Objective

To measure the consequences of nonadherence with the 2013 American Society for Reproductive Medicine elective single embryo transfer (eSET) guidelines for favorable-prognosis patients.

Design

Retrospective cohort.

Setting

In vitro fertilization clinics.

Patient(s)

A total of 28,311 fresh autologous, 2,500 frozen-thawed autologous, and 3,534 fresh oocyte-donor in vitro fertilization cycles in 2014–2016 at Society for Assisted Reproductive Technology-reporting centers.

Intervention(s)

Patients aged <35 years or using donors aged <35 years underwent first blastocyst transfer.

Main Outcome Measure(s)

Singleton birth rate, gestational age at delivery, and birth weight were compared between the eSET and non-eSET groups using the chi-square or Fisher's exact test or t-tests.

Result(s)

Among fresh transfers, 15,643 (55%) underwent eSET. Live births after non-eSETs were less likely singletons (38.0% vs. 96.5%; adjusted relative risk [aRR], 0.56) and more likely complicated by preterm delivery (55.0% vs. 20.1%; aRR, 2.39) and low birth weight (<2,500 g) (40.1% vs. 10.6%; aRR, 3.4) compared with those after eSET.

Among frozen-thawed transfers, 1,439 (58%) underwent eSET. Live births after non-eSETs were less likely singletons (41.9% vs. 95.2%; aRR, 0.69; 95% confidence interval, 0.66–0.73) and more likely complicated by preterm delivery (56.4% vs. 19.5%; aRR, 2.6; 95% confidence interval, 2.2–3.1) and low birth weight (38.0% vs. 8.9%; aRR, 3.9) compared with those after eSET.

Among fresh donor oocyte transfers, 1,946 (55%) underwent eSET. Live births after non-eSETs were less likely singletons (31.3% vs. 97.3%; aRR, 0.48) and more likely complicated by preterm delivery (61.1% vs. 25.7%; aRR, 2.09) and low birth weight (44.3% vs. 11.7%; aRR, 3.39) compared with those after eSET.

Conclusion(s)

Nonadherence with transfer guidelines was associated with dramatically increased multiple pregnancies, preterm births, and low birth weights.

中文翻译：

---

使用自体卵母细胞的 35 岁以下预后良好的患者和使用供体卵母细胞的受者遵守胚胎移植指南：辅助生殖技术协会临床结果报告系统研究

客观的

根据 2013 年美国生殖医学学会选择性单胚胎移植 (eSET) 指南对预后良好的患者进行评估，以衡量不依从性的后果。

设计

回顾性队列。

环境

体外受精诊所。

耐心）

2014-2016 年，辅助生殖技术协会报告中心共有 28,311 个新鲜自体、2,500 个冻融自体和 3,534 个新鲜卵母细胞供体体外受精周期。

干预措施

年龄<35 岁或使用年龄<35 岁的供体的患者接受了第一次囊胚移植。

主要观察指标）

使用卡方或费舍尔精确检验或 t 检验比较 eSET 组和非 eSET 组的单胎出生率、分娩胎龄和出生体重。

结果）

在新的转移中，15,643 (55%) 人接受了 eSET。非 eSET 后的活产不太可能是单胎（38.0% 对 96.5%；调整后的相对风险 [aRR]，0.56），更有可能并发早产（55.0% 对 20.1%；aRR，2.39）和低出生体重(<2,500 g) (40.1% vs. 10.6%; aRR, 3.4) 与 eSET 后的比较。

在冻融转移中，1,439 (5​​8%) 人接受了 eSET。非 eSET 后的活产不太可能是单胎（41.9% 对 95.2%；aRR，0.69；95% 置信区间，0.66-0.73）并且更可能因早产而复杂化（56.4% 对 19.5%；aRR，2.6；与 eSET 后相比，95% 置信区间，2.2-3.1）和低出生体重（38.0% 对 8.9%；aRR，3.9）。

在新鲜供体卵母细胞移植中，1,946 (55%) 人接受了 eSET。非 eSET 后的活产不太可能是单胎（31.3% 对 97.3%；aRR，0.48），更有可能并发早产（61.1% 对 25.7%；aRR，2.09）和低出生体重（44.3% 对11.7%；aRR，3.39）与 eSET 后的相比。

结论

不遵守转移指南与多胎妊娠、早产和低出生体重的显着增加有关。