臺灣地區經人工協助生殖產下單胞胎新生兒健康結果

Health Outcome of the Singleton Newborns Conceived by Assisted Reproductive Technology in Taiwan

林合晴(Her-Chyng Lin) ； 湯澡薰(Chao-Hsiun Tang)

《台灣醫學》 10卷3期 (2006/05) Pp. 277-291

https://doi.org/10.6320/FJM.2006.10(3).01

摘要

本研究主要在探討臺灣地區施行體外受精胚胎植入術(in vitro fertilization & embryo transfer，IVF-ET)之不孕夫妻的年齡、不孕歷史、治療方法，對懷孕及單胞胎新生兒健康結果的影響。本研究的資料來源為行政院衛生署國民健康局所提供之「台灣地區施行人工協助生殖技術個案」資料庫。選取其中施行IVF-ET之33554個治療週期個案做為研究對象以進行本研究分析，其中再選取單胞胎新生兒5119個治療週期個案進行新生兒健康結果分析。分析的方法是以Windows SPSS10.0 版進行描述性、卡方檢定及羅吉斯迴歸分析。研究結果顯示，夫的年齡≥40歲、妻的年齡≥35歲、不孕期間4年以上顯著地降低懷孕率，而且也顯著地較可能生出低週數、低體重的新生兒。多種因素引起的不孕問題較不易懷孕、男性因素引起的不孕問題較可能生出極低週數的新生兒、不明原因引起的不孕問題較可能生出低體重及呼吸窘迫的新生兒。妻的年齡≥35歲較可能生出心臟血管異常的新生兒；呈現中度、嚴重度的卵巢過度刺激反應較不易懷孕，也較可能生出低體重、心臟血管、消化器官異常之新生兒；嚴重度卵巢過度刺激還顯著地容易造成新生兒死亡。使用顯微操作技術中的協助孵化、顯微精蟲注射與協助孵化合併使用雖可增加懷孕率，然而也較易生出需要黃疸治療之新生兒。捐精、捐卵、使用冷凍胚胎雖可增加懷孕的機率，但使用冷凍胚胎受孕之新生兒較易產生胎兒窘迫現象，捐卵則可能增加新生兒身體其他方面異常的可能性。結論：施行體外受精胚胎植入術(IVF-ET)其懷孕率及產下單胞胎新生兒健康結果可能受到夫與妻的年齡、不孕原因、不孕期間的長短、卵巢過度刺激、顯微操作、精卵來源、冷凍胚胎卵的影響。故建議不孕夫妻把握適當生育年齡生育，若有不孕原因的危險因子存在時，宜儘早治療，以提高懷孕率、降低生低週數、低體重、身體異常新生兒。此外，建議對於施行人工協助治療的不孕症夫妻懷孕後之狀況建立完整之通報資料，並定期分析追蹤人工協助生殖技術之結果，據以做為臨床決策之參考，以提高人工生殖技術生產結果之品質。

關鍵字

人工生殖技術 ； 體外受精胚胎植入術 ； 不孕症 ； 顯微精蟲注射 ； 卵巢藥物刺激 ； 低體重新生兒 ； 早產 ； 新生兒結果 ； 新生兒身體異常

並列摘要

This study set out to determine whether parental age, causes and history of infertility and infertility treatment methods affect the likelihood of pregnancy and the risk of adverse neonatal outcome. Logistic regression and multinomial logistic regression were used to analyze the likelihood of pregnancy among 33554 women who received in vitro fertilization & embryo transfer (IVF-ET), as well as the risk of low birthweight, preterm and congenital anomalies or other birth defects among 5119 singleton newborns. Data were retrieved from national registries of the assisted reproductive technology cycles between January 1998 and December 2004, provided by the Bureau of Health Promotion, Department of Health, Taiwan. The results indicated that paternal age ≧40, maternal age ≧35 or years of infertility ≧4 significantly decreased the likelihood of pregnancy. Women with moderate and severe degree of ovarian hyper stimulation syndrome (OHSS), who received oocyte or sperm donation and who used cryoembryo, micromanipulation or ovarian stimulation were more likely to be pregnant. However, paternal age ≧40, maternal age ≧35 or women with moderate or severe degree of OHSS increased the risk of having low birthweight or preterm babies. In addition, women with moderate and severe degree of ovarian hyper stimulation syndrome (OHSS) were more likely to have babies with cardiovascular and gastroenteric defects. Severe OHSS significantly increased the risk of neonatal death. Moreover, intra cytoplasmic sperm injection (ICSI) or ICSI combined with assisted hatching increased the risk of having babies with jaundice. Cryoembryo increased the risk of having babies with fetal distress and oocyte donation increased the risk of other type of congenital defects. This study concludes that careful follow-up of the pregnancy and further studies to analyze the neonatal outcome after the assisted reproductive therapy is desirable to facilitate evidence-based clinical decisions.

並列關鍵字

assisted productive technology ； IVF-ET ； infertility ； micromanipulation ； ovarian stimulation ； low birth weight ； preterm ； neonatal outcome ； congenital anomalies