選擇性單個卵裂期胚胎移植可行性的Meta分析_《中國循證醫學雜志》

作者：

王致輝 ,  臘曉琳 , 趙靜 , 鞏曉蕓 , 胡泊 , 王鵬

新疆醫科大學第一附屬醫院生殖醫學科（烏魯木齊 830054）;

關鍵詞：

選擇性單胚胎移植體外受精-胚胎移植卵裂期 Meta分析系統評價隨機對照試驗

DOI：

10.7507/1672-2531.20130214

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目的　為給單胚胎移植的臨床應用提供更可靠的證據，對國內外公開發表的選擇性單個與兩個卵裂期胚胎移植的臨床研究進行Meta分析。
方法　計算機檢索PubMed、Ovid、EMbase、MEDLINE、CENTRAL等中外生物醫學數據庫，收集有關選擇性單個與兩個卵裂期胚胎移植的隨機對照試驗（RCT）。按Cochrane系統評價方法，由兩位研究者獨立選擇文獻、提取資料并評價納入研究的方法學質量后，采用RevMan 5.1軟件進行Meta分析。
結果　共納入9個RCT，共計2 784例患者，其中試驗組1 452例，對照組1 332例。Meta分析結果顯示：與兩個卵裂期胚胎移植比較，選擇性單個卵裂期胚胎移植降低了每個移植周期的活產率［RR=0.66，95%CI（0.59，0.73），P lt;0.000 01］，顯著降低了多胎妊娠率［RR=0.05，95%CI（0.02，0.11），P lt;0.000 01］，亦降低了早產兒發生率［RR=0.39，95%CI（0.26，0.60），P lt;0.000 1］和低體重兒發生率［RR=0.25，95%CI（0.15，0.44），P lt;0.000 01］，但對異位妊娠率［RR=0.55，95%CI（0.11，2.77），P=0.47］、流產率［RR=1.33，95%CI（0.92，1.91），P=0.13］和圍產兒死亡率［RR=0.31，95%CI（0.03，2.76），P=0.29］無影響。
結論　與兩個胚胎移植相比，選擇性單胚胎移植降低了每移植周期臨床妊娠率、多胎妊娠率、早產兒發生率及低體重兒發生率，在其他指標方面兩組無顯著差異。

引用本文： 王致輝,臘曉琳,趙靜,鞏曉蕓,胡泊,王鵬. 選擇性單個卵裂期胚胎移植可行性的Meta分析. 中國循證醫學雜志, 2013, 13(10): 1251-1257. doi: 10.7507/1672-2531.20130214 復制

1.	Milingos DS, Bhattacharya S. Single embryo transfer. Obstet Gynaecol Med, 2009, 19(8): 229-231.
2.	HFEA. HFEA register data 2003/2004. [2007-06-01] http://www.hfea.gov.uk.
3.	Ombelet W, de Sutter P, van der Elst J, et al. Multiple gestation and infertility treatment: registration, reflection and reaction-the Belgian project. Hum Reprod Update, 2005, 11(1): 3-14.
4.	Higgins J, Green S. Cochrance Handbook for Systematic Reviews of Interventions Version 5.1.0[updated March 2011]. The Cochrane Collaboration, 2011. Available from www. cochranehand-book. org.
5.	Gerris J, de ND, Mange lschots K, et al. Prevention of twin pregnancy after in-vitro fertilization or intracytoplasmic sperm injection based on strict embryo criteria : a prospective randomized clinical trial. Hum Reprod, 1999, 14(10): 2581-2587.
6.	Heijnen EM, Eijk emans MJ, de KC, et al. A mild treatment strategy for in-vitro fertilisation: a randomized non-inferiority trial. Lancet, 2007, 369(9563): 743-749.
7.	Kjellberg AT, Carlsson P, Bergh C. Randomized single versus double embryo transfer: obstetric and paediatric outcome and a cost-effectiveness analysis. Hum Reprod, 2006, 21(1): 210-216.
8.	Lukassen HG, Braat DD, Wetzels AM, et al. Two cycles with single embryo transfer versus one cycle with double embryo transfer: a randomized controlled trial. Hum Reprod, 2005, 20(3): 702-708.
9.	Martikainen H, Tiitinen A, Tomas C, et al. One versus two embryo transfer after IVF and ICSI: a randomized study. Hum Reprod, 2001, 16(9): 1900-1903.
10.	Moustafa MK, Sheded SA, El Aziz Mousta MA. Elective single embryo transfer versus double embryo transfer in assisted reproduction. Reprod Biomed Online, 2008, 17(1): 82-87.
11.	Thurin A, Hausken J, Hillensjo T, et al. Elective single -embryo transfer versus double-embryo transfer in in vitro fertilization. N Engl J Med, 2004, 351(23): 2392-2402.
12.	Thurin A, Olivius C, Bergh C, et al. Cumulative live-birth rates in a trial of single-embryo or double-embryo transfer. N Engl J Med, 2009, 361(18): 1812-1813.
13.	van Montfoort AP, Fiddelers AA, Janssen JM, et al. In unselected patients, elective single embryo transfer prevents all multiples, but results in significantly lower pregnancy rates compared with double embryo transfer: a randomized controlled trial. Hum Reprod, 2006, 21(2): 338-343.
14.	Adashi EY, Barri PN, Berkowitz R, et al. Infertility therapy-associated multiple pregnancies (births): an ongoing epidemic. Reprod Biomed Online, 2003, 7(5): 515-542.
15.	Rosheen Grady, Nika Alavi, Rachel Vale, et al. Elective single embryo transfer and perinatal outcomes: a systematic review and meta-analysis. Fertility and Sterility, 2012, 97(2): 324-331.
16.	Strandell A, Bergh C, Lundin K. Selection of patients suitable for one-embryo transfer may reduce the rate of multiple births by half without impairment of overall birth rates. Hum Reprod, 2000, 15(2): 2520-2525.
17.	Milingos DS, Bhattacharya S. Single embryo transfer. Obstetrics, Gynaecology and Reproductive Medicine, 2009, 19(8): 229-231.
18.	de Sutter P, Bontinck J, Schutysers V, et al. First-trimester bleeding and pregnancy outcome in singletons after assisted reproduction. Hum Reprod, 2006, 21(7): 1907-1911.
19.	De Sutter P, Delbaere I, Gerris J, et al. Birthweight of singletons after assisted reproduction is higher after single- than after double-embryo transfer. Hum Reprod, 2006, 21(10): 2633-2637.
20.	Sullivan EA, Wang YP, Hayward I, et al. Single embryo transfer reduces the risk of perinatal mortality, a population study. Hum Reprod, 2012, 36(18): 1732-1740.

1. Milingos DS, Bhattacharya S. Single embryo transfer. Obstet Gynaecol Med, 2009, 19(8): 229-231.
2. HFEA. HFEA register data 2003/2004. [2007-06-01] http://www.hfea.gov.uk.
3. Ombelet W, de Sutter P, van der Elst J, et al. Multiple gestation and infertility treatment: registration, reflection and reaction-the Belgian project. Hum Reprod Update, 2005, 11(1): 3-14.
4. Higgins J, Green S. Cochrance Handbook for Systematic Reviews of Interventions Version 5.1.0[updated March 2011]. The Cochrane Collaboration, 2011. Available from www. cochranehand-book. org.
5. Gerris J, de ND, Mange lschots K, et al. Prevention of twin pregnancy after in-vitro fertilization or intracytoplasmic sperm injection based on strict embryo criteria : a prospective randomized clinical trial. Hum Reprod, 1999, 14(10): 2581-2587.
6. Heijnen EM, Eijk emans MJ, de KC, et al. A mild treatment strategy for in-vitro fertilisation: a randomized non-inferiority trial. Lancet, 2007, 369(9563): 743-749.
7. Kjellberg AT, Carlsson P, Bergh C. Randomized single versus double embryo transfer: obstetric and paediatric outcome and a cost-effectiveness analysis. Hum Reprod, 2006, 21(1): 210-216.
8. Lukassen HG, Braat DD, Wetzels AM, et al. Two cycles with single embryo transfer versus one cycle with double embryo transfer: a randomized controlled trial. Hum Reprod, 2005, 20(3): 702-708.
9. Martikainen H, Tiitinen A, Tomas C, et al. One versus two embryo transfer after IVF and ICSI: a randomized study. Hum Reprod, 2001, 16(9): 1900-1903.
10. Moustafa MK, Sheded SA, El Aziz Mousta MA. Elective single embryo transfer versus double embryo transfer in assisted reproduction. Reprod Biomed Online, 2008, 17(1): 82-87.
11. Thurin A, Hausken J, Hillensjo T, et al. Elective single -embryo transfer versus double-embryo transfer in in vitro fertilization. N Engl J Med, 2004, 351(23): 2392-2402.
12. Thurin A, Olivius C, Bergh C, et al. Cumulative live-birth rates in a trial of single-embryo or double-embryo transfer. N Engl J Med, 2009, 361(18): 1812-1813.
13. van Montfoort AP, Fiddelers AA, Janssen JM, et al. In unselected patients, elective single embryo transfer prevents all multiples, but results in significantly lower pregnancy rates compared with double embryo transfer: a randomized controlled trial. Hum Reprod, 2006, 21(2): 338-343.
14. Adashi EY, Barri PN, Berkowitz R, et al. Infertility therapy-associated multiple pregnancies (births): an ongoing epidemic. Reprod Biomed Online, 2003, 7(5): 515-542.
15. Rosheen Grady, Nika Alavi, Rachel Vale, et al. Elective single embryo transfer and perinatal outcomes: a systematic review and meta-analysis. Fertility and Sterility, 2012, 97(2): 324-331.
16. Strandell A, Bergh C, Lundin K. Selection of patients suitable for one-embryo transfer may reduce the rate of multiple births by half without impairment of overall birth rates. Hum Reprod, 2000, 15(2): 2520-2525.
17. Milingos DS, Bhattacharya S. Single embryo transfer. Obstetrics, Gynaecology and Reproductive Medicine, 2009, 19(8): 229-231.
18. de Sutter P, Bontinck J, Schutysers V, et al. First-trimester bleeding and pregnancy outcome in singletons after assisted reproduction. Hum Reprod, 2006, 21(7): 1907-1911.
19. De Sutter P, Delbaere I, Gerris J, et al. Birthweight of singletons after assisted reproduction is higher after single- than after double-embryo transfer. Hum Reprod, 2006, 21(10): 2633-2637.
20. Sullivan EA, Wang YP, Hayward I, et al. Single embryo transfer reduces the risk of perinatal mortality, a population study. Hum Reprod, 2012, 36(18): 1732-1740.

《中國循證醫學雜志》

選擇性單個卵裂期胚胎移植可行性的Meta分析

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《中國循證醫學雜志》

選擇性單個卵裂期胚胎移植可行性的Meta分析

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