应用供精冷冻精液出生子代的安全性分析

Safety of the offspring conceived by assisted reproductive technology with cryopreserved donor sperm

目的:调查使用供精者精液行辅助生殖技术(ART)后的妊娠结局,探讨应用供精冷冻精液出生子代的安全性。方法:2006年1月至2012年12月我院人类精子库向全国31家生殖中心提供冷冻精液,共治疗50 247个周期。统计使用供精精液行宫颈内人工授精(ICI)、宫腔内人工授精(IUI)、体外受精(IVF)及卵细胞胞质内单精子注射(ICSI)的子代出生缺陷发生率及自然流产率,对比不同授精方式的出生缺陷率与自然流产率的差异。结果:使用供精者冷冻精液行人工授精39 047个周期,其中ICI周期数36 674个,临床妊娠8 612例,自然流产917例,自然流产率(<28孕周)10.6%(917/8 612);活胎数6 133例,发生出生缺陷者43例,出生缺陷发生率0.70%(43/6 133)。IUI周期数2 373个,共获得临床妊娠547例,自然流产41例,自然流产率为7.5%(41/547);活胎数426例,发生出生缺陷2例,出生缺陷率0.47%(2/426)。使用供精者冷冻精液行IVF、ICSI治疗共计11 200个周期,其中IVF临床妊娠5 860例,自然流产456例,自然流产率7.8%(456/5 860),活胎数5 089例,出生缺陷发生率1.08%(55/5 089);ICSI临床妊娠350例,自然流产30例,自然流产率8.6%(30/350),活胎数229例,出生缺陷发生率1.31%(3/229)。使用供精冷冻精液出生的后代缺陷发生率显著低于我国卫生部发布的监测数据(0.86%vs 1.53%,P<0.01)。结论:供精冷冻精液出生子代的安全性仍在可控的范围。

Objective： To investigate the pregnancy outcomes of assisted reproductive technology（ART） with cryopreserved donor sperm and the safety of the offspring thus conceived. Methods： The Human Sperm Bank of CITIC Xiangya Hospital provided cryopreserved donor semen to 31 reproductive centers in China between January 2006 and December 2012,with which 50 247 ART cycles were accomplished. We compared the rates of birth defects and spontaneous abortion of intracervical insemination（ ICI）,intrauterine insemination（ IUI）,in vitro fertilization（ IVF）,and intracytoplasmic sperm injection（ ICSI）. Results： A total of 39 047 ART cycles were performed by artificial insemination with cryopreserved donor sperm,including 36 674 cycles of ICI and 2 372 cycles of IUI. Among the 8 612 clinical pregnancies achieved by ICI,there were 917 cases of spontaneous abortion（ at 〈28 gestational wk）（10. 6%） and 6 133 live births,with 43 cases of birth defect（0. 70%）. Of the 547 clinical pregnancies achieved by IUI,there were41 cases of spontaneous abortion（7. 5%） and 426 live births,with 2 cases of birth defect（0. 47%）. Totally,11 200 cycles of IVF and ICSI were accomplished with cryopreserved donor sperm. Of the 5 860 clinical pregnancies achieved by IVF,there were 456 cases of spontaneous abortion（7. 8%） and 5 089 live births,with 55 cases of birth defect（1. 08%）. Among the 350 clinical pregnancies achieved by ICSI,there were 30 cases of spontaneous abortion（8. 6%） and 229 live births,with 3 cases of birth defect（1. 31%）.The birth defect rate of ART with cryopreserved donor sperm was significantly lower than that published by the Chinese Ministry of Health（0. 86% vs 1. 53%,P〈0. 01）. Conclusion： The safety of the offspring conceived by ART with cryopreserved donor sperm is controllable.