Clayton Heather B, Schieve Laura A, Peterson Herbert B, Jamieson Denise J, Reynolds Meredith A, Wright Victoria C
Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
Obstet Gynecol. 2006 Mar;107(3):595-604. doi: 10.1097/01.AOG.0000196503.78126.62.
To assess the ectopic pregnancy risk among women who conceived with assisted reproductive technology (ART) procedures.
The ectopic rate for ART pregnancies was calculated from population-based data of pregnancies conceived with ART in U.S. clinics in 1999-2001. Variation in ectopic risk by patient and ART treatment factors was assessed by using bivariate analyses and multivariable logistic regression.
Of 94,118 ART pregnancies, 2,009 (2.1%) were ectopic. Variation was observed by procedure type. In comparison with the ectopic rate (2.2%) among pregnancies conceived with in vitro fertilization and transcervical transfer of freshly fertilized embryos from the patient's oocytes (fresh, nondonor IVF-ET), the ectopic rate was significantly increased when zygote intrafallopian transfer (ZIFT) was used (3.6%) and significantly decreased when donor oocytes were used (1.4%) or when a gestational surrogate carried the pregnancy (0.9%). Among fresh nondonor IVF-ET procedures, the risk for ectopic pregnancy was increased among women with tubal factor infertility (odds ratio [OR] 2.0, 95% confidence interval [CI] 1.7-2.4; referent group = ART for male factor), endometriosis (OR 1.3, 95% CI 1.0-1.6), and other nontubal female factors of infertility (OR 1.4, 95% CI 1.2-1.6) and decreased among women with a previous live birth (OR 0.6, 95% CI 0.5-0.7). Transfer of embryos with an indication of high implantation potential was associated with a decreased ectopic risk when 2 or fewer embryos were transferred (OR 0.7, 95% CI 0.5-0.9), but not when 3 or more embryos were transferred.
Ectopic risk among ART pregnancies varied according to ART procedure type, reproductive health characteristics of the woman carrying the pregnancy, and estimated embryo implantation potential.
II-2.
评估接受辅助生殖技术（ART）受孕的女性发生异位妊娠的风险。
根据1999 - 2001年美国诊所ART受孕的基于人群的数据计算ART妊娠的异位妊娠率。通过双变量分析和多变量逻辑回归评估患者和ART治疗因素导致的异位妊娠风险差异。
在94,118例ART妊娠中，2,009例（2.1%）为异位妊娠。观察到不同手术类型存在差异。与采用体外受精及经宫颈移植患者新鲜受精胚胎（新鲜、非供体体外受精 - 胚胎移植，IVF - ET）受孕的异位妊娠率（2.2%）相比，采用输卵管内合子移植（ZIFT）时异位妊娠率显著升高（3.6%），而使用供体卵母细胞（1.4%）或妊娠由代孕母亲孕育时（0.9%）异位妊娠率显著降低。在新鲜非供体IVF - ET手术中，输卵管因素不孕女性发生异位妊娠的风险增加（比值比[OR] 2.0，95%置信区间[CI] 1.7 - 2.4；参照组 = 男性因素导致不孕的ART）、子宫内膜异位症（OR 1.3，95% CI 1.0 - 1.6）以及其他非输卵管因素导致不孕的女性（OR 1.4，95% CI 1.2 - 1.6），而既往有活产史的女性风险降低（OR 0.6，95% CI 0.5 - 0.7）。当移植2个或更少具有高着床潜力指征的胚胎时，异位妊娠风险降低（OR 0.7，95% CI 0.5 - 0.9），但移植3个或更多胚胎时则不然。
ART妊娠的异位妊娠风险因ART手术类型、妊娠女性的生殖健康特征以及估计的胚胎着床潜力而异。
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