Estimation of the Contribution of Non-Assisted Reproductive Technology Ovulation Stimulation Fertility Treatments to US Singleton and Multiple Births
Estimation of the Contribution of Non-Assisted Reproductive Technology Ovulation Stimulation Fertility Treatments to US Singleton and Multiple Births
复制标题
DOI：
10.1093/aje/kwp281
复制
发表时间：
2009-12-01
影响因子：
5
通讯作者：
Warner, Lee
中科院分区：
文献类型：
--
作者：
Schieve, Laura A.;Devine, Owen;Warner, Lee
包括促排卵（辅助生殖技术）和非辅助生殖技术促排卵)在内的不孕症治疗与多胎分娩以及伴随的后遗症和不良后果的风险增加有关，即使在单胎中也是如此。虽然美国正在进行抗逆转录病毒治疗诱导分娩的监测系统，但没有针对非抗逆转录病毒治疗导致的分娩的基于人群的跟踪系统。作者开发了一个多阶段模型来估计2005年出生的美国婴儿中使用非art排卵治疗受孕的不确定比例。利用已公布的监测数据，他们估计了美国自然和通过抗逆转录病毒治疗怀孕的多胞胎的比例，并假设其余的多胞胎是通过非抗逆转录病毒治疗怀孕的。他们使用贝叶斯荟萃分析来总结已发表的与非art排卵治疗相关的多胎妊娠风险的临床研究，应用胎儿生存因子，并使用该多胎妊娠风险估计值和他们自己对非art排卵刺激导致的美国多胎妊娠比例的估计值来估计接受此类治疗的婴儿的总比例（通过减法，单胎）。基于该模型，作者估计2005年出生的美国婴儿中有4.6%（95%不确定性范围：2.8%-7.1%）是由非art排卵治疗导致的。值得注意的是，这一数字是抗逆转录病毒治疗捐款的4倍。
Infertility treatments that include ovulation stimulation, both assisted reproductive technologies (ARTs) and non-ART ovulation stimulation, are associated with increased risks of multiple birth and concomitant sequelae and adverse outcomes, even among singletons. While a US surveillance system for ART-induced births is ongoing, no population-based tracking system exists for births resulting from non-ART treatments. The authors developed a multistage model to estimate the uncertain proportion of US infants born in 2005 who were conceived by using non-ART ovulation treatments. Using published surveillance data, they estimated proportions of US multiple births conceived naturally and by ART and assumed that the remainder were conceived with non-ART treatments. They used Bayesian meta-analyses to summarize published clinical studies on the multiple-gestation risk associated with non-ART ovulation treatments, applied a fetal survival factor, and used this multiple-birth risk estimate and their own estimate of the proportion of US multiple births attributable to non-ART ovulation stimulation to estimate the total (and, through subtraction, singleton) proportion of infants conceived with such treatments. On the basis of the model, the authors estimate that 4.6% of US infants born in 2005 (95% uncertainty range: 2.8%-7.1%) resulted from non-ART ovulation treatments. Notably, this figure is 4 times greater than the ART contribution.