摘要
目的 分析2017-2021年中国辅助生殖技术(ART)的使用情况及其安全性,以评估其临床应用效果,为未来的研究方向和政策制定提供科学依据.方法 本研究的数据来源于"中华医学会生殖医学分会(CSRM)数据上报系统",涵盖了ART的关键结局指标.结果 截至2023年9月25日,2017-2021年CSRM数据上报系统分别报告了 257家、293家、262家、230家、194家生殖中心数据.常规IVF/ICSI周期主要集中在35岁以下人群,2017-2021年分别占比为65.53％、64.21％、67.86％、69.30％、67.10％.控制性卵巢刺激(COS)周期单胚胎移植率呈现逐年上升趋势,分别为18.64％、25.73％、32.90％、36.09％、39.61％,新鲜移植周期中35岁以下人群多胎妊娠率逐年下降,然而35岁以下人群的多胎妊娠率明显高于35岁及以上人群.2017-2021年常规IVF周期:35岁以下人群临床妊娠率无显著变化(P＞0.05),范围为58.23％～59.06％;活产率2017年、2020年和2021年持平,均显著高于2018年和2019年(P＜0.05),范围为48.26％～50.16％;35岁及以上人群临床妊娠率和活产率2018年和2021年均显著高于2017年、2019年和2020年(P＜0.05),范围分别为39.65％～42.53％和28.69％～31.45％.2017-2021年ICSI周期:35岁以下人群临床妊娠率和活产率范围分别为53.67％～56.08％和45.84％～47.90％;35岁及以上人群临床妊娠率范围为35.87％～37.62％,活产率范围25.98％～27.11％.2017-2021年冻融胚胎移植(FET)周期:临床妊娠率和活产率呈上升趋势,范围分别为48.98％～53.95％和37.98％～43.05％;多胎妊娠率逐年下降,范围为19.26％～27.85％.2017-2021年辅助生殖助孕后子代出生缺陷发生率均控制在1％以内,中重度卵巢过度刺激综合征(OHSS)发生率范围为1.06％～1.58％,术后出血(＞300 ml)发生率、术后盆腔感染率及其他并发症发生率控制在0.01％～0.20％.结论 2017-2021年ART临床妊娠率和活产率略有提高;多胎妊娠率和子代出生缺陷发生率有所降低,并发症得到了有效控制.然而,多胎妊娠率仍处于较高水平,尤其是35岁以下人群中,未来仍需持续努力降低多胎妊娠率.
Abstract
Objective:The report concerning the application and safety of assisted reproductive technology(ART)in China from 2017 to 2021 were summarized,in order to assess its clinical outcomes and to provide a scientific basis for future research and policy-making.Methods:The data for this study were obtained from the Chinese Society of Reproductive Medicine(CSRM)Data Reporting System that covered the key outcomes of ART.Results:Up to September 25,2023,the CSRM Data Reporting System had received the ART data from 257,293,262,230 and 194 reproductive medicine centers in 2017,2018,2019,2020 and 2021,respectively.The conventional IVF/ICSI cycles were mainly applied in women under 35 years old,accounting for 65.53％,64.21％,67.86％,69.30％and 67.10％between 2017 and 2021,respectively.The rate of single embryo transfer in controlled ovarian stimulation(COS)cycles had increased year by year,accounting for 18.64％,25.73％,32.90％,36.09％and 39.61％between 2017 and 2021,respectively.The rate of multiple pregnancies in fresh embryo transfer cycles among individuals under the age of 35 had been declining year by year.However,the rate of multiple pregnancies among individuals under the age of 35 remained obviously higher than that of women aged 35 years and above.There was no significant change concerning the clinical pregnancy rates of conventional IVF cycles from 2017 to 2021 for people under 35 years old(58.23％to 59.06％,P＞0.05),while the live birth rates remained the same in 2017,2020 and 2021,which were significantly higher than those in 2018 and 2019(48.26％to 50.16％,P＜0.05).The clinical pregnancy rates and live birth rates for people aged 35 years and above were significantly higher in 2018 and 2021 than those in 2017,2019 and 2020,ranging from 39.65％to 42.53％and 28.69％to 31.45％,respectively(P＜0.05).The clinical pregnancy rate and live birth rate in ICSI cycles for people under 35 years old ranged from 53.67％to 56.08％and from 45.84％to 47.90％,respectively.The clinical pregnancy rate for women aged 35 years and above ranged from 35.87％to 37.62％,and the live birth rate ranged from 25.98％to 27.11％.The clinical pregnancy rate and live birth rate in FET cycles showed an upward trend,ranging from 48.98％to 53.95％and from 37.98％to 43.05％,respectively.The multiple pregnancy rate was declining year by year,from 19.26％to 27.85％.From 2017 to 2021,the incidence of birth defects after undergoing assisted reproduction was controlled under 1％.While the incidence of moderate to severe OHSS was controlled,ranging from 1.06％to 1.58％,and the incidence of postoperative bleeding(＞300 ml),postoperative pelvic infection and other complications all ranged from 0.01％to 0.20％.Conclusions:The ART clinical pregnancy rate and live birth rate increased slightly from 2017 to 2021.The multiple pregnancies rate and the incidence of birth defects decreased,and the complications were effectively controlled.However,the multiple pregnancies rate was still at a high level,especially among people under 35 years old.A sustained efforts are needed to reduce the multiple pregnancies rate in the future.
NETL
NSTL
万方数据