Equal3 Fertility, Cupertino, California.
Robinson Research Institute, University of Adelaide, Adelaide, Australia.
Fertil Steril. 2020 Oct;114(4):680-689. doi: 10.1016/j.fertnstert.2020.09.003. Epub 2020 Oct 1.
In the early years of in vitro fertilization, overall pregnancy rates were low, and it was considered necessary to transfer more than one embryo to increase the chances of pregnancy. It was not until advances in assisted reproductive technologies resulting in increased pregnancy rates that the concept of transferring just one embryo was considered possible. A consequence of improvements in implantation rates was also an increase in multiple pregnancies when more than one embryo was transferred. Although some countries have reduced the number of embryos transferred, international data show that in many parts of the world high twin and higher order multiple pregnancy rates still exist. Even in developed countries these problems persist depending on clinical practice, funding of health services, and patient demands. Perinatal and other outcomes are significantly worse with twins compared with singleton pregnancies and there is an urgent need to reduce multiple pregnancy rates to at least 10%. This has been achieved in several countries and clinics by introducing single embryo transfer but there are many barriers to the introduction of this technique in most clinics worldwide. We discuss the background to the high multiple rate in assisted reproduction and the factors that contribute to its persistence even in excellent clinics and in high-quality health services. Practices that may promote single embryo transfer are discussed.
在体外受精的早期，整体妊娠率较低，人们认为有必要移植多个胚胎以增加妊娠的机会。直到辅助生殖技术的进步提高了妊娠率，才考虑有可能移植一个胚胎。胚胎着床率的提高也导致了多胎妊娠的增加，因为移植了多个胚胎。尽管一些国家已经减少了胚胎的移植数量，但国际数据显示，在世界上许多地区，双胞胎和更高阶的多胎妊娠率仍然很高。即使在发达国家，根据临床实践、医疗服务资金和患者需求，这些问题仍然存在。与单胎妊娠相比，双胞胎的围产期和其他结局明显更差，因此迫切需要将多胎妊娠率降低至少 10%。通过引入单胚胎移植，一些国家和诊所已经实现了这一目标，但在全球大多数诊所引入这项技术存在许多障碍。我们讨论了辅助生殖中高多胎率的背景，以及即使在优秀的诊所和高质量的医疗服务中，其持续存在的因素。还讨论了可能促进单胚胎移植的做法。
