Division of Gynecological Endocrinology and Reproductive Medicine, Women's Hospital, University of Basel, Switzerland.
Swiss Med Wkly. 2012 May 2;142:w13569. doi: 10.4414/smw.2012.13569. eCollection 2012.
Since the first introduction of hormonal contraception, family planning and procreation have become increasingly medicalised. The rapid spread of assisted reproductive technology (ART) is part of this natural development of modern society. However, in Switzerland it has caused severe controversy and its use has been framed by a restrictive legislation since 2001. Despite this, the yearly number of reported treatments with in-vitro fertilisation (IVF), with intracytoplasmic sperm injection (ICSI) and with transfer of frozen/thawed oocytes in the pronucleate stage has risen to more than 10,000 in 2011. As over time the protocols for ovarian stimulation have reached higher levels of efficacy and as the composition of the culture media used for embryo development in the laboratory has become more elaborate, the implantation rate of the transferred embryos has steadily improved leading to higher pregnancy rates, but also resulting in a higher risk of multiple delivery. Deliveries of multiples, including those with twins, often occur prematurely causing significant maternal and neonatal morbidity and mortality. Improved assessment of the developmental potential of embryos together with better freezing protocols have lead to the selection and transfer of one single embryo per treatment cycle in an increasing number of countries but not in Switzerland. This strategy has been shown to be very effective in preventing multiple deliveries without compromising the overall pregnancy rates. In addition, well accepted treatment modalities in assisted reproduction, such as embryo cryopreservation, oocyte donation and preimplantation genetic diagnosis have not been implemented in Switzerland due to the current restrictive legislation. The still present ban on cryopreservation of embryos in Switzerland now leads to a higher incidence of complications and neonatal death than necessary in the presence of an adapted legal environment. There is an urgent need for a public debate about the future role of modern reproductive medicine in Swiss society. This discussion should focus not only on the risks of ART but also on its opportunities.
自激素避孕法问世以来，计划生育和生育已经越来越医学化。辅助生殖技术（ART）的快速传播是现代社会自然发展的一部分。然而，在瑞士，自 2001 年以来，其使用受到严格立法的限制，引起了激烈的争议。尽管如此，每年报告的体外受精（IVF）、胞浆内精子注射（ICSI）和冷冻/解冻卵母细胞转移到原核阶段的治疗数量在 2011 年已超过 10000 例。随着时间的推移，卵巢刺激方案的效果达到了更高的水平，同时胚胎在实验室中发育所使用的培养液的成分变得更加复杂，移植胚胎的着床率稳步提高，导致妊娠率更高，但也导致多胎分娩的风险增加。多胎分娩（包括双胞胎）往往早产，导致产妇和新生儿发病率和死亡率显著增加。胚胎发育潜能的评估方法的改进以及更好的冷冻方案，导致在越来越多的国家（但不是瑞士）在每个治疗周期中选择和移植一个胚胎。这种策略已被证明在不影响总体妊娠率的情况下非常有效地预防多胎分娩。此外，由于目前的限制性立法，瑞士尚未采用胚胎冷冻保存、卵母细胞捐赠和植入前遗传学诊断等辅助生殖领域中公认的治疗方法。瑞士目前禁止胚胎冷冻保存，这导致在适应法律环境的情况下，并发症和新生儿死亡的发生率高于必要水平。瑞士社会迫切需要就现代生殖医学在未来的作用进行公开辩论。这种讨论不仅应关注 ART 的风险，还应关注其机遇。
