Factors influencing adverse perinatal outcomes in pregnancies achieved through use of in vitro fertilization
Factors influencing adverse perinatal outcomes in pregnancies achieved through use of in vitro fertilization
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DOI：
10.1016/j.fertnstert.2006.04.038
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发表时间：
2006-12-01
影响因子：
6.7
通讯作者：
Barnhart, Kurt T.
中科院分区：
文献类型：
--
作者：
Chung, Karine;Coutifaris, Christos;Barnhart, Kurt T.
目的：探讨体外受精治疗中特定因素与异常围产儿结局的关系。设计：病例对照研究。地点：以大学和社区为基础的不孕不育中心。患者(S)：1999年1月至2004年3月期间通过体外受精获得的所有存活妊娠。干预(S)：无。主要结局指标(S)：不孕症病因、促性腺激素暴露、胚胎操作和质量。结果(S)：在研究期间确定的455例可存活妊娠中，435例符合纳入标准。在调整了母亲的年龄、种族、产次、体重指数、不孕中心和试管受精的年份后，与单胎相比，多胎妊娠与不良围产儿结局的风险增加12倍。卵巢过度刺激综合征的风险增加3倍以上(优势比为3.14，95%可信区间为1.08-9.14)，而子宫内膜厚度具有显著的保护作用(优势比为0.89；95%可信区间为0.80-0.99)。我们没有发现不孕症的病因、刺激性药物的剂量或类型、胚胎操作技术的使用或质量对围产儿结局的影响。结论：这些数据证实并量化了与多胎相关的围产儿发病风险。在调整了多胎因素后，卵巢过度刺激综合征和子宫内膜发育不佳与通过试管受精获得的妊娠不良结局相关。我们的研究结果表明，影响IVF后胎儿生长和围产儿结局的可能是子宫内膜，而不是胚胎。
Objective: To determine the associations of specific components of IVF treatment with abnormal perinatal outcomes.Design: Case-control study.Setting: University-based and community-based infertility centers.Patient(s): All viable pregnancies achieved through IVF procedures performed between January 1999 and March 2004.Intervention(s): None.Main Outcome Measure(s): Infertility etiology, gonadotropin exposure, embryo manipulation, and quality.Result(s): Of 455 viable pregnancies identified during the study period, 435 met inclusion criteria. While adjusting for maternal age, race, parity, body mass index, infertility center, and year of IVF procedure, multiple gestations were associated with a 12-fold increased risk of poor perinatal outcome compared to singletons. Ovarian hyperstimulation syndrome significantly increased the risk more than 3-fold (odds ratio = 3.14; 95% confidence interval, 1.08-9.14), while endometrial thickness was found to have a significant protective effect (odds ratio = 0.89; 95% confidence interval, 0.80-0.99). We found no effect of etiology of infertility, dose or type of medication used for stimulation, use of embryo-manipulation techniques, or quality on perinatal outcome.Conclusion(s): These data confirm and quantify the risk of perinatal morbidity associated with multiple births. After adjusting for multiple births, ovarian hyperstimulation syndrome and suboptimal endometrial development are associated with adverse outcomes in pregnancies achieved through IVF. Our findings suggest that it may be the endometrium rather than the embryo that influences fetal growth and perinatal outcomes after IVF.