辅助生殖技术相关并发症的研究进展

doi:10.12280/gjszjk.20200730

摘要/Abstract

摘要：

辅助生殖技术（ART）已被广泛应用于不孕症的治疗,包括人工授精（AI）和体外受精-胚胎移植（IVF-ET）,及其相关衍生技术如胞浆内单精子注射（ICSI）、胚胎植入前遗传学筛查（PGS）、卵母细胞体外成熟（IVM）、胚胎辅助孵化（AH）等技术。随着ART的普及和妊娠率的逐步提高,其带来的并发症及其安全性也越来越受到重视。能够及时发现和处理并发症,可以最大限度地使不孕症患者获得安全优质的妊娠结局。目前,ART相关并发症发生的原因仍存在争议,有部分研究认为是由于ART导致的多胎妊娠或不孕症病因,也有研究认为是由于ART本身。故对近年来相关文献进行分析,总结ART相关并发症的最新研究进展。

关键词: 生殖技术,辅助, 并发症, 不育,女（雌）性, 体外受精, 胚胎移植

Abstract:

Assisted reproductive technology (ART) has been widely used in the treatment of infertility, including artificial insemination (AI) and in vitro fertilization-embryo transfer (IVF-ET), and many derivative techniques such as intracytoplasmic sperm injection (ICSI), preimplantation genetic screening (PGS), in vitro maturation (IVM), and assisted hatching (AH). With the popularity of ART and the gradual improvement of pregnancy rate, more and more attention has been paid to the complications of ART and the safety of ART. Detection and treatment of complications in time can maximize the safety and high quality of pregnancy, and the good outcomes for patients. At present, the causes of ART-related complications are still controversial. Some studies believe that the increased rate of multiple pregnancy caused by ART or the factors related to infertility are the main causes. However, other studies believe that the factors of ART itself cannot be overlooked. In this review, we analyzed the complications related to ART and the causes.

Key words: Reproductive techniques,assisted, Complications, Infertility,female, Fertilization in vitro, Embryo transfer

谢奇君, 李欣, 赵纯, 凌秀凤. 辅助生殖技术相关并发症的研究进展[J]. 国际生殖健康/计划生育, 2021, 40(3): 204-208.

XIE Qi-jun, LI Xin, ZHAO Chun, LING Xiu-feng. Research Progress of Complications Related to Assisted Reproductive Technology[J]. Journal of International Reproductive Health/Family Planning, 2021, 40(3): 204-208.

参考文献 30

[1]	庄广伦. 必须重视辅助生殖技术可能风险的防治[J]. 国际生殖健康/计划生育杂志, 2011,30(4):263-264,271. doi: 10.3969/j.issn.1674-1889.2011.04.001.
[2]	Schirmer DA 3rd, Kulkarni AD, Zhang Y, et al. Ovarian hyperstimulation syndrome after assisted reproductive technologies: trends, predictors, and pregnancy outcomes[J]. Fertil Steril, 2020,114(3):567-578. doi: 10.1016/j.fertnstert.2020.04.004. doi: 10.1016/j.fertnstert.2020.04.004 URL
[3]	Hilbert SM, Gunderson S. Complications of Assisted Reproductive Technology[J]. Emerg Med Clin North Am, 2019,37(2):239-249. doi: 10.1016/j.emc.2019.01.005. doi: 10.1016/j.emc.2019.01.005 URL
[4]	Grandone E, Di Micco PP, Villani M, et al. Venous Thromboembolism in Women Undergoing Assisted Reproductive Technologies: Data from the RIETE Registry[J]. Thromb Haemost, 2018,118(11):1962-1968. doi: 10.1055/s-0038-1673402. doi: 10.1055/s-0038-1673402 URL
[5]	Levi-Setti PE, Cirillo F, Scolaro V, et al. Appraisal of clinical complications after 23, 827 oocyte retrievals in a large assisted reproductive technology program[J]. Fertil Steril, 2018, 109(6):1038-1043.e1. doi: 10.1016/j.fertnstert.2018.02.002. doi: 10.1016/j.fertnstert.2018.02.002 URL
[6]	Hilbert SM, Gunderson S. Complications of Assisted Reproductive Technology[J]. Emerg Med Clin North Am, 2019,37(2):239-249. doi: 10.1016/j.emc.2019.01.005. doi: 10.1016/j.emc.2019.01.005 URL
[7]	章烨, 谢华芳. 辅助生殖技术后异位妊娠发生的类型及危险因素探讨[J]. 临床和实验医学杂志, 2018, 17(15):1679-1680,后插1. doi: 10.3969/j.issn.1671-4695.2018.15.035.
[8]	Xing W, Ou J, Cai L. Thawed embryo transfer and ectopic pregnancy: a meta-analysis[J]. Arch Gynecol Obstet, 2018,297(6):1345-1352. doi: 10.1007/s00404-018-4724-6. doi: 10.1007/s00404-018-4724-6 URL
[9]	Vignarajan CP, Malhotra N, Singh N. Ovarian Reserve and Assisted Reproductive Technique Outcomes After Laparoscopic Proximal Tubal Occlusion or Salpingectomy in Women with Hydrosalpinx Undergoing in Vitro Fertilization: A Randomized Controlled Trial[J]. J Minim Invasive Gynecol, 2019,26(6):1070-1075. doi: 10.1016/j.jmig.2018.10.013. doi: 10.1016/j.jmig.2018.10.013 URL
[10]	Guidance on the limits to the number of embryos to transfer: a committee opinion[J]. Fertil Steril, 2017,107(4):901-903. doi: 10.1016/j.fertnstert.2017.02.107. doi: 10.1016/j.fertnstert.2017.02.107 URL
[11]	孙贻娟, 黄国宁, 孙海翔, 等. 关于胚胎移植数目的中国专家共识[J]. 生殖医学杂志, 2018,27(10):940-945. doi: 10.3969/j.issn.1004-3845.2018.10.003.
[12]	Committee on Practice Bulletins-Obstetrics. Practice Bulletin No. 183: Postpartum Hemorrhage[J]. Obstet Gynecol, 2017,130(4):e168-e186. doi: 10.1097/AOG.0000000000002351. doi: 10.1097/AOG.0000000000002351 URL
[13]	Bahadur G, Homburg R, Bosmans JE, et al. Observational retrospective study of UK national success, risks and costs for 319,105 IVF/ICSI and 30,669 IUI treatment cycles[J]. BMJ Open, 2020,10(3):e034566. doi: 10.1136/bmjopen-2019-034566. doi: 10.1136/bmjopen-2019-034566 URL
[14]	Bensdorp AJ, Hukkelhoven CW, van der Veen F, et al. Dizygotic twin pregnancies after medically assisted reproduction and after natural conception: maternal and perinatal outcomes[J]. Fertil Steril, 2016, 106(2):371-377.e2. doi: 10.1016/j.fertnstert.2016.03.042.
[15]	丁卉, 凌秀凤, 李秀玲, 等. 伴有单卵双胎的三胎妊娠经阴道减胎术后的妊娠结局分析[J]. 国际生殖健康/计划生育杂志, 2020,39(3):198-201.doi: 10.3969/j.issn.1674-1889.2020.03.006.
[16]	Qin JB, Sheng XQ, Wu D, et al. Worldwide prevalence of adverse pregnancy outcomes among singleton pregnancies after in vitro fertilization/intracytoplasmic sperm injection: a systematic review and meta-analysis[J]. Arch Gynecol Obstet, 2017,295(2):285-301. doi: 10.1007/s00404-016-4250-3. doi: 10.1007/s00404-016-4250-3 URL
[17]	Qin J, Liu X, Sheng X, et al. Assisted reproductive technology and the risk of pregnancy-related complications and adverse pregnancy outcomes in singleton pregnancies: a meta-analysis of cohort studies[J]. Fertil Steril, 2016, 105(1):73-85.e1-e6. doi: 10.1016/j.fertnstert.2015.09.007. doi: 10.1016/j.fertnstert.2015.09.007 URL
[18]	Wessel JA, Mol F, Danhof NA, et al. Birthweight and other perinatal outcomes of singletons conceived after assisted reproduction compared to natural conceived singletons in couples with unexplained subfertility: follow-up of two randomized clinical trials[J]. Hum Reprod, 2021,36(3):817-825. doi: 10.1093/humrep/deaa298. doi: 10.1093/humrep/deaa298 URL
[19]	Martin AS, Chang J, Zhang Y, et al. Perinatal outcomes among singletons after assisted reproductive technology with single-embryo or double-embryo transfer versus no assisted reproductive technology[J]. Fertil Steril, 2017,107(4):954-960. doi: 10.1016/j.fertnstert.2017.01.024. doi: 10.1016/j.fertnstert.2017.01.024 URL
[20]	许华, 李亚东, 伏静, 等. 辅助生殖门诊中23 317例不孕女性的病因分析[J]. 中华生殖与避孕杂志, 2019,39(9):750-755. doi: 10.3760/cma.j.issn.2096-2916.2019.09.011.
[21]	Goldstein RF, Abell SK, Ranasinha S, et al. Association of Gestational Weight Gain With Maternal and Infant Outcomes: A Systematic Review and Meta-analysis[J]. JAMA, 2017,317(21):2207-2225. doi: 10.1001/jama.2017.3635. doi: 10.1001/jama.2017.3635 URL pmid: 28586887
[22]	Wennberg AL, Opdahl S, Bergh C, et al. Effect of maternal age on maternal and neonatal outcomes after assisted reproductive technology[J]. Fertil Steril, 2016, 106(5):1142-1149.e14. doi: 10.1016/j.fertnstert.2016.06.021. doi: 10.1016/j.fertnstert.2016.06.021 URL
[23]	Kondapalli LA, Perales-Puchalt A. Low birth weight: is it related to assisted reproductive technology or underlying infertility?[J]. Fertil Steril, 2013,99(2):303-310. doi: 10.1016/j.fertnstert.2012.12.035. doi: 10.1016/j.fertnstert.2012.12.035 URL
[24]	Nirgianakis K, Kalaitzopoulos DR, Schwartz A, et al. Fertility, pregnancy and neonatal outcomes of patients with adenomyosis: a systematic review and meta-analysis[J]. Reprod Biomed Online, 2021,42(1):185-206. doi: 10.1016/j.rbmo.2020.09.023. doi: 10.1016/j.rbmo.2020.09.023 URL
[25]	Van Heertum K, Weinerman R. Neonatal outcomes following fresh as compared to frozen/thawed embryo transfer in in vitro fertilization[J]. Birth Defects Res, 2018,110(8):625-629. doi: 10.1002/bdr2.1216. doi: 10.1002/bdr2.v110.8 URL
[26]	Johnson KM, Hacker MR, Resetkova N, et al. Risk of ischemic placental disease in fresh and frozen embryo transfer cycles[J]. Fertil Steril, 2019,111(4):714-721. doi: 10.1016/j.fertnstert.2018.11.043. doi: 10.1016/j.fertnstert.2018.11.043 URL
[27]	Luke B, Brown MB, Wantman E, et al. Factors associated with monozygosity in assisted reproductive technology pregnancies and the risk of recurrence using linked cycles[J]. Fertil Steril, 2014,101(3):683-689. doi: 10.1016/j.fertnstert.2013.11.034. doi: 10.1016/j.fertnstert.2013.11.034 URL
[28]	Farhi A, Reichman B, Boyko V, et al. Congenital malformations in infants conceived following assisted reproductive technology in comparison with spontaneously conceived infants[J]. J Matern Fetal Neonatal Med, 2013,26(12):1171-1179. doi: 10.3109/14767058.2013.776535. doi: 10.3109/14767058.2013.776535 URL
[29]	Zheng Z, Chen L, Yang T, et al. Multiple pregnancies achieved with IVF/ICSI and risk of specific congenital malformations: a meta-analysis of cohort studies[J]. Reprod Biomed Online, 2018,36(4):472-482. doi: 10.1016/j.rbmo.2018.01.009. doi: 10.1016/j.rbmo.2018.01.009 URL
[30]	黄巧瑶, 吴小环, 汪晨曦, 等. 辅助生殖技术助孕后子代出生缺陷风险:基于队列研究的Meta分析[J]. 中国计划生育和妇产科, 2020,12(5):69-76,84. doi: 10.3969/j.issn.1674-4020.2020.05.15.