What is the most relevant standard of success in assisted reproduction? Redefining success in the context of elective single embryo transfer: evidence, intuition and financial reality.
What is the most relevant standard of success in assisted reproduction? Redefining success in the context of elective single embryo transfer: evidence, intuition and financial reality.
复制标题
辅助生殖成功的最相关标准是什么？
作者：
S. Bhattacharya;A. Templeton
与治疗相关的多胎妊娠对体外受精的安全性构成最大威胁。尽管大多数欧洲中心实行双胚胎移植(DET)政策，但双胞胎比率仍然高得令人无法接受，高达20%-35%。选择性单胚胎移植(SET)是减少双胎妊娠的有效方法，但围绕其常规临床应用的争论仍在继续。对文献进行综述，以寻找SET有效性的证据，并确定其在临床实践中被接受的障碍。来自随机对照试验(RCT)的数据表明，与DET相比，SET导致每个新鲜试管受精周期的活产率更低(优势比0.53；95%可信区间0.31-0.89；P=0.02)。从随机对照试验中无法获得累积活出生率的数据，尽管预期这两组数据具有可比性。SET不太可能适用于所有接受体外受精的妇女，结果可能对不同的实验室方案敏感。SET的感知有效性受到对现有证据的解释方式的影响。影响SET常规使用的其他因素包括实验室技术、个人偏好和资金问题。
Treatment-related multiple pregnancy poses the biggest threat to the safety of IVF. Despite a double embryo transfer (DET) policy in most European centres, twin rates continue to be unacceptably high, at 20-35%. Elective single embryo transfer (SET) is an effective way to minimize twin pregnancies, but the debate surrounding its routine clinical use continues. A review of the literature was undertaken in order to seek evidence about the effectiveness of SET, and identify barriers to its acceptance in clinical practice. Data from randomized controlled trials (RCTs) indicate that SET results in lower live birth rates per fresh IVF cycle (odds ratio 0.53; 95% confidence interval 0.31-0.89; P = 0.02) in comparison with DET. Data on cumulative live birth rates are unavailable from RCTs, although the expectation is that these are comparable in the two groups. SET is unlikely to be suitable for all women undergoing IVF and outcomes may be sensitive to different laboratory protocols. The perceived effectiveness of SET is influenced by the way existing evidence is interpreted. Other factors affecting the routine use of SET include laboratory techniques, individual preferences and funding issues.