目的:探讨新鲜胚胎移植(fresh-ETs)和冷冻胚胎移植(croved-ETs)后死产和新生儿死亡的风险是否与没有医疗帮助的单胎相比不同。
方法:基于人群的队列研究。
方法:不适用。
方法:丹麦全国医学出生登记处之间的数据联系(1994-2014年),挪威和瑞典(1988-2015)国家质量登记处和辅助生殖技术数据库共确定了4590853例单胎,包括新鲜ET构思的78,642和冷冻ET构思的18,084。
方法:无主要结局指标(S):死产(分娩前和分娩中的胎儿死亡)和新生儿死亡(产后0-27天死亡的活产)。
结果:总体而言,17,123例(0.37%)单胎死胎,7,685例(0.17%)新生儿死亡。与没有医疗援助的单身人士相比,新鲜ET和冷冻ET后死产的几率相似,而新鲜ET后新生儿死亡的几率很高(比值比[OR],1.69;95%置信区间[CI],1.46-1.95)和冷冻ET(或,1.51;95%CI,1.08-2.10)。新鲜ET(8.0%)和冷冻ET(6.6%)后早产(<37孕周)比没有医疗帮助的单胎(5.0%)更常见,并且与所有受孕方法的新生儿死亡率密切相关。在胎龄类别中,所有受孕方法的死产和新生儿死亡风险相似,除了来自新鲜ET的单身人士在妊娠22-27周有更高的死产风险(OR,1.85;95%CI,1.51-2.26)。
结论:总体而言,新鲜ET和冷冻ET后死产的风险与没有医疗帮助的单胎相比相似,而新生儿死亡率很高,与没有医疗帮助的单胎相比,可能是由早产的高风险介导的。我们的结果没有明确支持选择一种治疗方法。
To investigate whether risks of stillbirth and neonatal death differ after fresh embryo transfers (fresh-ETs) and frozen embryo transfers (frozen-ETs) compared with singletons conceived without medical assistance.
A population-based cohort study.
Not applicable.
Data linkage between the nationwide Medical Birth Registries in Denmark (1994-2014), Norway and Sweden (1988-2015), and national quality registries and databases on assisted reproductive technology identified a total of 4,590,853 singletons, including 78,642 conceived by fresh-ET and 18,084 by frozen-ET.
None MAIN OUTCOME MEASURE(S): Stillbirth (fetal death before and during delivery) and neonatal death (live born with death 0-27 days postpartum).
Overall, 17,123 (0.37%) singletons were stillborn and 7,685 (0.17%) died neonatally. Compared with singletons conceived without medical assistance, the odds of stillbirth were similar after fresh-ET and frozen-ET, whereas the odds of neonatal death were high after fresh-ET (odds ratio [OR], 1.69; 95% confidence interval [CI], 1.46-1.95) and frozen-ET (OR, 1.51; 95% CI, 1.08-2.10). Preterm birth (<37 gestational weeks) was more common after fresh-ET (8.0%) and frozen-ET (6.6%) compared with singletons conceived without medical assistance (5.0%), and strongly associated with neonatal mortality across all conception methods. Within gestational age categories, risk of stillbirth and neonatal death was similar for all conception methods, except that singletons from fresh-ET had a higher risk of stillbirth during gestational week 22-27 (OR, 1.85; 95% CI, 1.51-2.26).
Overall, the risk of stillbirth was similar after fresh-ET and frozen-ET compared with singletons conceived without medical assistance, whereas neonatal mortality was high, possibly mediated by the high risk of preterm birth when compared with singletons conceived without medical assistance. Our results gave no clear support for choosing one treatment over the other.