Rebar Robert W
The American Society for Reproductive Medicine 1209 Montgomery Hwy 35216 Birmingham AL USA.
Reprod Med Biol. 2013 Jun 11;12(4):151-158. doi: 10.1007/s12522-013-0156-y. eCollection 2013 Oct.
Although assisted reproductive technologies (ART) have become established procedures performed around the world, there are still many unanswered questions regarding safety. Possible risks associated with infertility and ART include (1) those inherent to pregnancy, delivery, and childhood; (2) those associated with the infertility itself and its causes; and (3) risks iatrogenic to ART. Although there are many potential risks associated with ART, it has become clear that the major risk is multiple pregnancy and its consequences. Major efforts are warranted to reduce the risk of multiple gestations with IVF, but it is also clear that single-embryo transfer is not the solution in all cases. Moreover, several studies have now documented that perinatal outcomes are somewhat poorer in IVF singleton infants than in spontaneously conceived singletons, but it is not clear if this increased risk is due to the ART or the infertility. Concerns about the impact of abnormalities in genomic imprinting persist at this time, as do risks associated with the culture conditions and even our environment. Only time will tell if children born following ART are at any increased risk of developing certain chronic diseases as they age. In any case, the risks to IVF children and mothers are likely to remain higher than those for children and mothers conceived spontaneously without medical assistance. However, since there have been over 5 million births after ART worldwide, and the vast majority of pregnancies and children have been essentially "normal", it is obvious that any excess risk must be relatively small. The normality of most pregnancies mandates that extreme care be exercised in making any changes to current practice.
尽管辅助生殖技术（ART）已成为在世界各地开展的既定程序，但关于安全性仍有许多未解决的问题。与不孕症和ART相关的潜在风险包括：（1）怀孕、分娩和儿童期固有的风险；（2）与不孕症本身及其病因相关的风险；以及（3）ART医源性风险。尽管ART存在许多潜在风险，但很明显主要风险是多胎妊娠及其后果。有必要做出重大努力以降低IVF中多胎妊娠的风险，但同样明显的是，单胚胎移植并非在所有情况下都是解决方案。此外，多项研究现已证明，IVF单胎婴儿的围产期结局比自然受孕的单胎婴儿略差，但尚不清楚这种风险增加是由于ART还是不孕症。目前，对基因组印记异常影响的担忧依然存在，与培养条件甚至我们的环境相关的风险也是如此。只有时间才能证明ART出生的儿童随着年龄增长患某些慢性病的风险是否会增加。无论如何，IVF儿童和母亲面临的风险可能仍高于自然受孕且无医疗协助的儿童和母亲。然而，由于全球ART后出生已超过500万例，并且绝大多数妊娠和儿童基本“正常”，显然任何额外风险必定相对较小。大多数妊娠的正常性要求在对当前做法进行任何改变时都要格外谨慎。
