背景:妊娠携带者的使用增加了无法自行怀孕的人和夫妇的家庭建设机会。随着时间的推移,美国国家生殖医学协会针对妊娠携带者的指南已经改变,以反映生殖技术的进步和越来越多的证据支持与单胎妊娠相关的医疗益处。
目的:评估美国妊娠携带者周期实践模式的变化以及与不断变化的美国生殖医学学会指南相关的妊娠结局,这在2013年和2017年发生了变化。
方法:这项回顾性研究使用了辅助生殖技术临床结果报告系统的数据,包括2014-2020年报告的所有周期,涉及胚胎移植到妊娠携带者。二项回归模型评估了非整倍性植入前遗传测试的趋势,美国生殖医学学会指南坚持,移植的胚胎数量,和妊娠结局随着时间的推移。
结果:在2014-2020年的40,177个妊娠载体转移周期中,冻融周期显着增加(增加41.3%),使用辅助孵化(增加53.4%),卵胞浆内单精子注射(增加50.0%),和非整倍性植入前基因检测(增加155.7%)。对于自体卵母细胞移植到妊娠携带者,非整倍体的植入前基因检测在2020年的可能性高于2014年。两者都适用于年龄≥38岁的人群(调整后相对风险,2.38[95%置信区间,2.11-2.70])和年龄<38岁的人(调整后相对风险,2.85[95%置信区间,2.58-3.15]).随着非整倍体使用的植入前基因检测的增加,自体单胚胎移植均上升(调整后相对风险,2.22[95%置信区间,1.94-2.50])和供体周期(相对风险,1.91[95%置信区间,1.81-2.02]).从2014-2020年,这种向单胚胎移植的转变对应于多胚胎移植减少了79.2%,随后在供体中多胎妊娠减少了68.8%,在自体卵母细胞周期中减少了73.6%。在整个研究期间,妊娠载体周期仍然高度遵守不断变化的美国生殖医学学会指南。在活产中,供体和自体卵母细胞周期中的足月分娩增加了19.4%和7.9%,分别,从2014年到2020年。
结论:在整个研究期间,实践模式发生了巨大变化,随着非整倍体植入前遗传学检测的使用大幅增加,卵胞浆内单精子注射,辅助孵化,冻结转移。为了应对不断变化的美国生殖医学协会指南,在妊娠周期中,多次胚胎移植的使用减少,随后多次妊娠和流产减少,活产率略有增加.
BACKGROUND: The increased use of gestational carriers has expanded family-building opportunities for people and couples unable to carry pregnancies on their own. National American Society of Reproductive Medicine
guidelines for gestational carriers have changed over time to reflect advances in reproductive technology and mounting evidence supporting the medical benefits associated with singleton gestations.
OBJECTIVE: Assess changes in gestational carrier cycle practice patterns and resultant pregnancy outcomes in the United States in relation to changing national American Society of Reproductive Medicine
guidelines, which changed in 2013 and 2017.
METHODS: This retrospective study used data from the Society for Assisted Reproductive Technology Clinic Outcomes Reporting System and included all cycles that were reported from 2014-2020 involving an embryo transfer to a gestational carrier. Binomial regression models evaluated trends in preimplantation genetic testing for aneuploidy, American Society of Reproductive Medicine
guideline adherence, number of embryos transferred, and pregnancy outcomes over time.
RESULTS: Of the 40,177 gestational carrier transfer cycles from 2014-2020, there was a significant increase in frozen-thawed cycles (41.3% increase), use of assisted hatching (53.4% increase), intracytoplasmic sperm injection (50.0% increase), and preimplantation genetic testing for aneuploidy (155.7% increase). The likelihood of preimplantation genetic testing for aneuploidy was higher in 2020 than in 2014 for autologous oocyte transfers to gestational carriers, both for those aged ≥38 years (adjusted relative risk, 2.38 [95% confidence interval, 2.11-2.70]) and than those aged <38 years (adjusted relative risk, 2.85 [95% confidence interval, 2.58-3.15]). As preimplantation genetic testing for aneuploidy usage increased, single embryo transfer rose for both autologous (adjusted relative risk, 2.22 [95% confidence interval, 1.94-2.50]) and donor cycles (relative risk, 1.91 [95% confidence interval, 1.81-2.02]). This shift toward single embryo transfer corresponded with a decrease in multiple embryo transfer by 79.2% and subsequent decreases in multiple gestations by 68.8% in donor and 73.6% in autologous oocyte cycles from 2014-2020. Gestational carrier cycles remained highly adherent to changing American Society of Reproductive Medicine
guidelines throughout the study period. Among live births, there was a 19.4% and 7.9% increase in term deliveries among donor and autologous oocyte cycles, respectively, from 2014 to 2020.
CONCLUSIONS: Practice patterns have drastically changed throughout the study period, with major increases in the use of preimplantation genetic testing for aneuploidy, intracytoplasmic sperm injection, assisted hatching, and frozen transfers. In response to changing American Society of Reproductive Medicine
guidelines, the use of multiple embryo transfers has decreased for gestational carrier cycles with subsequent decreases in multiple gestations and miscarriages and slight increases in live birth rates.