Perkins Kiran M, Boulet Sheree L, Jamieson Denise J, Kissin Dmitry M
Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, Georgia.
Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, Georgia.
Fertil Steril. 2016 Aug;106(2):435-442.e2. doi: 10.1016/j.fertnstert.2016.03.050. Epub 2016 Apr 14.
To evaluate trends and reproductive outcomes of gestational surrogacy in the United States.
Retrospective cohort study.
Infertility clinics.
PATIENT(S): IVF cycles transferring at least one embryo.
INTERVENTION(S): Use of a gestational carrier.
MAIN OUTCOME MEASURE(S): Trends in gestational carrier cycles during 1999-2013, overall and for non-U.S. residents; reproductive outcomes for gestational carrier and nongestational carrier cycles during 2009-2013, stratified by the use of donor or nondonor oocytes.
RESULT(S): Of 2,071,984 assisted reproductive technology (ART) cycles performed during 1999-2013, 30,927 (1.9%) used a gestational carrier. The number of gestational carrier cycles increased from 727 (1.0%) in 1999 to 3,432 (2.5%) in 2013. Among gestational carrier cycles, the proportion with non-U.S. residents declined during 1999-2005 (9.5% to 3.0%) but increased during 2006-2013 (6.3% to 18.5%). Gestational carrier cycles using nondonor oocytes had higher rates of implantation (adjusted risk ratio [aRR], 1.22; 95% confidence interval [CI], 1.17-1.26), clinical pregnancy (aRR, 1.14; 95% CI, 1.10-1.19), live birth (aRR, 1.17; 95% CI, 1.12-1.21), and preterm delivery (aRR, 1.14; 95% CI, 1.05-1.23) compared with nongestational carrier cycles. When using donor oocytes, multiple birth rates were higher among gestational carrier compared with nongestational carrier cycles (aRR, 1.13; 95% CI, 1.08-1.19).
CONCLUSION(S): Use of gestational carriers increased during 1999-2013. Gestational carrier cycles had higher rates of ART success than nongestational carrier cycles, but multiple birth and preterm delivery rates were also higher. These risks may be mitigated by transferring fewer embryos given the higher success rates among gestational carrier cycles.
评估美国妊娠代孕的趋势及生殖结局。
回顾性队列研究。
不孕不育诊所。
至少移植一个胚胎的体外受精周期。
使用妊娠载体。
1999 - 2013年期间妊娠载体周期的总体趋势以及非美国居民的情况；2009 - 2013年期间妊娠载体周期和非妊娠载体周期的生殖结局，按是否使用供体卵母细胞分层。
在1999 - 2013年进行的2,071,984个辅助生殖技术（ART）周期中，30,927个（1.9%）使用了妊娠载体。妊娠载体周期的数量从1999年的727个（1.0%）增加到2013年的3,432个（2.5%）。在妊娠载体周期中，非美国居民的比例在1999 - 2005年期间下降（从9.5%降至3.0%），但在2006 - 2013年期间上升（从6.3%升至18.5%）。与非妊娠载体周期相比，使用非供体卵母细胞的妊娠载体周期有更高的着床率（调整风险比[aRR]，1.22；95%置信区间[CI]，1.17 - 1.26）、临床妊娠率（aRR，1.14；95% CI，1.10 - 1.19）、活产率（aRR，1.17；95% CI，1.12 - 1.21）和早产率（aRR，1.14；95% CI，1.05 - 1.23）。当使用供体卵母细胞时，妊娠载体周期的多胎出生率高于非妊娠载体周期（aRR，1.13；95% CI，1.08 - 1.19）。
1999 - 2013年期间妊娠载体的使用有所增加。妊娠载体周期的ART成功率高于非妊娠载体周期，但多胎出生率和早产率也更高。鉴于妊娠载体周期成功率较高，可通过减少胚胎移植数量来降低这些风险。
