Obstetrical and perinatal outcomes following blastocyst transfer compared to cleavage transfer: a systematic review and meta-analysis
Obstetrical and perinatal outcomes following blastocyst transfer compared to cleavage transfer: a systematic review and meta-analysis
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DOI：
10.1093/humrep/dew244
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发表时间：
2016-11-01
影响因子：
6.1
通讯作者：
Racowsky, C.
中科院分区：
文献类型：
--
作者：
Martins, W. P.;Nastri, C. O.;Racowsky, C.
在产科和围产期结局方面，胚泡移植与卵裂期胚胎移植相比安全吗？囊胚期和卵裂期胚胎移植之间的临床平衡仍然是囊胚移植与某些不良围产儿结局相关的证据，质量低/非常低。将胚胎培养扩展到囊胚期提供了一些理论上的优势和劣势。虽然它允许胚胎自我选择，但它也使这些胚胎暴露在可能由于体外环境而造成的伤害中。在临床实践中，应该权衡有效性和安全性，以便做出循证决策。这是对随机对照试验(RCT)和观察性研究的系统回顾和荟萃分析，这些研究报告了单胎胚胎移植的围产期结局，比较了胚泡和卵裂期胚胎移植的结果。纳入观察性研究是因为主要结果、围产期死亡率和出生缺陷是罕见的，需要对大量参与者(>；50000)进行适当评估。最后一次电子搜索是在2016年3月11日。这项研究包括12项观察性研究，涵盖195 325名单身孕妇。无随机对照试验报告研究结果。根据纽卡斯尔-渥太华量表对纳入研究的质量进行评估，并根据分级标准对证据的质量进行评估。胚泡期转移与早产(37周)、早产(32周)、胎龄和围产儿死亡率的增加相关，尽管后者只从一项研究中被证实。相反，胚泡期移植与小于胎龄儿和双胞胎消失的风险降低有关，尽管只有一项研究报道了后者。纳入研究的观察性以及分析中的一些不一致和不准确降低了我们对估计的信心。由于现有证据的总体质量较低，卵裂期和胚泡移植之间的临床平衡仍然存在。需要进行更多的大型研究来阐明胚泡移植的潜在风险和好处。由于这项审查是为了支持关于最佳做法的全球建议，并考虑到在较低的资源环境下为囊胚期提供扩展培养所面临的挑战，因此必须考虑这些产科和新生儿结局，以确保任何建议都不会导致现有的妇幼保健系统和服务负担过重。作者没有竞争利益可言。CRD42015023910。
Is blastocyst transfer safe when compared to cleavage stage embryo transfer regarding obstetric and perinatal outcomes?The clinical equipoise between blastocyst and cleavage stage embryo transfer remains as the evidence associating blastocyst transfer with some adverse perinatal outcomes is of low/very low quality.Extended embryo culture to the blastocyst stage provides some theoretical advantages and disadvantages. While it permits embryo self-selection, it also exposes those embryos to possible harm due to the in vitro environment. Both effectiveness and safety should be weighed to permit evidence-based decisions in clinical practice.This is a systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies reporting perinatal outcomes for singletons comparing the deliveries resulting from blastocyst and cleavage stage embryo transfer. Observational studies were included because the primary outcomes, perinatal mortality and birth defects, are rare and require a large number of participants (> 50 000) to be properly assessed. The last electronic searches were last run on 11 March 2016.There were 12 observational studies encompassing 195 325 singleton pregnancies included in the study. No RCT reported the studied outcomes. The quality of the included studies was evaluated according to the Newcastle-Ottawa Scale and the quality of the evidence was evaluated according to GRADE criteria.Blastocyst stage transfer was associated with increased risks of preterm birth (< 37 weeks), very preterm birth (< 32 weeks), large for gestational age and perinatal mortality, although the latter was only identified from one study. Conversely, blastocyst stage transfer was associated with a decrease in the risks of small for gestational age and vanishing twins, although the latter was reported by only one study.The observational nature of the included studies and some inconsistency and imprecision in the analysis contributed to decreasing our confidence in the estimates.Due to the overall low quality of available evidence, the clinical equipoise between cleavage stage and blastocyst transfer remains. More large well-conducted studies are needed to clarify the potential risks and benefits of blastocyst transfer. As this review was initiated to support global recommendations on best practice, and in light of the challenges in lower resource settings to offer extended culture to blastocyst stage, it is critical to take into consideration these obstetric and neonatal outcomes in order to ensure any recommendation will not result in the overburdening of existing maternal and child health care systems and services.No external funding was either sought or obtained for this study. The authors have no competing interests to declare.CRD42015023910.