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Intervention Review

Number of embryos for transfer following in-vitro fertilisation or intra-cytoplasmic sperm injection

  1. Zabeena Pandian1,*,
  2. Siladitya Bhattacharya2,
  3. Ozkan Ozturk3,
  4. Gamal Serour4,
  5. Allan Templeton5

Editorial Group: Cochrane Menstrual Disorders and Subfertility Group

Published Online: 15 APR 2009

Assessed as up-to-date: 14 MAY 2008

DOI: 10.1002/14651858.CD003416.pub3

How to Cite

Pandian Z, Bhattacharya S, Ozturk O, Serour G, Templeton A. Number of embryos for transfer following in-vitro fertilisation or intra-cytoplasmic sperm injection. Cochrane Database of Systematic Reviews 2009, Issue 2. Art. No.: CD003416. DOI: 10.1002/14651858.CD003416.pub3.

Author Information

  1. 1

    Aberdeen Maternity Hospital, Obstetrics & Gynaecology, Aberdeen , UK

  2. 2

    Aberdeen Maternity Hospital, Department of Obstetrics and Gynaecology, Aberdeen, UK

  3. 3

    University College London Hospitals, Academic Department of Obstetrics and Gynaecology, London, UK

  4. 4

    Al Azhar University , The Egyptian IVF-ET Center, Cairo, Egypt

  5. 5

    University of Aberdeen, Department of Obstetrics and Gynaecology, Aberdeen, UK

*Zabeena Pandian, Obstetrics & Gynaecology, Aberdeen Maternity Hospital, Foresterhill, Aberdeen , AB25 2ZD, UK. ogy211@abdn.ac.uk. z.pandian@abdn.ac.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 15 APR 2009

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Multiple embryo transfer during IVF has increased multiple pregnancy rates (MPR) causing maternal and perinatal morbidity. Elective single embryo transfer (SET) is now being considered as an effective means of reducing this iatrogenic complication.

Objectives

To determine in couples undergoing IVF/ICSI (intra-cytoplasmic sperm injection) whether:

(1) elective transfer of two embryos improves the probability of livebirth compared with:

(a) elective single embryo transfer,

(b) three embryo transfer (TET) or

(c) four embryo transfer (FET).

(2) elective transfer of three embryos improves the probability of livebirth compared with:

(a) elective single embryo transfer, or

(b) elective four embryo transfer.

Search methods

We searched the Cochrane Menstrual Disorders and Subfertility Group's trials register (searched March 2008), the Cochrane Central Register of Controlled Trials (Cochrane Library, Issue 1, 2008), MEDLINE (1970 to 2008), EMBASE (1985 to 2008) and reference lists of articles. Relevant conference proceedings were hand-searched and researchers in the field contacted.

Selection criteria

Randomised controlled trials were included.

Data collection and analysis

Two reviewers independently assessed eligibility and quality of trials.

Main results

For the update in 2008 five trials compared DET with SET. DET versus TET and DET versus FET were evaluated in a single small trial each. The difference in cumulative livebirth rates (CLBR) after DET and those after SET followed by transfer of a single frozen thawed embryo (1FZET) was not statistically significant (OR 0.81, 95% CI 0.59 to 1.11; p=0.18). There was no statistically significant difference in CLBR after a single fresh cycle of DET versus two fresh cycles of SET (OR 1.23, 95% CI 0.56 to 2.69, p= 0.60 ). The live birth rate (LBR) per woman in a single fresh treatment was higher following DET than SET (OR 2.10, 95% CI 1.65 to 2.66, p<0.00001). The MPR was lower following SET (OR 0.04, 95% CI 0.01 to 0.11; p< 0.00001). The CLBR following two fresh cycles of DET versus two fresh cycles of TET (OR 0.77, 95%CI 0.22 to 2.65, p=0.67) and CLBR after three fresh cycles of DET versus three fresh cycles of TET showed no statistically significant differences (OR 0.77, 95% CI 0.24 to 2.52; p=0.67). There were no statistically significant differences between DET and TET in terms of LBR (OR 0.40, 95%CI 0.09 to 1.85; p=0.24) and MPR (OR 0.17, 95%CI 0.01 to 3.85; p= 0.27). DET led to lower LBR than FET but the difference was not statistically significant (OR 0.35, 95% CI 0.11 to 1.05; p = 0.06).

Authors' conclusions

In a single fresh IVF cycle, SET is associated with a lower LBR than DET. However there is no significant difference in CLBR following SET+ 1FZET and the LBR following a single cycle of DET. MPR are lowered following SET compared with other transfer policies. There are insufficient data on the outcome of two versus three and four embryo transfer policies.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Number of embryos for transfer following in-vitro fertilisation or intra-cytoplasmic sperm injection

Women undergoing in vitro fertilisation (IVF) with multiple embryo transfer face an increased risk of twins and triplets. The social and economic consequences of multiple pregnancies are significant, as are risks to the mother and baby. Single embryo transfer can minimise the risk of multiples. This review of trials found that elective single embryo transfer (SET) resulted in fewer multiple pregnancies than double embryo transfer (DET), but the pregnancy and livebirth rate per fresh IVF cycle was lower. The cumulative livebirth rate associated with SET followed by a single frozen and thawed embryo transfer (1FZET) was comparable with that after one cycle of DET, whilst still maintaining a significantly lower rate of multiple births.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

在體外受精或是卵細胞質內的精蟲注射之後,用來移植的胚胎數目

為了要獲得最大的懷孕機會,傳統上會仰賴在體外受精(IVF)的期間之內進行好幾個胚胎的移植,可是這樣的作法卻造成了懷上多胞胎的比率增高。選擇接受體外受精的婦女們,懷上雙胞胎的風險會提高20倍,至於懷上更多胎數的風險則會提高400倍(Martin 1998)。跟單胞胎的狀況比較起來,因為懷有多胞胎的關係,針對母親的以及周產兒的罹病率與死亡率,以及新生兒健康服務方面的花費,都會明顯地高出許多(Luke 1992;Callahan 1994;Goldfarb 1996)。目前,人們已經將單1個胚胎移植視作1種有效的方法,可以減少產生這種醫源性的併發症。這份系統性的回顧評估了在體外授精及ICSI (卵細胞質內的精蟲注射) 治療後,移植2個胚胎相較於移植1個以及多於2個胚胎的功效。

目標

本篇回顧的目的,是要在不論這些夫妻們是否有接受體外受精/卵細胞質內的精蟲注射之條件下,確認:(1)挑選出2個胚胎的移植可以提升產下活胎的可能性,而比較的對象則為:(a)單1個胚胎移植,(b)3個胚胎移植,或是(c)4個胚胎移植。(2)挑選出3個胚胎的移植可以提升產下活胎的可能性,而比較的對象則為:(a)單1個胚胎移植,(b)4個胚胎移植。

搜尋策略

我們搜尋 Cochrane Menstrual Disorders以及Subfertility Group's trials register (searched June 2003) 、 Cochrane Central Register of Controlled Trials (Cochrane Library, Issue 4, 2003) 、MEDLINE (1970年2003年) 、EMBASE (1985年2003年) 以及文章的參考資料清單。我們也人工搜尋相關研討會手冊並與本領域研究人員聯繫。

選擇標準

當中只收集了隨機對照試驗。

資料收集與分析

有2位審稿者獨立地評估了這些試驗的合格性與品質。

主要結論

針對在1個週期上移植多個胚胎的策略,以及使用冷凍保存而且又在多個週期之中進行單1個胚胎移植的策略,我們發現,並沒有任何研究曾經在這2種策略之間進行過比較。我們也發現,並沒有任何試驗曾經在2個與3個胚胎的移植之間進行過比較。有3份小型的、並沒有經過妥善報告的試驗,曾經針對過某個單1週期,移植2個與1個胚胎作比較,同時還有1份小型的、並沒有經過妥善報告的試驗,曾經針對過某個單1週期,比較移植2個及4個胚胎的結果。跟單1個胚胎移植比較起來,進行過2個胚胎移植之後所帶來的每名婦女/每對夫妻之臨床懷孕比率,都明顯地提高了(OR 2.08,95% CI 1.24到3.50;對於整體影響的測試p = 0.006)。移植單一胚胎而產下活胎的比率比較起來,進行過2個胚胎移植之後所帶來的每名婦女/每對夫妻之產下活胎的比率,也明顯地提高了(OR 1.90,95% CI 1.12到3.22,對於整體影響的測試p = 0.02)。對於使用單1個胚胎移植的婦女們而言,懷上多胞胎的比率明顯地降低了(OR 9.97,95% CI 2.61到38.19;p = 0.0008)。跟4個胚胎移植比較起來,進行2個胚胎移植之後的功效,曾經在某1份單獨的試驗當中進行過測試。在這2個組別之間,對於臨床的懷孕比率(OR 0.75,95% CI 0.26到2.16;p = 0.6),以及懷上多胞胎的比率(OR 0.44,95% CI 0.10到1.97;p = 0.28)而言,並沒有統計學上的顯著差異存在。移植4個胚胎相較於移植2個胚胎而言,有較高的存活率,但是這些結果在統計學方面都不是很明顯(OR 0.35,95% CI 0.11到1.05;p = 0.06)。

作者結論

在這份系統性回顧中所得到的結果認為,跟那些接受過2個胚胎移植之後所得到的結果比較起來,經過單1個胚胎移植之後,產下活胎與懷孕的比率都會比較低,因為這些懷上多胞胎的機會也包括了雙胞胎。因為如此,如果要說這些結論已經強大到足以促成臨床實務當中的某種改變,則是不太可能的。這些被收集在內的研究,都因為它們的樣本規模太小而受到限制,以致於即使有大型的差異存在,卻也有可能被隱藏起來。很少有報告提到關於累積的產下活胎之比率。關於單1胚胎移植,以及第1次的冷凍單1胚胎移植(1FZET)或是接下來的單1冷凍胚胎移植,這些資料都不適合用來歸納出結論。等到能夠取得更多證據的時候,對於所有正在接受體外受精/卵細胞質內的精蟲注射之患者們而言,單1胚胎移植或許就不再是受到人們喜歡的選擇了。基於這些夫妻們可能會有懷上多胞胎的風險,臨床醫師們可能會需要針對他們來對這些方法給予個人化的設計。還是需要有1份最後具有實用性、大型的多中心隨機對照試驗,並且就臨床與費用方面的功效以及接受程度等角度來考量,在內容中針對單1胚胎與2個胚胎的移植來進行比較。經過測量所得到的主要結果,應該為每名婦女/每對夫妻所累積起來的產下活胎之數目。

翻譯人

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

跟2個胚胎移植(DET)比較起來,在體外受精的過程中使用單1胚胎移植(SET),或許可以讓懷上多胞胎的機率降低,但是使用單1胚胎移植所得到的懷孕比率,卻也是比較低的。接受過體外受精(IVF)治療的婦女們,在產下雙胞胎以及3胞胎(懷上多胞胎)方面,都會有比較高的風險。跟單1個胎兒比較起來,因為懷上多胞胎的關係,在社會以及經濟上的代價,就會像是對於母親與嬰兒的風險一樣,都會變得比較高。單1胚胎移植(SET)可以讓懷上多胞胎的風險降到最低。本篇試驗的回顧發現,跟2個胚胎移植(DET)比較起來,單1胚胎移植可以讓懷上多胞胎的機率降到比較低,但是使用單1胚胎移植所得到的懷孕比率,卻也是比較低的。然而,因為在這些試驗當中,並沒有對累積起來的產下活胎之比率進行適當的說明,而這樣的比率在評估單1胚胎移植方面又是1種重要的結果,所以目前還沒辦法對這份研究作出結論。