Systematic review of worldwide trends in assisted reproductive technology 2004-2013.
Systematic review of worldwide trends in assisted reproductive technology 2004-2013.
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2004 - 2013年辅助生殖技术的全球趋势的系统评价。
DOI：
10.1186/s12958-016-0225-2
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发表时间：
2017-01-10
期刊：
影响因子：
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通讯作者：
Gleicher N
中科院分区：
文献类型：
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作者：
Kushnir VA;Barad DH;Albertini DF;Darmon SK;Gleicher N
辅助生殖技术(ART)在过去十年中经历了相当大的变化，但对世界不同地区ART结果的影响尚不清楚。我们对已公布的国家和地区ART登记数据进行了系统的审查，以评估2004至2013年间临床实践的变化如何影响澳大利亚和新西兰、加拿大、欧洲大陆、英国、日本、拉丁美洲和美国的结果。这些数据反映了7,079,145个ART周期，使用的是来自自体卵母细胞的新鲜和先前冷冻保存的胚胎，导致了1,454,724个活产。本文就近年来ART周期的体积、冷冻胚胎的使用、单胚胎移植(SET)、新鲜和冻融周期的活产率以及围产儿结局等方面的研究进展作一综述。在研究期间，全球范围内冷冻解冻胚胎的成套和利用都有所增加。2012年，SET在所有ART周期中的使用率最高的是日本和澳大利亚/新西兰(分别为82.6%和76.3%)，拉丁美洲最低(16.0%)。虽然在大多数地区都观察到活出生率的逐步改善，但一些地区出现了下降。到2012-2013年，新周期活产儿出生率在美国最高(29%)，在日本最低(5%)。在日本，观察到的新鲜周期活产率的下降与向最低刺激方案过渡、移植冷冻解冻胚胎而不是新鲜胚胎以及实施既定政策相一致。同样，在加拿大部分地区实施既定政策之后，新周期活产儿出生率下降。世界各地都可以看到，冷冻-解冻胚胎周期中不断增加的活出生率，部分弥补了新的ART周期的下降。2012-2013年间，澳大利亚/新西兰和日本的多重递送率最低，分别为5.6%和4%，而美国的多重递送率最高，为27%。近年来，所有地区的单胎早产率在9.0%至16.6%之间，双胞胎早产率在53.9%至67.3%之间，三胞胎及以上倍数早产率在91.4%至100%之间。不同登记处提供围产期结局数据的方式不一致，使区域间的比较变得困难。艺术实践的特点是不同地区之间的结果差异。国际上对抗逆转录病毒治疗成功的定义达成了共识，这可能有助于标准化世界范围内的抗逆转录病毒治疗实践，改善结局。PROSPERO(CRD42016033011)本文的在线版本(DOI：10.1186/s12958-0160225-2)包含补充材料，授权用户可以使用。
Assisted Reproductive Technology (ART) has undergone considerable changes over the last decade, with consequences on ART outcomes in different regions of the world being unknown. We conducted a systematic review of published national and regional ART registry data to assess how changes in clinical practice between 2004 and 2013 have impacted outcomes in Australia and New Zealand, Canada, Continental Europe, the United Kingdom (U.K.), Japan, Latin America, and the United States (U.S.). The data reflect 7,079,145 total ART cycles utilizing both fresh and previously cryopreserved embryos from autologous oocytes that resulted in 1,454,724 live births. This review focused on the following measures: ART cycle volume, use of cryopreserved embryos, single embryo transfer (SET), live birth rates in fresh and frozen-thawed cycles, and perinatal outcomes in recent years. SETs and utilization of frozen-thawed embryos increased worldwide over the study period. In 2012 SET utilization in all ART cycles was highest in Japan and Australia/New Zealand (82.6% and 76.3% respectively) and lowest in Latin America (16.0%). While gradual improvements in live birth rates were observed in most regions, some demonstrated declines. By 2012–2013, fresh cycle live birth rates were highest in the U.S. (29%) and lowest in Japan (5%). In Japan, the observed decline in fresh cycle live birth rate coincided with transition to minimal stimulation protocols, transfer of frozen-thawed rather than fresh embryos, and implementation of an SET policy. Similarly, implementation of an SET policy in parts of Canada was followed by a decline in fresh cycle live birth rate. Increasing live birth rates in frozen-thawed embryo cycles, seen all over the world, partially compensated for declines in fresh ART cycles. During 2012–2013 Australia/New Zealand and Japan reported the lowest multiple delivery rates of 5.6 and 4% respectively while the US had the highest of 27%. In recent years, preterm delivery rates in all regions ranged between 9.0 to 16.6% for singletons, 53.9 to 67.3% for twins, and 91.4 to 100% for triplets and higher order multiples. Inconsistencies in the way perinatal outcome data are presented by various registries, made comparison between regions difficult. ART practices are characterized by outcome differences between regions. International consensus on the definition of ART success, which accounts for perinatal outcomes, may help to standardize worldwide ART practice and improve outcomes. PROSPERO (CRD42016033011) The online version of this article (doi:10.1186/s12958-016-0225-2) contains supplementary material, which is available to authorized users.