| Object: In 1978,the world’s first IVF baby had been born,since then ART has gradually been the important mean to treat infertile couples.ART mainly includes in vitro fertilization(IVF),intracytoplasmic sperm injection(ICSI),frozen thawed embryo transfer(FET)and preimplantation genetic diagnosis/screening(PGD/PGS).However,ART is very different from natural pregnancy,it involve a series of unnatural interventions,such as ovulation induction,egg retrievals,fertilizing in vitro environment and embryo transfer et al,also company with ovarian hyperstimulation syndrome and multiple et al.So the safety of women and newborn of IVF technology has been on debate.Now domestic and foreign reports about the perinatal outcomes of women and children through IVF stand controversial.base on this,our study had continued to follow-up perinatal outcomes of women and children of our center,intend to provide more theoretical basis and references data for this controversial issue.Part1 Perinatal outcomes of women through ARTMethods:Collection of 1237 cases of pregnant women in our center through IVF/ICSI/FET assisted pregnancy technology from January 2011 to July 2014(IVF group),Among them there are 711 cases of fresh embryo transfer cycles and 526 cases of frozen thawed embryo transfer cycle,and 5040 cases of natural pregnancy in our hospital during 2014 as the control group.In IVF group,frozen egg cycle,egg donation cycle,patients who loss to follow-up were excluded.All cases were examined by review and telephone follow-up to collect perinatal outcomes of women of the two groups,also all data were informed consent of patients and their families.This study was approved by the ethics committee of Southwest Hospital [scientific research(number 67),Third Military M edical University,2015].Collecting these datas,1、basic information: the reason of infertilityand women’ s age.2、complexity pregnancy of IVF group:abortion rate and ectopic pregnancy rate.3、perinatal outcomes: pregnancy-inducted hypertension,eclampsia,placenta previa,placental abruption,premature rupture of fetal membranes,intrahepaticcholestasis in pregnancy,postpartum hemorrhage.4、the process of birth:the mode of production and whether mother in ICU.Results: 1、Average age of IVF women was 30.4±4.2,the reason of infertility includes 962 cases of pelvic and tubal factors(77.8%),35 cases of ovulation disorder(2.8%),26 cases of Endometriosis(2.1%),and other reason is unknown and factors of man(azoospermia and extreme oligospermia et al),average age of natural pregnancy women was 29.0±4.0.2、Average age of fresh embryo cycle women was 30.6±4.3,average age of FET women was 30.2±4.2,there were no difference in average age between the two groups(P>0.05).In fresh embryo group,there were 117 cases of early abortion,60 cases of late abortion,34 cases of ectopic pregnancy.In FET group,there were 115 cases of early abortion,18 cases of late abortion,33 cases of ectopic pregnancy.The rate of early abortion was lower,and late abortion was higher in fresh embryo group(P<0.05),there were no difference in ectopic pregnancy between the two groups(P>0.05).3、The total rate of perinatal outcomes of IVF women was 53%,among them,104 cases of pregnancy-inducted hypertension,13 cases of eclampsia,145 cases of placenta previa,7cases of placental abruption,257 cases of premature rupture of fetal membranes,74 cases of intrahepaticcholestasis in pregnancy and 56 cases of postpartum hemorrhage.the total rate of perinatal outcomes of natural pregnancy women was 33.1 %,among them,54 cases of pregnancy-inducted hypertension,50 cases of eclampsia,176 cases of placenta previa,24 cases of placental abruption,1057 cases of premature rupture of fetal membranes,219 cases of intrahepaticcholestasis in pregnancy and 85 cases of postpartum hemorrhage,the incidence of pregnancy-inducted hypertension,placenta previa,intrahepaticcholestasis in pregnancy and postpartum hemorrhage were higher in IVF group(P<0.05).4、 The total rate of perinatal outcomes of fresh embryo women was 42.8%,among them,58 cases of pregnancy-inducted hypertension,8cases of eclampsia,74 cases of placenta previa,4cases of placental abruption,109 cases of premature rupture of fetal membranes,27 cases of intrahepaticcholestasis in pregnancy and 24 cases of postpartum hemorrhage.The total rate of perinatal outcomes of FET women was 66.9%,among them,46 cases of pregnancy-inducted hypertension,5cases of eclampsia,71 cases of placenta previa,3cases of placental abruption,48 cases of premature rupture of fetal membranes,47 cases of intrahepaticcholestasis in pregnancy and 32 cases of postpartum hemorrhage,the incidence of intrahepaticcholestasis in pregnancy,premature rupture of fetal membranes and postpartum hemorrhage were higher in FET group(P<0.05).5、In single group,the total rate of perinatal outcomes of IVF women was 51.3%,among them,66 cases of pregnancy-inducted hypertension,11 cases of eclampsia,112 cases of placenta previa,5cases of placental abruption,172 cases of premature rupture of fetal membranes,58 cases of intrahepaticcholestasis in pregnancy and 33 cases of postpartum hemorrhage.The total rate of perinatal outcomes of natural pregnancy women was 32.8%,among them,52 cases of pregnancy-inducted hypertension,46 cases of eclampsia,172 cases of placenta previa,21 cases of placental abruption,1038 cases of premature rupture of fetal membranes,209 cases of intrahepaticcholestasis in pregnancy and 82 cases of postpartum hemorrhage,the incidence of pregnancy-inducted hypertension,placenta previa,intrahepaticcholestasis in pregnancy and postpartum hemorrhage were higher in IVF group(P<0.05).6、In twin group,the total rate of perinatal outcomes of IVF women was 57.5%,among them,38 cases of pregnancy-inducted hypertension,2cases of eclampsia,33 cases of placenta previa,2cases of placental abruption,85 cases of premature rupture of fetal membranes,16 cases of intrahepaticcholestasis in pregnancy and 23 cases of postpartum hemorrhage.The total rate of perinatal outcomes of natural pregnancy women was 49%,among them,4cases of pregnancy-inducted hypertension,4cases of eclampsia,4cases of placenta previa,3cases of placental abruption,19 cases of premature rupture of fetal membranes,10 cases of intrahepaticcholestasis in pregnancy and 3cases of postpartum hemorrhage,the incidence of intrahepaticcholestasis in pregnancy and eclampsia were higher in IVF group(P<0.05).7、The rate of cesarean section in IVF group was higher than that of natural pregnancy group(1127/1237,91.1% vs 2450/5040,48.6%)(P<0.05).8、the incidence of mother in ICU in IVF group was higher than that of natural pregnancy group(10/1237 vs 3/5040)(P<0.05),but there was no difference in the rate of mother in ICU between fresh group and FET group(4/711 vs 6/526,P>0.05).Conclude:1.IVF women always with disease of infertility and their age was older.The incidence of pregnancy-inducted hypertension,eclampsia,placenta previa,intrahepaticcholestasis in pregnancy and postpartum hemorrhage were higher in IVF group.2.the incidence of early abortion,intrahepaticcholestasis in pregnancy,premature rupture of fetal membranes and postpartum hemorrhage were higher in FET group,but the rate of late abortion of FET group was lower.3.the rate of cesarean section and mother in ICU were higher in IVF group.Part 2 neonatal outcomes of ART new birthsMethods:Collection of 1237 cases of pregnant women in our center through IVF/ICSI/FET assisted pregnancy technology from January 2011 to July 2014(IVF group),total newborns were 1583 cases,among them,there were 925 cases of fresh embryo transfer cycles and 658 cases of FET,and 5136 cases newborns of natural pregnancy in our hospital during 2014 as the control group,follow the situations of newborns at birth.Exclusion criteria as the same as before.Collecting these datas:1、basic information: numbers of new birth,multiple,gestational age.2、outcomes of newborn: weight,low birth weight infant,premature,neonatal intensive care unit(NICU),neonatal hospitalization,stillbirth,newborn death.3、birth defect:cardiac dysplasia,six finger deformity,hypospadias et al.Result: 1、In IVF group,there were 1583 new births,average gestational age was 38.1±2.2,891 cases of single,346 cases of twins(692 new births),multiple rate was 28%,in natural group,there were 5136 new births,average gestational age was 38.8 ± 1.9,4944 cases of single,96 cases of twins(192 new births),multiple rate was 1.9%,multiple rate was higher and gestational age was smaller in IVF group(P<0.05).2、In fresh embryo group,there were 925 new births,average gestational age was 37.4 ±2.2,497 cases of single,214 cases of twins(428 new births),multiple rate was 30.18%,in FET group,there were 658 new births,average gestational age was 37.9±1.9,394 cases of single,132 cases of twins(264 new births),multiple rate was 25.1%,gestational age was smaller in fresh group(P<0.05).3、In IVF group,there were 43 cases of stillbirth and neonatal death,3cases of NICU,401 cases of low birth weight infant,150 cases of premature,285 cases of neonatal hospitalization,average weight of new birth was 2964±635(g),in natural group,there were 143 cases of stillbirth and neonatal death,0case of NICU,346 cases of low birth weight infant,320 cases of premature,661 cases of neonatal hospitalization,average weight of new birth was 3241±531(g),the rate of NICU,low birth weight infant,premature and neon atal hospitalization were higher in IVF group(P<0.05),and weigh of new birth was lower in IVF group(P<0.05).4、In fresh embryo group,there were 25 cases of stillbirth and neonatal death,0case of NICU,253 cases of low birth weight infant,93 cases of prema ture,162 cases of neonatal hospitalization,average weight of new birth was 2900±621(g),in FET group,there were 18 cases of stillbirth and neonatal death,3cases of NICU,148 cases of low birth weight infant,57 cases of premature,123 cases of neonatal hospitalization,average weight of new birth was 3055±645(g),the rate of low birth weight infant was higher in fresh group(P<0.05),and weigh of new birth was lower in fresh group(P<0.05).5、In IVF single group,there were 2cases of NICU,59 cases of low birth weight infant,63 cases of premature,171 cases of neonatal hospitalization,average weight of new birth was 3326 ±513(g),average gestational age was 38.7±1.8.In natural single group,there were 0case of NICU,229 cases of low birth weight infant,298 cases of premature,602 cases of neonatal hospitalization,average weight of new birth was 3280±488(g),average gestational age was 38.9±1.8,the weigh of new birth and rate of NICU,low birth weight infant and neonatal hospitalization were higher in IVF group,and gestational age was lower in IVF group(P<0.05).6、In IVF twin group,there were 1case of NICU,342 cases of low birth weight infant,87 cases of premature,114 cases of neonatal hospitalization,average weight of new birth was 2501±450(g),average gestational age was 36.4±2.2,in natural single group,there were 0case of NICU,117 cases of low birth weight infant,22 cases of premature,59 cases of neonatal hospitalization,average weight of new birth was 2233 ±601(g),average gestational age was 35.1±3.0,the weigh of new birth and gestational age were higher in IVF group,and rate of low birth weight infant and neonatal hospitalization were lower in IVF group(P<0.05).7、The rate of malformation was 1.6% in IVF group,they were 13 cases of Cardiac dysplasia,7cases of Six finger deformity,4cases of Hypospadias,2cases of Single umbilical artery,and the rate of malformation was 1.5% in control group,they were 10 cases of Hypospadias,12 cases of Cleft lip and palate,5cases of Single umbilical artery,17 cases of Six finger deformity,25 cases of Cardiac dysplasia,2cases of Umbilicus,3cases of Double kidney malformation,2cases of External genital malformation and 2cases of Digestive tract malformation,there were no difference in malformation between the two groups(P>0.05),also there were no difference in malformation between fresh group(16cases)and FET group(10cases)(P>0.05).Conclusion:1.multiple rate was higher and gestational age and weight of newborn was lower in IVF group.2.In single,the rate of NICU,low birth weight infant and neonatal hospitalization were higher in IVF group.3.In twin,the rate of low birth weight infant and neonatal hospitalization were lower in IVF group,and weight of newborn was higher in IVF group.4.the rate of low birth weight infant was higher and weight of new birth was lower in fresh group.5.there were no difference in malformation between IVF group and control group. |
PDF Full Text Request