What about the remaining twins since single-embryo transfer? How far can (should) we go?
What about the remaining twins since single-embryo transfer? How far can (should) we go?
复制标题
单胚胎移植后剩下的双胞胎怎么办？
DOI：
10.1093/humrep/dei425
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发表时间：
2006
影响因子：
6.1
通讯作者：
Jan Gerris
中科院分区：
文献类型：
--
作者：
D. D. Neubourg;Jan Gerris
单胚胎移植（SET）和更具体的选择性SET（eSET）已经在良好的临床IVF/ICSI实践中占据了一席之地。在对双胞胎倾向患者的特征进行初步的谨慎研究和选择具有最高植入潜力的胚胎之后，许多中心已经开始（逐步）实施SET，或者通过定罪，或者通过立法强制，或者两者兼而有之。只是因为持续的妊娠率基本上没有受到影响，SET才被接受。一般来说，可以说，在年轻女性的第一个和第二个新鲜IVF/ICSI周期中，仅通过移植一个优质胚胎，IVF/ICSI后的双胞胎率至少下降了50%，而总体妊娠率没有下降。预防IVF/ICSI双胞胎的“后半期”是另一个可能更艰巨的挑战，因为目标群体是由临床情况非常不同的患者组成的异质性混合体。我们是否可以将我们的经验扩展到更大年龄的妇女和更高级别的周期，而不会显着降低妊娠率？我们能把它扩展到更多的冷冻保存周期吗？为了了解SET应用增加的未来目标群体，我们分析了双胚胎移植（DET）后剩余的双胞胎，根据这些数据，我们建议将eSET政策扩展到38岁以下的女性，直到第三个周期和冷冻保存周期。
Single-embryo transfer (SET) and more specifically elective SET (eSET) have taken their place in good clinical IVF/ICSI practice. After the initial cautious search for the characteristics of the twin-prone patient and of the selection of the embryo with the highest implantation potential many centres have embarked on the (progressive) implementation of SET, either by conviction or forced by legislation or both. It was only because the ongoing pregnancy rates remained largely unaffected that SET was accepted. Generally speaking, it can be said that the twinning rate after IVF/ICSI has dropped by at least 50% simply by transferring only one good-quality embryo in the first and second fresh IVF/ICSI cycles in young women, without decrease in the overall pregnancy rate. Preventing 'the second half' of IVF/ICSI twins constitutes another and probably tougher challenge because the target group is a heterogeneous mix consisting of patients in very different clinical situations. Can we expand our experience for further twin prevention to women of older age and to cycles of higher rank without a significant drop in pregnancy rates? Can we extend it to more cryopreservation cycles? To have an idea of future target groups for increased application of SET, we analysed the remaining twins after double-embryo transfer (DET), and from these data we suggest expanding the eSET policy to women <38 years of age until the third cycle and to cryopreservation cycles.