Assisted reproductive technology service availability, efficacy and safety in mainland China: 2016
Assisted reproductive technology service availability, efficacy and safety in mainland China: 2016
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DOI：
10.1093/humrep/dez245
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发表时间：
2020-02-01
影响因子：
6.1
通讯作者：
Song, L.
中科院分区：
文献类型：
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作者：
Bai, F.;Wang, D. Y.;Song, L.
研究问题：中国大陆辅助生殖技术（ART）服务的可用性、有效性和安全性的现状如何？总结回答：在这份中国大陆首份关于ART现状的国家报告中，分别提供和分析了2016年的治疗数量、结局和并发症数据。已知信息：中国大陆定期开展全国ART服务提供调查。对数据进行了分析，本论文由中国疾病预防控制中心国家妇女儿童健康中心和中华人民共和国国家卫生委员会妇女儿童健康司的团队成员撰写。研究设计、规模和持续时间：2018年完成了一项全国性的横断面调查，其中有关ART治疗的数据，收集了2016年1月1日至12月31日在中国大陆31个省的445个ART诊所进行的研究。2016年，中国大陆共有451家获得许可的ART诊所（包括人工授精诊所），其中445家提交了服务数据。323家体外受精（IVF）诊所共提供906 840个周期，其中常规IVF周期375 770个，卵胞浆内单精子注射（ICSI）周期154 948个，冷冻胚胎移植（FED）解冻周期367 146个，植入前遗传学诊断（PGD）治疗周期8976个。共161 376人4-43次碰撞报告了126 872个周期（即宫内）授精（AI），其中126 872个周期使用丈夫精液（AIH），34 504个周期使用供体精液（AID）。总体而言，98.7%的有执照诊所提供了100%的抗逆转录病毒治疗服务（包括艾滋病和艾滋病免疫治疗周期），这些诊所被列入本报告。(Six诊所仅提供机构信息，并被排除在外。中国大陆人口超过13亿，共进行了906840个体外受精周期，全国每百万居民（C/M）的周期数从2013年的360个增加到2016年的657个（各省之间的范围：45-3676）。常规IVF治疗后，每个取卵周期的临床妊娠率（PR）为23.2%，每个取卵周期的分娩率（DR）为18.7%，双胎分娩占总分娩数的27.9%。ICSI周期的PR、DR和TDR分别为20.5%、16.7%和27.2%。对于每次解冻的FET，PR、DR和TDR分别为48.2%、37.6%和24.2%。每诊断周期PGD的PR、DR和TDR分别为38.1%、29.7%和4.2%。AIH周期的PR和DR分别为13.3%和10.5%; AID周期的PR和DR分别为24.3%和21.1%。2016年中国大陆出生的活婴总数为1846万，2016年通过ART出生的婴儿数量为311309，占总数的1.69%。报告的出生缺陷率约为87/10 000。中度至重度卵巢过度刺激综合征（OHSS）的发病率为11.5每1000个取卵周期，其他并发症是罕见得多。局限性和原因预防：这份报告是根据提供的ART服务的汇总数据。未按年龄分层计算成功率。低出生缺陷率的报道，这可能是混淆的变化，出生后的后续方法，统计时间和记录taking.WIDER的影响的发现：ART服务的可用性显着改善，近年来在中国大陆。由于中国幅员辽阔，ART服务的提供确实存在明显的不平衡，但主要疗效和安全性指标与西方国家接近。
STUDY QUESTION: What is the current status of assisted reproductive technology (ART) service availability, efficacy and safety in mainland China?SUMMARY ANSWER: In this first national report on ART status in mainland China, data on treatment numbers, outcomes and complications in 2016 are provided and analyzed, respectively.WHAT IS KNOWN ALREADY: National ART Service Provision Surveys are conducted in mainland China regularly. Data were analyzed, and this manuscript was written by team members from the National Center for Women and Children's Health, China CDC and the Department of Women and Children Health, National Health Commission of the People's Republic of china.STUDY DESIGN, SIZE AND DURATION: A cross-sectional nationwide survey was completed in 2018, in which data regarding ART treatments, performed from 1st January to 31st December20 I 6 in 445 ART clinics located in 31 provinces of mainland China, were collected.PARTICIPANTS/MATERIALS, SETTING AND METHODS: There were in total 451 licensed ART clinics (including artificial insemination clinics) in mainland China in 2016, of which 445 submitted service data. A total of 906 840 cycles were provided by 323 in vitro fertilization (IVF) clinics, involving 375 770 conventional IVF cycles, 154 948 intracytoplasmic sperm injection (ICSI) cycles, 367 146 frozen embryo transfer (FED thawing cycles and 8976 preimplantation genetic diagnosis (PGD) treatment cycles. A total of 161 376 artificial (i.e. intrauterine) insemination (Al) cycles were reported by 4-43 clinks, with 126 872 cycles using the husband's semen (AIH) and 34 504 using donor semen (AID).MAIN RESULTS AND THE ROLE OF CHANCE: In total, 98.7% of the licensed clinics, contributing to 100% of the ART services (including AID and AIH cycles), were included in this report. (Six clinics provided institutional information only and were excluded.) There were 906 840 in vitro fertilization cycles performed in mainland China with a population of over 1.3 billion inhabitants, with cycles per million inhabitants (C/M) increasing from 360 in 2013 to 657 in 2016, nationwide (range among provinces: 45-3676). After treatment with conventional IVF, the clinical pregnancy rate (PR) per oocyte retrieval cycle was 23.2%, the delivery rate (DR) per oocyte retrieval cycle was 18.7% and the proportion of twin delivery among the total deliveries was 27.9%. For ICSI cycles, the PR, DR and TDR were 20.5%, 16.7% and 27.2%, respectively. For FET per thawing cycles, the PR, DR and TDR were 48.2%, 37.6% and 24.2%. For PGD per diagnosis cycles, the PR, DR and TDR were 38.1%, 29.7% and 4.2%. For AIH cycles, the PR and DR were 13.3% and 10.5%; for AID cycles, the PR and DR were 24.3% and 21.1%, respectively. The total number of live infants born in mainland China in 2016, was 18.46 million, and the number of infants born through ART conducted in 2016 was 31 1309, which accounted for 1.69% of the total. The reported rate of birth defects was about 87/10 000. The incidence of moderate to severe ovarian hyper-stimulation syndrome (OHSS) was 11.5 per 1000 oocyte retrieval cycles, and other complications were much more rare.LIMITATIONS AND REASONS FOR CAUTION: This report is based on the summary data of ART services provided. The success rates were not calculated by age stratification. A low rate of birth defects was reported, which might be confounded by variations in birth follow-up methods, statistical timing and record taking.WIDER IMPLICATIONS OF THE FINDINGS: ART service availability has improved significantly in recent years in mainland China. Because China is a vast country, significant imbalances in ART service provision do exist; however, the main efficacy and safety indicators were close to those of western countries.