Lansac J, Thepot F, Mayaux M J, Czyglick F, Wack T, Selva J, Jalbert P
University Hospital Bretonneau, Tours, France.
Eur J Obstet Gynecol Reprod Biol. 1997 Aug;74(2):223-8. doi: 10.1016/s0301-2115(97)00102-4.
To assess pregnancies and conceptus after artificial insemination (AID) or IVF with frozen semen donor (IVF-D) on sufficiently large study population in order to distinguished minor variations.
From 1987 to 1994, all pregnancies obtained after AID or IVF-D were registered prospectively in the French CECOS Federation data base. Different factors were recorded for this study: first menarche age of the recipient women, cycle length, insemination date in the conception cycle, maternal age at delivery, hormonal treatments, donor age, sperm conservation length and follow up of the pregnancy: miscarriage, tubal pregnancy, time at delivery, sex of the foetus, weight, malformation.
21,597 pregnancies obtained after AID and 3381 after IVF-D were registered. 2% were lost to follow up. Foetal loss rate is 18% after AID and 21.5% after IVF-D (p < 0.001). The tubal pregnancy rate is 0.9% after AID and 1.7% after IVF-D (p < 0.0001). 18,128 children were born after AID and 3313 after IVF-D. After AID, the twin pregnancy rate is 6.9% and the multiple pregnancy (> or = 3 foetus) rate is 0.7%. After IVF-D, these rates are 24.8% and 4.2% respectively (p < 0.0001). After AID the mean weight at delivery, sex ratio, premature rate, intra uterine growth retardation rate are not different from national rates published in 1995. The foetus malformation rate (including medical abortions) is 1.9% after AID and 2.7% after IVF-D (p < 0.009). After AID the trisomy 21 rate increases with the mother age but also with the donors age if the maternal age is equal. The birth defects rate is not different from those registered in Paris, Strasbourg and Marseille. The birth defects rate observed after IVF-D is not different from the rate observed after IVF with husband semen. (2.74% versus 2.99%; p = 0.16).
After AID the miscarriage and tubal pregnancy rate, the children's weight, the premature rate is not different from that of the general French population. Sex ratio is normal as is the global malformation rate. The multiple pregnancy rate (x 7 for twin and by 10 for multiple pregnancies more than 3 foetus) is high, showing the influence of ovulation induction treatment. The birth chromosomal abnormalities rate is normal and correlated not only to the mother's age but also to the donor's age. This result without clear biological explanation will require further verification in a greater population. Practically speaking, these observations encourages lowering the age limit for semen donors less than 45 years. IVF-D practice instead of AID doubles the tubal pregnancy rate (0.9% versus 1.7% and increases the twin pregnancy rate by 2.5% and the multiple pregnancy (> or = 3 fetus) rate by 3. It is necessary to promote good practice for AID for which the pregnancy rate is very different from one centre to another within the centres with AID low results a too high rate of IVF-D. Finally we can say that pregnancies from IVF-D or IVF with husband semen are not significantly different. In other words pregnancy outcome is not changed after sperm cryopreservation.
在足够大的研究人群中评估人工授精（AID）或使用冷冻精液供体的体外受精（IVF-D）后的妊娠情况和胚胎，以区分微小差异。
1987年至1994年，法国CECOS联合会数据库前瞻性地记录了所有AID或IVF-D后的妊娠情况。本研究记录了不同因素：受者女性的初潮年龄、月经周期长度、受孕周期的授精日期、分娩时的产妇年龄、激素治疗、供体年龄、精子保存时间以及妊娠随访情况：流产、输卵管妊娠、分娩时间、胎儿性别、体重、畸形。
记录了21597例AID后的妊娠和3381例IVF-D后的妊娠。2%失访。AID后的胎儿丢失率为18%，IVF-D后为21.5%（p<0.001）。AID后的输卵管妊娠率为0.9%，IVF-D后为1.7%（p<0.0001）。AID后出生18128名儿童，IVF-D后出生3313名儿童。AID后，双胎妊娠率为6.9%，多胎妊娠（≥3个胎儿）率为0.7%。IVF-D后，这些率分别为24.8%和4.2%（p<0.0001）。AID后分娩时的平均体重、性别比、早产率、宫内生长迟缓率与1995年公布的全国率无差异。AID后的胎儿畸形率（包括人工流产）为1.9%，IVF-D后为2.7%（p<0.009）。AID后21三体率随母亲年龄增加而增加，但如果母亲年龄相同，也随供体年龄增加。出生缺陷率与巴黎、斯特拉斯堡和马赛记录的无差异。IVF-D后观察到的出生缺陷率与使用丈夫精液的IVF后观察到的率无差异（2.74%对2.99%；p=0.16）。
AID后的流产和输卵管妊娠率、儿童体重、早产率与法国普通人群无异。性别比正常，总体畸形率也正常。多胎妊娠率（双胎增加7倍，3个以上胎儿的多胎妊娠增加10倍）较高，显示了促排卵治疗的影响。出生染色体异常率正常，不仅与母亲年龄有关，还与供体年龄有关。这一结果无明确生物学解释，需要在更大人群中进一步验证。实际上，这些观察结果鼓励降低精液供体年龄限制至45岁以下。与AID相比，IVF-D使输卵管妊娠率翻倍（0.9%对1.7%），双胎妊娠率增加2.5%，多胎妊娠（≥3个胎儿）率增加3倍。有必要推广AID的良好做法，因为AID的妊娠率在不同中心差异很大，在AID成功率低的中心IVF-D率过高。最后可以说，IVF-D或使用丈夫精液的IVF后的妊娠无显著差异。换句话说，精子冷冻保存后妊娠结局未改变。
