試管嬰兒是冷凍胚胎移植還是新鮮胚胎移植懷孕結果好?

版主: 克莉絲

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寶醫師
文章: 297
註冊時間: 2013年 10月 15日, 07:38

2019年 1月 2日, 09:42

薈萃分析是否可累計提供了明確的回答?

結果:二十六項研究符合納入標準。
優點
從凍胚的胚胎優於新鮮胚胎植入的結果以單胞胎懷孕而言相對較低早產風險(RR)(0.90; 95%CI 0.84-0.97),較少低出生體重(0.72; 95%CI 0.67-0.77)和早產(0.61;
95%CI 0.56-0.67),
缺點
相對於新鮮胚胎植入, 凍胚的胚胎的植入有高血壓疾病風險增加(RR),過期妊娠期(1.29; 95%CI 1.07-1.56)和嬰兒出生體重(1.85; 95%CI 1.46-2.33)。

兩組之間的先天性異常和圍產期死亡風險沒有差異。
更廣泛的影響:這項累積薈萃分析的結果證實,小於胎齡兒的風險降低了
出生體重和早產以及與懷孕相關的大胎齡和高出生體重的風險增加
多年來,冷凍胚胎的方向和效果一致,懷孕率普遍高於新鮮胚胎植入是共識

凍胚植入胚胎的出生體重較重。同時,應該謹慎行事,採取有選擇性凍結的政策,IVF中的所有胚胎,因為對於孕齡較大的嬰兒和妊娠期高血壓疾病,風險增加。因此,理想情況下,選擇性冷凍應在特定病例中進行,如避免卵巢過度刺激症候群及保留生育能力方面。

對臨床應用的影響
本文評價的數據為胚胎冷凍保存提供了保證體外受精(IVF)中的選擇,由於嬰儿期大嬰兒的風險較高,因此要謹慎以及妊娠期高血壓的風險增加。這是
特別相關的是,冷凍胚胎植入的門檻正在下降和增加,因為冷凍胚胎懷孕率高且不易外孕來自於冷凍胚胎的內膜環境穩定,不像新鮮週期排卵針的促排刺激出更高的E2(雌激素)而著床窗的改變較大。胚胎的數量正在被選擇性地凍結並保留
延期轉讓。事實上,在一些生殖中心,隨後採取了“全胚冷凍”的政策
通過解凍冷凍胚胎移植已成為常態。

對研究的啟示
經發表了許多觀察性研究
多年來評估單胎妊娠的產科和週產期結局,由於凍結的門檻已經下降,
“全胚冷凍”。也就是分兩回合,先新鮮週期取卵,而後休息至少一個月再進入自然週期或口服雌激素增厚內膜解凍胚胎植入,此時的E2血中濃度與自然週期相似。
冷凍胚胎治療優先於傳統的選擇性新鮮胚胎移植。雖然數據通常可以讓人放心
解凍冷凍胚胎轉移的安全性,稍有一些揮之不去,但並未減少冷凍胚胎植入為主的趨勢。

台灣國健屬公告的植入懷孕率在各年齡層均是冷凍胚胎植入顯著優於新鮮胚胎

本文部分參考Human Reproduction Update, Vol.24, No.1 pp. 35–58, 2018
大喬依絲
文章: 10
註冊時間: 2013年 10月 17日, 04:22

2019年 1月 4日, 15:57

凍胚植入胚胎的寶寶出生體重較重,同時對於孕齡較大的嬰兒和妊娠期高血壓疾病,風險增加,所以對高齡產婦而言,是不是要更注意妊娠高血壓的潛在風險?
還有一個疑問,新鮮週期取卵後,休息一個週期後植入相較於不休息於下個週期植入,何者懷孕率較高?
註:如果我有解讀錯的話,請包涵!!
寶醫師
文章: 297
註冊時間: 2013年 10月 15日, 07:38

2019年 1月 4日, 21:13

高齡產婦而言,是不是要更注意妊娠高血壓的潛在風險?只是相対,不是普遍。小心理解利大於弊。妊娠率及活產率在高齡是凍胚大勝。

休息一個月較恰當
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