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首页> 外文学位 >The push for a singleton gestation following in vitro fertilization: Balancing the risk of multiples with risk of cycle failure.
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The push for a singleton gestation following in vitro fertilization: Balancing the risk of multiples with risk of cycle failure.

机译：体外受精后推动单胎妊娠的方法：在发生多胎风险与循环衰竭风险之间取得平衡。

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摘要

Background: In order to decrease the high rate of multiple gestation pregnancies following in vitro fertilization (IVF), elective transfer of a single embryo (eSET) in good prognosis patients has been proposed. The purpose of this dissertation is to evaluate the present efficacy of eSET policies and to investigate whether modifications to patient guidelines could better identify patients who should be targeted for eSET.;Methods: De-identified patient records from a private fertility center were reviewed to identify patients who had undergone IVF from 2006 through 2012. Three analyses were undertaken: (1) Comparing the equivalency of pregnancy and live-birth rates between patients opting for single blastocyst transfer (eSBT) and double blastocyst transfer (eDBT), (2) Assessment of whether clinical factors associated with multiple gestation pregnancies could be identified by comparing multiple and singleton gestation cycles, and (3) Development of a predictive model for the probability of cycle failure among young patients, by examining patients younger than 35 who failed to achieve a live-birth and those who attained a live-birth.;Results: No significant differences in pregnancy and live-birth rates were observed between the eSBT and eDBT groups, however, clinical equivalence was only demonstrated for pregnancy rates. Odds of multiple birth decreased as maternal age increased, whereas risk increased in cycles with a fertilization rate >80%, when embryos were transferred at the blastocyst stage, and when the second best embryo transferred was graded as "good". The most relevant early predictors of cycle failure among young patients were a history of previous preterm or full-term live-birth, biochemical pregnancies and spontaneous abortions, day 3 follicle stimulating hormone level, antral follicle count, and number of follicles larger than 14mm on the day of human chorionic gonadotropin administration.;Conclusions: While we are moving in the right direction towards clinical efficacy in eSET, addressing potential gaps in clinical guidelines could further increase acceptability of the procedure. In considering both clinical patient factors and embryo cohort characteristics, a more comprehensive profile of patients best suited for eSET could be developed that would increase the successfulness of the procedure, while simultaneously decreasing the high rate of multiple gestation pregnancies seen in IVF.
机译：背景：为了降低体外受精（IVF）后多胎妊娠的高发生率，已经提出了在预后良好的患者中选择性移植单个胚胎（eSET）的方法。本文的目的是评估当前eSET政策的有效性，并研究对患者指南的修改是否可以更好地确定应针对eSET的患者。方法：审查来自私人生育中心的身份不明的患者记录，以识别2006年至2012年接受IVF的患者。进行了三项分析：（1）比较选择单囊胚移植（eSBT）和双囊胚移植（eDBT）的患者的妊娠率和活产率，（2）评估通过比较多胎妊娠和单胎妊娠周期是否可以鉴定出与多胎妊娠相关的临床因素，以及（3）通过检查35岁以下未达到预期胎龄的患者，开发了年轻患者周期失败可能性的预测模型活产和获得活产的人；结果：怀孕和活产没有显着差异在eSBT和eDBT组之间观察到三分之二的发生率，但是，仅在妊娠率方面证明了临床等效性。多胎出生的几率随着产妇年龄的增加而降低，而受精率大于80％的周期在胚泡期转移胚胎时，次生的第二次最好的胚胎被评为“好”时，生育风险增加。在年轻患者中，周期衰竭的最相关的早期预测因素是既往有早产或足月活产，生化妊娠和自然流产，第3天卵泡刺激激素水平，肛门卵泡计数和大于14mm的卵泡数目的历史。结论：当我们朝着正确的方向迈向eSET临床疗效时，解决临床指南中的潜在空白可能会进一步提高该程序的可接受性。在考虑临床患者因素和胚胎队列特征的同时，可以开发出最适合eSET的患者更全面的资料，这将增加手术的成功率，同时降低IVF中出现的多胎妊娠的高比率。

著录项

  • 作者

    Jacobs, Marni Beth.;

  • 作者单位

    University of California, San Diego.;

  • 授予单位 University of California, San Diego.;
  • 学科 Health Sciences Public Health.;Health Sciences Epidemiology.
  • 学位 Ph.D.
  • 年度 2013
  • 页码 105 p.
  • 总页数 105
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类
  • 关键词

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