulted in 38,910 live-birth deliveries and 52,041 infants. Nationwide, 73% of ART procedures used freshly fertilized embryos from the patient's eggs, 15% used thawed embryos from the patient's eggs, 8% used freshly fertilized embryos from donor eggs, and 4% used thawed embryos from donor eggs. Overall, 42% of ART transfer procedures resulted in a pregnancy, and 35% resulted in a live-birth delivery (delivery of one or more live-born infants). The highest live-birth rates were observed among ART procedures that used freshly fertilized embryos from donor eggs (52%). The highest numbers of ART procedures were performed among residents of California (18,655), New York (12,032), Illinois (9,449), New Jersey (9,325), and Massachusetts (8,571). These five states also reported the highest number of live-birth deliveries. Of 52,041 infants born through ART, 49% were born in multiple-birth deliveries. The multiple-birth risk was highest for women who underwent ART transfer procedures that used freshly fertilized embryos from either donor eggs (41%) or their own eggs (32%). Approximately 1% of U.S. infants born in 2005 were conceived through ART. Those infants accounted for 17% of multiple births nationwide. Approximately 9% of ART singletons, 57% of ART twins, and 95% of ART triplets or higher-order multiples were low birthweight. Similarly, 15% of ART singletons, 66% of ART twins, and 97% of ART triplets or higher-order multiples were born preterm.
INTERPRETATION
Whether an ART procedure resulted in a pregnancy and live-birth delivery varied according to different patient and treatment factors. ART poses a major risk for multiple births that are associated with adverse maternal and infant outcomes (e.g., preterm delivery, low birthweight, and infant mortality). This risk varied according to the patient's age, the type of ART procedure performed, the number of embryos available for transfer to the uterus, the number actually transferred, and the day of transfer (day 3 or day 5).
PUBLIC HEALTH ACTIONS
ART-related multiple births represent a sizable proportion of all multiple births nationwide and in selected states. To minimize the adverse maternal and child health effects that are associated with multiple pregnancies, ongoing efforts to limit the number of embryos transferred in each ART procedure should be continued and strengthened. Adverse maternal and infant outcomes (e.g., low birthweight and preterm delivery) associated with ART treatment choices should be explained fully when counseling patients who are considering ART.