Pregnancy and birth outcomes in couples with infertility with and without assisted reproductive technology: with an emphasis on US population-based studies.
Pregnancy and birth outcomes in couples with infertility with and without assisted reproductive technology: with an emphasis on US population-based studies.
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不孕夫妇使用和不使用辅助生殖技术的妊娠和分娩结局：重点是美国人群研究
DOI：
10.1016/j.ajog.2017.03.012
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发表时间：
2017-09
影响因子：
9.8
通讯作者：
Luke, Barbara
中科院分区：
文献类型：
--
作者：
Luke, Barbara
关键词：
不孕症，定义为在无保护性交后1年内无法怀孕，影响全世界估计8000万人，或10-15%的育龄夫妇。辅助生殖技术包括实现受孕的所有不孕症治疗;体外受精是卵母细胞在体外被精液受精的过程;非体外受精辅助生殖技术治疗包括促排卵、人工授精和宫腔内人工授精。在过去的20年里，辅助生殖技术的使用在美国稳步上升，原因有几个，包括高龄产妇生育和保险覆盖面的增加。从2000年到2013年，美国体外受精周期的数量几乎翻了一番，目前美国所有活产的1.7%是这项技术的结果。自35年前第一个体外受精婴儿出生以来，已有超过500万婴儿通过体外受精出生，其中一半是在过去6年内出生的。据估计，1%的单胎、19%的双胞胎和25%的三胞胎或更高倍数的婴儿是由于体外受精，而4%、21%和52%的婴儿是由于非体外受精辅助生殖技术。多胎双胞胎早产和低出生体重的风险比单胎多10倍（校正比值比，11.84; 95%置信区间，10.56-13.27和校正比值比，10.68; 95%置信区间，9.45-12.08）。使用供体卵母细胞与妊娠高血压（校正比值比，1.43; 95%置信区间，1.14-1.78）和早产（校正比值比，1.43; 95%置信区间，1.11-1.83）的风险增加相关。使用解冻胚胎与妊娠高血压（校正比值比，1.30; 95%置信区间，1.08-1.57）和妊娠期大出生体重（校正比值比，1.74; 95%置信区间，1.45-2.08）的风险较高相关。在单胎中，与生育分娩相比，体外受精与严重孕产妇发病风险增加有关（阴道：校正比值比，2.27; 95%置信区间，1.78-2.88;剖宫产：校正比值比，1.67; 95%置信区间，1.40-1.98）和低生育力分娩（阴道：校正比值比，1.97; 95%置信区间，1.30-3.00;剖宫产：校正比值比，1.75; 95%置信区间，1.30-2.35）。在双胞胎中，剖腹产体外受精分娩与剖腹产生育分娩相比，有显著更高的严重孕产妇发病率（调整后的比值比，1.48; 95%置信区间，1.14-1.93）。低生育力，有或没有体外受精或非体外受精不孕症治疗，以实现怀孕，与不良孕产妇和围产期结局的风险增加。随着时间的推移，多胞胎体外受精治疗的主要风险（以及相关的围产期发病率过高）已经减少，移植的胚胎数量更少，质量更好。
Infertility, defined as the inability to conceive within 1 year of unprotected intercourse, affects an estimated 80 million individuals worldwide, or 10-15% of couples of reproductive age. Assisted reproductive technology includes all infertility treatments to achieve conception; in vitro fertilization is the process by which an oocyte is fertilized by semen outside the body; non-in vitro fertilization assisted reproductive technology treatments include ovulation induction, artificial insemination, and intrauterine insemination. Use of assisted reproductive technology has risen steadily in the United States during the past 2 decades due to several reasons, including childbearing at older maternal ages and increasing insurance coverage. The number of in vitro fertilization cycles in the United States has nearly doubled from 2000 through 2013 and currently 1.7% of all live births in the United States are the result of this technology. Since the birth of the first child from in vitro fertilization >35 years ago, >5 million babies have been born from in vitro fertilization, half within the past 6 years. It is estimated that 1% of singletons, 19% of twins, and 25% of triplet or higher multiples are due to in vitro fertilization, and 4%, 21%, and 52%, respectively, are due to non-in vitro fertilization assisted reproductive technology. Higher plurality at birth results in a >10-fold increase in the risks for prematurity and low birthweight in twins vs singletons (adjusted odds ratio, 11.84; 95% confidence interval, 10.56–13.27 and adjusted odds ratio, 10.68; 95% confidence interval, 9.45–12.08, respectively). The use of donor oocytes is associated with increased risks for pregnancy-induced hypertension (adjusted odds ratio, 1.43; 95% confidence interval, 1.14–1.78) and prematurity (adjusted odds ratio, 1.43; 95% confidence interval, 1.11–1.83). The use of thawed embryos is associated with higher risks for pregnancy-induced hypertension (adjusted odds ratio, 1.30; 95% confidence interval, 1.08–1.57) and large-for-gestation birthweight (adjusted odds ratio, 1.74; 95% confidence interval, 1.45–2.08). Among singletons, in vitro fertilization is associated with increased risk of severe maternal morbidity compared with fertile deliveries (vaginal: adjusted odds ratio, 2.27; 95% confidence interval, 1.78–2.88; cesarean: adjusted odds ratio, 1.67; 95% confidence interval, 1.40–1.98, respectively) and subfertile deliveries (vaginal: adjusted odds ratio, 1.97; 95% confidence interval, 1.30–3.00; cesarean: adjusted odds ratio, 1.75; 95% confidence interval, 1.30–2.35, respectively). Among twins, cesarean in vitro fertilization deliveries have significantly greater severe maternal morbidity compared to cesarean fertile deliveries (adjusted odds ratio, 1.48; 95% confidence interval, 1.14–1.93). Subfertility, with or without in vitro fertilization or non-in vitro fertilization infertility treatments to achieve a pregnancy, is associated with increased risks of adverse maternal and perinatal outcomes. The major risk from in vitro fertilization treatments of multiple births (and the associated excess of perinatal morbidity) has been reduced over time, with fewer and better-quality embryos being transferred.
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