选择性单个卵裂期胚胎移植可行性的Meta分析_《中国循证医学杂志》

作者：

王致辉 ,  腊晓琳 , 赵静 , 巩晓芸 , 胡泊 , 王鹏

新疆医科大学第一附属医院生殖医学科（乌鲁木齐 830054）;

关键词：

选择性单胚胎移植体外受精-胚胎移植卵裂期 Meta分析系统评价随机对照试验

DOI：

10.7507/1672-2531.20130214

视频：

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摘要 全文 图表 视频 参考文献 施引文献 补充材料

目的　为给单胚胎移植的临床应用提供更可靠的证据，对国内外公开发表的选择性单个与两个卵裂期胚胎移植的临床研究进行Meta分析。
方法　计算机检索PubMed、Ovid、EMbase、MEDLINE、CENTRAL等中外生物医学数据库，收集有关选择性单个与两个卵裂期胚胎移植的随机对照试验（RCT）。按Cochrane系统评价方法，由两位研究者独立选择文献、提取资料并评价纳入研究的方法学质量后，采用RevMan 5.1软件进行Meta分析。
结果　共纳入9个RCT，共计2 784例患者，其中试验组1 452例，对照组1 332例。Meta分析结果显示：与两个卵裂期胚胎移植比较，选择性单个卵裂期胚胎移植降低了每个移植周期的活产率［RR=0.66，95%CI（0.59，0.73），P lt;0.000 01］，显著降低了多胎妊娠率［RR=0.05，95%CI（0.02，0.11），P lt;0.000 01］，亦降低了早产儿发生率［RR=0.39，95%CI（0.26，0.60），P lt;0.000 1］和低体重儿发生率［RR=0.25，95%CI（0.15，0.44），P lt;0.000 01］，但对异位妊娠率［RR=0.55，95%CI（0.11，2.77），P=0.47］、流产率［RR=1.33，95%CI（0.92，1.91），P=0.13］和围产儿死亡率［RR=0.31，95%CI（0.03，2.76），P=0.29］无影响。
结论　与两个胚胎移植相比，选择性单胚胎移植降低了每移植周期临床妊娠率、多胎妊娠率、早产儿发生率及低体重儿发生率，在其他指标方面两组无显著差异。

引用本文： 王致辉,腊晓琳,赵静,巩晓芸,胡泊,王鹏. 选择性单个卵裂期胚胎移植可行性的Meta分析. 中国循证医学杂志, 2013, 13(10): 1251-1257. doi: 10.7507/1672-2531.20130214 复制

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.

《中国循证医学杂志》

选择性单个卵裂期胚胎移植可行性的Meta分析

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《中国循证医学杂志》

选择性单个卵裂期胚胎移植可行性的Meta分析

摘要 全文 图表 视频 参考文献 施引文献 补充材料

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