Eindhoven S C, van Uitert E M, Laven J S E, Willemsen S P, Koning A H J, Eilers P H C, Exalto N, Steegers E A P, Steegers-Theunissen R P M
Division of Obstetrics and Prenatal Medicine, Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands.
Division of Reproductive Medicine, Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands.
Hum Reprod. 2014 Dec;29(12):2628-36. doi: 10.1093/humrep/deu271. Epub 2014 Oct 14.
Is in vitro fertilization treatment with or without intracytoplasmatic sperm injection (IVF/ICSI) associated with changes in first and second trimester embryonic and fetal growth trajectories and birthweight in singleton pregnancies?
Embryonic and fetal growth trajectories and birthweight are not significantly different between pregnancies conceived with IVF/ICSI treatment and spontaneously conceived pregnancies with reliable pregnancy dating.
IVF/ICSI treatment has been associated with increased risks of preterm birth, fetal growth restriction and low birthweight. Decreased first-trimester crown-rump length (CRL) in the general population has been inversely associated with the same adverse pregnancy outcomes.
STUDY DESIGN, SIZE, DURATION: In a prospective periconception birth cohort study conducted in a tertiary centre, 146 singleton pregnancies with reliable pregnancy dating and nonmalformed live borns were investigated, comprised of 88 spontaneous and 58 IVF/ICSI pregnancies.
PARTICIPANTS/MATERIALS, SETTING, METHODS: Serial 3D ultrasound scans were performed from 6 to 12 weeks of gestation. As estimates of embryonic growth, CRL and embryonic volume (EV) were measured using the I-Space virtual reality system. General characteristics were obtained from self-administered questionnaires at enrolment. Fetal growth parameters at 20 weeks and birthweight were obtained from medical records. To assess associations between IVF/ICSI and embryonic growth trajectories, estimated fetal weight and birthweight, stepwise linear mixed model analyses and linear regression analyses were performed using square root transformed CRL and fourth root transformed EV.
In 146 pregnancies, 934 ultrasound scans were performed of which 849 (90.9%) CRLs and 549 (58.8%) EVs could be measured. Embryonic growth trajectories were comparable between IVF/ICSI pregnancies and spontaneously conceived pregnancies (CRL: βIVF/ICSI = 0.10√mm; P = 0.10; EV: βIVF/ICSI = 0.03(4)√cm³; P = 0.13). Estimated fetal weight and birthweight were also comparable between both groups (βIVF/ICSI = 6 g; P = 0.36 and βIVF/ICSI = 80 g; P = 0.24, respectively).
LIMITATIONS, REASONS FOR CAUTION: Variations in embryonic growth trajectories of spontaneously conceived pregnancies with reliable pregnancy dating may partially be a result of less precise pregnancy dating and differences in endometrium receptivity compared with IVF/ICSI pregnancies.
The absence of a significant difference in embryonic and fetal growth trajectories suggests safety of IVF/ICSI treatment with regard to early embryonic growth. However, further research is warranted to ascertain the influence of IVF/ICSI treatments in a larger study population, and to estimate the impact of the underlying causes of the subfertility and other periconceptional exposures on human embryonic and fetal growth trajectories.
This study was supported by the Department of Obstetrics and Gynaecology of the Erasmus MC, University Medical Centre.
No competing interests are declared.
体外受精治疗（无论有无卵胞浆内单精子注射，即IVF/ICSI）是否与单胎妊娠中孕早期和孕中期胚胎及胎儿生长轨迹以及出生体重的变化有关？
接受IVF/ICSI治疗的妊娠与妊娠日期可靠的自然受孕妊娠相比，胚胎和胎儿生长轨迹以及出生体重并无显著差异。
IVF/ICSI治疗与早产、胎儿生长受限和低出生体重风险增加有关。一般人群中孕早期头臀长（CRL）降低与相同不良妊娠结局呈负相关。
研究设计、规模、持续时间：在一家三级中心进行的一项前瞻性受孕前出生队列研究中，对146例妊娠日期可靠且出生时无畸形的单胎妊娠进行了调查，其中包括88例自然受孕妊娠和58例IVF/ICSI妊娠。
研究对象/材料、地点、方法：在妊娠6至12周期间进行了系列三维超声扫描。使用I-Space虚拟现实系统测量CRL和胚胎体积（EV），作为胚胎生长的评估指标。通过入组时的自填问卷获取一般特征。从病历中获取20周时的胎儿生长参数和出生体重。为评估IVF/ICSI与胚胎生长轨迹、估计胎儿体重和出生体重之间的关联，使用平方根转换后的CRL和四次方根转换后的EV进行逐步线性混合模型分析和线性回归分析。
在146例妊娠中，共进行了934次超声扫描，其中849次（90.9%）可测量CRL，549次（58.8%）可测量EV。IVF/ICSI妊娠与自然受孕妊娠的胚胎生长轨迹具有可比性（CRL：βIVF/ICSI = 0.10√mm；P = 0.10；EV：βIVF/ICSI = 0.03(4)√cm³；P = 0.13）。两组间估计胎儿体重和出生体重也具有可比性（βIVF/ICSI分别为6 g；P = 0.36和βIVF/ICSI为80 g；P = 0.24）。
局限性、谨慎原因：妊娠日期可靠的自然受孕妊娠胚胎生长轨迹的差异，部分可能是由于与IVF/ICSI妊娠相比，妊娠日期不够精确以及子宫内膜容受性存在差异所致。
胚胎和胎儿生长轨迹无显著差异表明IVF/ICSI治疗在早期胚胎生长方面的安全性。然而，有必要进行进一步研究，以确定在更大研究人群中IVF/ICSI治疗的影响，并评估亚生育潜在原因和其他受孕前暴露因素对人类胚胎和胎儿生长轨迹的影响。
本研究由伊拉斯姆斯医学中心大学医学中心妇产科资助。
未声明存在利益冲突。
