Assisted reproductive technology surveillance--United States, 2003.
Assisted reproductive technology surveillance--United States, 2003.
复制标题
辅助生殖技术监测——美国，2003 年。
DOI：
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发表时间：
2006
期刊：
影响因子：
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通讯作者：
M. Macaluso
中科院分区：
文献类型：
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作者：
V. Wright;Jeani Chang;Gary Jeng;M. Macaluso
问题/状况
1996年，疾病预防控制中心根据《生育诊所成功率和认证法》（FCSRCA）（公法102 - 493，1992年10月24日）的规定，开始收集有关在美国进行的辅助生殖技术（ART）程序的数据。ART包括在实验室中处理卵子和精子的生育治疗（即，体外受精和相关程序）。接受ART治疗的患者比自然怀孕的妇女更有可能分娩多胞胎婴儿。多胞胎与母亲和婴儿的风险增加有关（例如，妊娠并发症、早产、低出生体重儿和婴儿长期残疾）。
涉报告期
2003.
系统描述
疾病预防控制中心与辅助生殖技术协会（SART）签订合同，从位于美国的ART医疗中心获得数据。自1997年以来，疾病预防控制中心汇编了与抗逆转录病毒疗法程序有关的数据。
结果
2003年，向疾病控制和预防中心报告的抗逆转录病毒疗法手术共有122 872例。这些手术导致35 785例活产和48 756名婴儿。在全国范围内，74%的ART程序使用来自患者卵子的新鲜受精胚胎; 14%使用来自患者卵子的解冻胚胎; 8%使用来自捐赠卵子的新鲜受精胚胎; 4%使用来自捐赠卵子的解冻胚胎。总体而言，42%的抗逆转录病毒疗法转移程序导致怀孕，35%导致活产分娩（分娩一个或多个活产婴儿）。在使用来自供体卵子的新鲜受精胚胎的ART程序中观察到最高的活产率（51%）。在加州（15，911）、纽约（15，534）、马萨诸塞州（8，813）、伊利诺伊州（8，676）和新泽西（8，299）的居民中进行ART手术的人数最多。这五个州也报告了通过抗逆转录病毒疗法怀孕的婴儿数量最多。在48,756名通过抗逆转录病毒疗法出生的婴儿中，51%是多胎分娩。对于接受ART移植手术的妇女来说，多胞胎的风险最高，这些手术使用的是来自捐赠者卵子（40%）或自己卵子（34%）的新鲜受精胚胎。移植的胚胎数量，胚胎可用性（胚胎质量的指标）和患者的年龄也是多胎风险的强预测因素。2003年出生的美国婴儿中约有1%是通过ART受孕的，这些婴儿占全国多胞胎的18%。ART婴儿低出生体重的百分比从单胎婴儿的9%到三胎或更高倍数的94%不等。ART早产婴儿的比例从单胎婴儿的15%到三胎或更高倍数的97%不等。
解释
抗逆转录病毒疗法是否导致怀孕和活产取决于不同的患者和治疗因素。抗逆转录病毒疗法对多胞胎构成重大风险。这种风险根据患者的年龄，所进行的ART程序的类型，移植的胚胎数量和胚胎可用性（胚胎质量的指标）而有所不同。
公共卫生行动
在全国和某些州，与抗逆转录病毒疗法相关的多胎分娩在所有多胎分娩中占相当大的比例。应努力限制接受ART的患者移植的胚胎数量。此外，不良的婴儿健康结果（例如，在评估ART的有效性和安全性时，应考虑低出生体重和早产）。
PROBLEM/CONDITION
In 1996, CDC initiated data collection regarding assisted reproductive technology (ART) procedures performed in the United States, as mandated by the Fertility Clinic Success Rate and Certification Act (FCSRCA) (Public Law 102-493, October 24, 1992). ART includes fertility treatments in which both eggs and sperm are handled in the laboratory (i.e., in vitro fertilization and related procedures). Patients who undergo ART treatments are more likely to deliver multiple-birth infants than women who conceive naturally. Multiple births are associated with increased risk for mothers and infants (e.g., pregnancy complications, premature delivery, low-birthweight infants, and long-term disability among infants).
REPORTING PERIOD COVERED
2003.
DESCRIPTION OF SYSTEM
CDC contracted with the Society for Assisted Reproductive Technology (SART) to obtain data from ART medical centers located in the United States. Since 1997, CDC has compiled data related to ART procedures.
RESULTS
In 2003, a total of 122,872 ART procedures were reported to CDC. These procedures resulted in 35,785 live-birth deliveries and 48,756 infants. Nationwide, 74% of ART procedures used freshly fertilized embryos from the patient's eggs; 14% used thawed embryos from the patient's eggs; 8% used freshly fertilized embryos from donor eggs; and 4% used thawed embryos from donor eggs. Overall, 42% of ART transfer procedures resulted in a pregnancy, and 35% resulted in a live-birth delivery (delivery of one or more live-born infants). The highest live-birth rates were observed among ART procedures using freshly fertilized embryos from donor eggs (51%). The highest numbers of ART procedures were performed among residents of California (15,911), New York (15,534), Massachusetts (8,813), Illinois (8,676), and New Jersey (8,299). These five states also reported the highest number of infants conceived through ART. Of 48,756 infants born through ART, 51% were born in multiple-birth deliveries. The multiple-birth risk was highest for women who underwent ART transfer procedures using freshly fertilized embryos from either donor eggs (40%) or their own eggs (34%). Number of embryos transferred, embryo availability (an indicator of embryo quality), and patient's age were also strong predictors of multiple-birth risk. Approximately 1% of U.S. infants born in 2003 were conceived through ART. Those infants accounted for 18% of multiple births nationwide. The percentage of ART infants who were low birthweight ranged from 9% among singletons to 94% among triplets or higher order multiples. The percentage of ART infants born preterm ranged from 15% among singletons to 97% among triplets or higher order multiples.
INTERPRETATION
Whether an ART procedure resulted in a pregnancy and live-birth delivery varied according to different patient and treatment factors. ART poses a major risk for multiple births. This risk varied according to the patient's age, the type of ART procedure performed, the number of embryos transferred, and embryo availability (an indicator of embryo quality).
PUBLIC HEALTH ACTIONS
ART-related multiple births represent a sizable proportion of all multiple births nationwide and in selected states. Efforts should be made to limit the number of embryos transferred for patients undergoing ART. In addition, adverse infant health outcomes (e.g., low birthweight and preterm delivery) should be considered when assessing the efficacy and safety of ART.
孕妇患有疟疾。
影响因子：
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作者：
Duffy,PE;Fried,M
通讯作者：
Fried,M