1998-2007年上海市体外受精-胚胎移植子代出生缺陷情况分析

A lO-year survey on birth defects after in vitro fertilization-embryo transfer in Shanghai

目的对1998--2007年上海市体外受精-胚胎移植（IVF—ET）子代出生缺陷情况进行分析，了解影响出生缺陷发生的因素。方法回顾性分析1998--2007年于上海市7个生殖医学中心（包括上海集爱遗传与不育诊疗中心、上海交通大学医学院附属仁济医院生殖医学中心、上海交通大学医学院附属瑞金医院生殖医学中心、国际和平妇幼保健院生殖医学中心、上海第一妇婴保健院生殖医学中心、上海市第九人民医院及上海长海医院生殖医学中心）接受辅助生殖技术助孕并妊娠28周后分娩活产新生儿的产妇及其子代的随访资料。共收集产妇6551例及其子代8507例。了解子代的出生缺陷类型及发生率，并分析不同辅助生殖技术、子代性别、产妇年龄、妊娠胚胎数及精子获取方式对出生缺陷发生的影响。结果8507例子代中，出生缺陷发生率为1．08％（92／8507），其中循环系统畸形的发生率最高，占所有出生缺陷的34％（31／92）。IVF后移植新鲜胚胎、IVF后移植冻融胚胎、卵母细胞胞质内单精子注射（ICSI）后移植新鲜胚胎及ICSI后移植冻融胚胎者的出生缺陷率分别为1．21％（34／2799）、1．07％（20／1871）、1．04％（23／2212）和0．92％（15／1625），分别比较，差异均无统计学意义（P〉0．05）。男性和女性子代出生缺陷的发生率分别为1．12％（49／4371）和1．02％（42／4136），两者比较，差异无统计学意义（P〉0．05）；子代出生缺陷的发生率随母亲年龄的增加而增长，其中母亲年龄〈30岁者为0．84％（41／4884），与〉35岁者[1．77％（16／902）]比较，差异有统计学意义（P〈0．05）；单胎、双胎及三胎妊娠者的子代出生缺陷发生率分别为0．53％（25／4679）、1．59％（57／3576）和3．97％（10／252），分别比较，差异均有统计学意义（P〈0．05）；采用自然射精、附睾穿刺和他人供精方式出生的子代出生缺陷发生率分别为1．09％（81／7419）、1．21％（7／579）和0．79％（4／509），分别比较，差异均无统计学意义（P〉0．05）。结论IVF—ET未增加子代出生缺陷的发生率，不同授精方式、胚胎处理方式及精子获取方式也与子代出生缺陷发生率无关，而高龄产妇和多胎妊娠则明显增加子代出生缺陷的发生率。

Objective To survey birth defects of neonates conceived by using various types of in vitro fertilization and embryo transfer （IVF-ET） between 1998 and 2007 in Shanghai. Methods From 1998 to 2007, 8507 neonates from 6551 pregnancies conceived through assistant reproductive technology （ART） from 7 reproductive medicine center in Shanghai were enrolled in this retrospective study, including Shanghai Ji-Ai Genetics and IVF Institute, Shanghai Jiaotong University School of Medicine affiliated Renji Hospital, Ruijin Hospital, China Welfare Institute International Maternal and Infant Health Hospital, Shanghai First Maternity and Infant Health Hospital, Shanghai the Ninth People＇s Hospital and the Second Military Medical University affiliated Changhai Hospital. The clinical data about the type and incidence of birth defect were analyzed. Meanwhile, the factors associated with birth defect were investigated, such as various ART, gender, mother age, numbers of gestational sac, the source and quality of sperm. Results The birth defect rate was 1.08% （92/8507） and the most remarkable malformation occurred in circulation system [ 34% （31/92） ]. The rates of major congenital malformations were 1.21% （34/2799） in fresh conventional IVF-ET, 1.07% （20/1871） in IVF-frozen-thawed embryo transfer（IVF-FET）, 1.04% （23/2212） in fresh intracyto plasmic sperm injection （ ICSI）-ET and 0. 92% （ 15/1625 ） in ICSI-FET, which did not show statistical difference （ P 〉 0. 05 ） . There was also no significantly different incidence of malformations between 1.12% （49/4371） in male neonates and 1.02% （42/4136） in female neonates （ P 〉 0.05 ）. However, the occurrence of congenital malformation is positively related with maternal age, the rates were 0. 84% （41/4884） in mother＇s age less than 30 years and 1.77% （16/902） in mother＇ age more than 35 years, which reached statistical difference （P 〈 0.05 ）. It also showed remarkable different incidence among 0. 53% （25/4679） in singletons, 1.59% （57/3576） in twins and 3.97% （10/252） in triplets （P 〈 0.05）. No remarkable difference of malformation rate among sperm sources used in fertilization were observed, including 1.09% （81/7419） in ejaculated sperm, 1.21% （7/579） in percutaneous epididymal aspiration （PESA）and 0. 79% （4/509）in donor sperm （P 〉0.05）. Conclusions The overall incidence of birth defect in neonates from ART is similar to those conceived naturally and is not associated with different types of IVF-ET, embryo cryopreservation, sperm sources. However, maternal age and multiple pregnancies confer the higher possibility of birth defect.