Kapiteijn K, de Bruijn C S, de Boer E, de Craen A J M, Burger C W, van Leeuwen F E, Helmerhorst F M
Division of Reproductive Medicine, Department of Gynaecology, Leiden University Medical Center, Leiden, The Netherlands.
Hum Reprod. 2006 Dec;21(12):3228-34. doi: 10.1093/humrep/del311. Epub 2006 Oct 5.
The primary objective of this study was to investigate whether subfertility explains poor perinatal outcome after assisted conception. A secondary objective was to test the hypothesis that ovarian hyperstimulation rather than the IVF procedure may influence the perinatal outcome.
Using data from a Dutch population-based historical cohort of women treated for subfertility, we compared perinatal outcome of singletons conceived after controlled ovarian hyperstimulation (COHS) and IVF (IVF + COHS; n = 2239) with perinatal outcome in subfertile women who conceived spontaneously (subfertile controls; n = 6343) and in women who only received COHS (COHS only; n = 84). Furthermore, we compared perinatal outcome of singletons conceived after the transfer of thawed embryos with (Stim + Cryo; n = 66) and without COHS (Stim - Cryo; n = 73).
The odds ratios (ORs) for very low birthweight (<1500 g) and low birthweight (1500-2500 g) were 2.8 [95% confidence interval (95% CI) 1.9-3.9] and 1.6 (95% CI 1.2-1.8) in the IVF + COHS group compared with the subfertile control group. The ORs for very preterm birth (<32 weeks) and for preterm birth (32-37 weeks) were 2.0 (95% CI 1.4-2.9) and 1.5 (95% CI 1.3-1.8), respectively. Adjustment for confounders did not materially change these risk estimates. The difference in risk between the COHS-only group and the subfertile group was significant only for very low birthweight (OR 3.5; 95% CI 1.1-11.4), but the association became weaker after adjustment for maternal age and primiparity (OR 3.1; 95% CI 1.0-10.4). No significant difference in birthweight and preterm delivery was found between the group of children conceived after ovarian stimulation/ovulation induction and (Stim + Cryo) and the group of children conceived after embryo transfer of thawed embryos in a spontaneous cycle without ovarian stimulation/ovulation induction (Stim - Cryo).
The poor perinatal outcome in this database could not be explained by subfertility and suggests that other factors may be important in the known association between assisted conception and poor perinatal outcome.
本研究的主要目的是调查生育力低下是否可以解释辅助受孕后围产期结局不良。次要目的是检验卵巢过度刺激而非体外受精程序可能影响围产期结局这一假设。
利用来自荷兰一个基于人群的生育力低下治疗女性历史队列的数据，我们将控制性卵巢过度刺激（COHS）和体外受精后（体外受精+COHS；n = 2239）单胎妊娠的围产期结局与自然受孕的生育力低下女性（生育力低下对照组；n = 6343）以及仅接受COHS的女性（仅COHS组；n = 84）的围产期结局进行了比较。此外，我们还比较了解冻胚胎移植后单胎妊娠的围产期结局，其中一组有COHS（刺激+冷冻；n = 66），另一组无COHS（刺激-冷冻；n = 73）。
与生育力低下对照组相比，体外受精+COHS组极低出生体重（<1500 g）和低出生体重（1500 - 2500 g）的比值比（OR）分别为2.8 [95%置信区间（95%CI）1.9 - 3.9]和1.6（95%CI 1.2 - 1.8）。极早产（<32周）和早产（32 - 37周）的OR分别为2.0（95%CI 1.4 - 2.9）和1.5（95%CI 1.3 - 1.8）。对混杂因素进行调整并没有实质性改变这些风险估计值。仅COHS组与生育力低下组之间的风险差异仅在极低出生体重方面有统计学意义（OR 3.5；95%CI 1.1 - 11.4），但在调整产妇年龄和初产情况后，这种关联变弱了（OR 3.1；95%CI 1.0 - 10.4）。在卵巢刺激/促排卵后受孕的儿童组（刺激+冷冻）与自然周期解冻胚胎移植后受孕且无卵巢刺激/促排卵的儿童组（刺激-冷冻）之间，未发现出生体重和早产方面的显著差异。
该数据库中围产期结局不良不能用生育力低下来解释，这表明在辅助受孕与围产期结局不良之间的已知关联中，其他因素可能很重要。
