Kliebisch T K, Bielfeld A P, Krüssel J S, Baston-Büst D M
Medical Research School der Medizinischen Fakultät der Heinrich-Heine-Universität, Düsseldorf.
Medical Center University of Düsseldorf, Dept. of OB/GYN/REI, Düsseldorf.
Geburtshilfe Frauenheilkd. 2016 Jun;76(6):690-698. doi: 10.1055/s-0042-105747.
Patients receiving fertility treatment in Germany appear to be disadvantaged in comparison to those in other countries due to the restrictive Embryo Protection Act ("Embryonenschutzgesetz, ESchG"), which prohibits the selection of a "top" embryo. The so-called German Middleway ("Deutscher Mittelweg, DMW") now provides for a liberal interpretation of the ESchG by allowing the culture of numerous pronuclear stages (2PN stage). Retrospective cohort study of 2 assisted reproduction treatment cycles in n = 400 patients between the ages of 21 and 45 years, either treated 2× conservatively or 1× conservatively and 1× liberally according to DMW. Pregnancy was achieved in 35 % of patients in the DMW group and 31 % of controls. The birth rate among controls was 28.5 % and 30.5 % in the DMW group. Most pregnancies resulted from the culture of 4 × 2PN stages. Patients in the DMW group had significantly higher pregnancy and birth rates compared to their previous cycles despite significantly increased age and significantly fewer transferred embryos. Key factors were the number of 2PNs generated and the quality of embryos transferred. Thus it can be assumed that particularly older patients with adequate ovarian reserves will benefit from DMW, i.e. the transfer of fewer embryos of the best possible quality.
与其他国家的患者相比，由于严格的《胚胎保护法》（“Embryonenschutzgesetz, ESchG”）禁止选择“优质”胚胎，在德国接受生育治疗的患者似乎处于劣势。所谓的德国中间路线（“Deutscher Mittelweg, DMW”）现在允许对ESchG进行宽松解释，即允许培养多个原核期（2PN期）。对400名年龄在21至45岁之间的患者进行了2个辅助生殖治疗周期的回顾性队列研究，这些患者要么接受2次保守治疗，要么根据DMW进行1次保守治疗和1次宽松治疗。DMW组35%的患者和对照组31%的患者实现了妊娠。对照组的出生率为28.5%，DMW组为30.5%。大多数妊娠来自4个2PN期的培养。尽管年龄显著增加且移植胚胎数量显著减少，但DMW组患者的妊娠率和出生率明显高于其先前的周期。关键因素是产生的2PN数量和移植胚胎的质量。因此，可以假设，特别是卵巢储备充足的老年患者将从DMW中受益，即移植尽可能少的优质胚胎。
