Grainger David A, Frazier Linda M, Rowland Courtney A
Department of Obstetrics and Gynecology, University of Kansas School of Medicine-Wichita, Wichita, Kansas, USA.
Matern Child Health J. 2006 Sep;10(5 Suppl):S161-4. doi: 10.1007/s10995-006-0094-y.
Couples with fertility problems seeking treatment with assisted reproductive technologies (ART) such as in vitro fertilization should receive preconception counseling on all factors that are provided when counseling patients without fertility problems. Additional counseling should address success rates and possible risks from ART therapies. Success rates from ART are improving, with the highest live birth rates averaging about 40% per cycle among women less than 35 years old. A woman's age lowers the chance of achieving a live birth, as do smoking, obesity, and infertility diagnoses such as hydrosalpinx, uterine leiomyoma, or male factor infertility. Singletons conceived with ART may have lower birth weights. Animal studies suggest that genetic imprinting disorders may be induced by certain embryo culture conditions. The major risk from ovarian stimulation is multiple gestation. About one-third of live-birth deliveries from ART have more than one infant, and twins represent 85% of these multiple-birth children. There are more complications in multiple gestation pregnancies, infants are more likely to be born preterm and with other health problems, and families caring for multiples experience more stress. Transferring fewer embryos per cycle reduces the multiple birth rate from ART, but the patient may have to pay for additional cycles of ART because of a lower likelihood of pregnancy.
寻求体外受精等辅助生殖技术（ART）治疗的不孕夫妇，应接受与未患不孕症患者咨询时所提供的所有因素相关的孕前咨询。额外的咨询应涉及ART治疗的成功率和可能风险。ART的成功率正在提高，35岁以下女性的最高活产率平均约为每个周期40%。女性年龄、吸烟、肥胖以及诸如输卵管积水、子宫肌瘤或男性因素不孕等不孕诊断都会降低活产几率。通过ART受孕的单胎婴儿出生体重可能较低。动物研究表明，某些胚胎培养条件可能会诱发基因印记障碍。卵巢刺激的主要风险是多胎妊娠。ART活产分娩中约三分之一有不止一个婴儿，双胞胎占这些多胞胎婴儿的85%。多胎妊娠有更多并发症，婴儿更易早产并伴有其他健康问题，照顾多胞胎的家庭压力更大。每个周期移植较少胚胎可降低ART的多胎出生率，但由于怀孕可能性降低，患者可能需支付额外的ART周期费用。
