Impact of medically assisted fertility on preterm birth
Impact of medically assisted fertility on preterm birth
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DOI：
10.1111/j.1471-0528.2005.00598.x
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发表时间：
2005-03-01
影响因子：
5.8
通讯作者：
Bernardi, S
中科院分区：
文献类型：
--
作者：
Filicori, M;Cognigni, GE;Bernardi, S
早产是接受不孕症治疗的妇女经常遇到的问题。许多因素似乎有助于这种并发症的发生。不孕妇女似乎有早产和低出生体重婴儿的倾向。这些并发症也发生在有不孕症史的妇女中，她们未经治疗就怀孕了，并且是单胎妊娠。接受体外受精（IVF）和卵胞浆内单精子注射（ICSI）治疗的辅助生殖患者，即使是单胎妊娠，早产的发生率也不成比例地高。自发性早产可能与女性伴侣的基础医学状况有关，因为在接受ICSI治疗的受试者中其发生率并未增加（即，当不育问题与正常女性伴侣的男性生殖功能障碍相关时）。多胎妊娠是不孕妇女早产的最可能相关因素。单独使用药物诱导排卵或与宫腔内人工授精相结合会导致多胎妊娠显着增加。高阶多胎妊娠的发生率也有所增加。接受IVF或ICSI的女性的多胎妊娠与治疗结束时移植的胚胎数量有关。35岁以下女性移植两个以上胚胎与受孕机会增加无关，而多胎妊娠的发生率显着增加。40岁以上的女性可能受益于两个以上胚胎的移植，多胎妊娠的风险较小。单胚胎移植越来越被认为是一种可行的临床选择，特别是在年轻女性中。希望对不孕症管理采取更谨慎的方法将减少多胎妊娠，自发性早产和治疗这些妇女后出生的低出生体重儿的数量。
Preterm birth is a frequent problem in women who undergo treatment for infertility. Many factors appear to contribute to the occurrence of this complication. Infertile women seem to have a predisposition to giving birth preterm and to having low birthweight babies. These complications also occur in women with a history of infertility who achieve pregnancy without treatment and who have singleton pregnancies. Assisted reproduction patients treated with in vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI) have a disproportionately high occurrence of preterm births even with singleton pregnancies. Spontaneous preterm labour may be related to underlying medical conditions of the female partner, as its occurrence is not increased in subjects treated with ICSI (i.e. when the infertility problem is associated with male reproductive dysfunction in normal female partners). Multiple pregnancy is the factor most likely to be related to preterm birth in infertile women. The administration of drugs to induce ovulation either alone or combined with intrauterine insemination causes a significant increase in multiple pregnancies. The occurrence of higher order multiple pregnancy is also increased. Multiple pregnancy in women undergoing IVF or ICSI is related to the number of embryos transferred at the end of treatment. The transfer of more than two embryos in women under 35 is not associated with an increased chance of conception, while the occurrence of multiple pregnancy is significantly increased. Women over 40 may benefit from the transfer of more than two embryos, with fewer risks of multiple pregnancy. Single embryo transfer is increasingly considered a workable clinical option, particularly in young women. Hopefully, a more cautious approach to infertility management will reduce the occurrence of multiple pregnancy, spontaneous preterm labour and the high number of low birthweight infants born after treating these women.