Department of Epidemiology and Biostatistics, Case Western Reserve University School of Medicine, Cleveland, OH 44106-4945, USA.
J Assist Reprod Genet. 2011 Aug;28(8):699-705. doi: 10.1007/s10815-011-9583-z. Epub 2011 May 31.
To estimate the effect of assisted reproductive technology (ART) on major malformation (MM) rate in ART offspring independent of the effect of subfertility on MM.
Meta-analysis.
This meta-analysis is based on our previously published meta-analysis of observational studies evaluating the relationship between ART treatment and MM rates, as well as recent research by Zhu et al. to estimate the impact of subfertility alone on MM in subfertile couples conceiving spontaneously.
The overall odds ratio for MM in our original meta-analysis, in which all studies used apparently inappropriate control groups of "normal" populations, was 1.29 (95% CI 1.01-1.67). Here we attempted to estimate the risk of subfertility and used this estimate to perform an adjusted meta-analysis. Zhu et al. found that about 40% of the odds of MM was due to subfertility. When we took Zhu's finding into account, the adjusted odds ratio in the meta-analysis was 1.01 (95% CI 0.82-1.23).
Our study suggests ART does not increase the risk of MM as much as previously reported. More research is needed to quantify the underlying risk of subfertility and separate it from the risk associated with ART. Physicians who counsel subfertile couples should recognize that previous studies of MM rates in ART patients probably overestimated the risk.
在不考虑不育症对主要畸形（MM）发生率的影响的情况下，评估辅助生殖技术（ART）对 MM 发生率的影响。
荟萃分析。
本荟萃分析基于我们之前发表的关于评估 ART 治疗与 MM 发生率之间关系的观察性研究的荟萃分析，以及 Zhu 等人最近的研究，以评估不育症本身对自然受孕的不育夫妇中 MM 的影响。
在我们最初的荟萃分析中，所有研究均使用明显不适当的“正常”人群对照组，整体 MM 的优势比为 1.29（95%CI 1.01-1.67）。在这里，我们尝试估计不育症的风险，并使用此估计值进行调整后的荟萃分析。Zhu 等人发现，大约 40%的 MM 几率归因于不育症。当我们考虑到 Zhu 的发现时，荟萃分析中的调整后优势比为 1.01（95%CI 0.82-1.23）。
我们的研究表明，ART 并不会像之前报道的那样增加 MM 的风险。需要进一步研究来量化不育症的潜在风险，并将其与与 ART 相关的风险分开。为不育夫妇提供咨询的医生应该认识到，以前对 ART 患者 MM 发生率的研究可能高估了风险。
