D5& D6的囊胚植入較第3天胚胎移植後單胎妊娠早產的風險增加

 D3 的胚胎
D5 & D6的囊胚

 

 出處:第二名的不孕症期刊

D5& D6的囊胚植入較第3天胚胎移植後單胎妊娠早產的風險增加：加拿大試管嬰兒登錄系統於生育和男性不孕學會醫學會的分析。

抽象
研究的問題：卵裂期(D3)胚胎移植與（ET）5/6天的囊胚階段所取得的成果比較單胎妊娠胎兒的生產影響>

摘要答：有一個風險顯著較高的早產（<37週）後，單身延長胚胎體外培養（5/6日）相比，卵裂期（3天）轉移。

什麼是已知的了：最近的兩項研究，從瑞典和美國，D5& D6的囊胚植入增加單胎妊娠早產的風險。美國的研究發現D5& D6的囊胚植入增加單胎妊娠極度早產的風險,瑞典的研究顯示增加胎兒畸形。

研究設計，大小和持續時間進行了回顧性隊列研究。數據收集新鮮IVF / ICSI ET週期（2001-2009）的所有單胞胎後，從加拿大ART註冊數據庫。

參加者/材料，設置方法：一共有12 712單胞胎都包括在內。這些，9506單胎妊娠來自第3天胚胎移植，3206單胎妊娠來自囊胚（5/6天）胚胎移植。

主要結果和作用的機會：早產率<37週（未經調整潛在的混雜因素）5天/ 6與日3傳輸（17.2％比14.1％，P <0.001）。使用logistic回歸分析調整混雜因素，<37週的早產率是5/6天與第3天轉移（比值比為1.32，95％可信區間1.17-1.49）相比，顯著增加後的唯一結果。下面的混雜因素進行了調整：一年的治療，產婦年齡（連續），奇偶（0比≥1出生），診斷類別，數量的卵母細胞檢索（2001-2009）[≤20與20（高反應組） ，人工授精的方法（IVF與ICSI），移植胚胎數（1，2或≥3）和存在的消失雙（≥1胎兒心臟上的初始超聲檢查）。

限制，需要注意的原因：產後隨訪研究，以確定如果我們觀察到這種差異轉化為長期的不利影響，這些後代。早期的早產率（<32週）在5/6日與第3天高，但數量很少的情況下，在這一類沒有顯示出差異（3.0對2.7％，P = 0.34）。

廣泛影響的調查結果：我們發現一個風險顯著較高的早產（<37週）D5& D6的囊胚植入較第3天胚胎移植後單胎妊娠早產的風險增加，單身延長胚胎體外培養（5/6日）相比，卵裂期（第3天）傳輸，即使在調整混雜因素。我們的研究結果與前兩個研究，但是，我們並沒有表現出美國的研究發現D5& D6的囊胚植入增加單胎妊娠極度早產的風險,瑞典的研究顯示增加胎兒畸形。我們推測，有可能是一個長期的有害影響，在隨後的胎盤在體外胚胎培養。將需要更長的長期隨訪研究，以確定如果長時間在體外培養到囊胚階段相較較短的卵裂階段的胚胎培養有不利影響的長期健康的後代。

 

陳醫師的Comment:

來自文明進步的國家如美國、瑞典及加拿大的權威研究顯示:D5&D6的囊胚植入較第3天胚胎移植後單胎妊娠早產的風險增加,可能來自長時間在體外培養到囊胚階段相較較短的卵裂階段的胚胎培養有不利影響的長期健康的後代。IVF前的充份諮詢，產前遺傳診斷及高水準的產檢照顧在醫病間會的認知是非常重要的。

 

Hum Reprod. 2013 Jan 24. [Epub ahead of print]

Increased risk of preterm birth in singleton pregnancies after blastocyst versus Day 3 embryo transfer: Canadian ART Register (CARTR) analysis.

Dar S, Librach CL, Gunby J, Bissonnette F, Cowan L; on behalf of the IVF Directors Group of the Canadian Fertility and Andrology Society.

Source

CReATe Fertility Center , 790 Bay Street, Suite 1100 , Toronto , Ontario , Canada M 5G 1N8 .

Abstract

STUDY QUESTION:

Are the fetal outcomes of singleton pregnancies that result from cleavage stage embryo transfer (ET) different from the outcomes from Day 5/6 blastocyst stage ET?

SUMMARY ANSWER:

There was a significantly higher risk of preterm birth (<37 weeks) in singletons after extended embryo culture (Day 5/6) compared with cleavage stage (Day 3) transfer.

WHAT IS KNOWN ALREADY:

Two recent studies, from Sweden and the USA , reported an increased risk of preterm birth in singleton pregnancies after Day 5/6 ET compared with Day 3 ET. The US study also showed increased early preterm births and the Swedish study showed increased fetal malformations in this group.

STUDY DESIGN, SIZE AND DURATION:

A retrospective cohort study was performed. Data were collected from the Canadian ART Register database for all singleton births after fresh IVF/ICSI ET cycles (2001-2009).

PARTICIPANTS/MATERIALS, SETTING, METHODS:

A total of 12 712 singleton births were included. Of these, 9506 resulted from a Day 3 ET and 3206 resulted from a blastocyst (Day 5/6) ET.

MAIN RESULTS AND THE ROLE OF CHANCE:

Preterm birth rate <37 weeks (unadjusted by potential confounding factors) was higher with Day 5/6 versus Day 3 transfers (17.2 versus 14.1%, P < 0.001). Using logistic regression analysis to adjust for confounding factors, preterm birth rate <37 weeks was the only outcome significantly increased after Day 5/6 compared with Day 3 transfer (odds ratio 1.32, 95% confidence interval 1.17-1.49). The following confounding factors were adjusted for: year of treatment (2001-2009), maternal age (continuous), parity (0 versus ≥1 birth), diagnosis category, number of oocytes retrieved [≤20 versus >20 (high responder group)], insemination method (IVF versus ICSI), number of embryos transferred (1, 2 or ≥3) and the presence of a vanishing twin (≥1 fetal heart on the initial ultrasonographic examination).

LIMITATIONS, REASONS FOR CAUTION:

Post-natal follow-up studies will be required to determine if this difference we observed translates into adverse long-term effects on these offspring. The rate of early preterm births (<32 weeks) was higher in Day 5/6 versus Day 3, but the low number of cases in this category did not have the power to show a difference (3.0 versus 2.7%, P = 0.34).

WIDER IMPLICATIONS OF THE FINDINGS:

We found a significantly higher risk of preterm birth (<37 weeks) in singletons after extended embryo culture (Day 5/6) compared with cleavage stage (Day 3) transfer, even when adjusting for confounding factors. Our findings are in agreement with the previous two studies; however, we did not show a difference in the very preterm deliveries (unlike the US study) or in fetal malformations (as in the Swedish study). We hypothesize that there may be a deleterious effect of prolonged in vitro embryo culture on subsequent placentation. Longer term follow-up studies will be required to determine if prolonged in vitro culture to the blastocyst stage has an adverse effect on the long-term health of offspring when compared with shorter cleavage stage culture.