| Objective To explore the safety of offspring and infertile women after in vitro fertilization and embryo transfer(IVF-ET),to understand the birth defects of offspring in perinatal stage after IVF-ET,the incidence and risk factors of long-term malignancies in infertile women.Methods In the period from 1999 to 2015,infertile women who were treated at the Reproductive Center of Tianjin Medical University General Hospital were treated with 1 to multiple IVF / ICSI cycles and patients undergoing artificial insemination(IUI).Elimination of infertility due to ovarian or other tumor disease,including pre-pregnancy borderline or malignant tumor patients.The IVF / ICSI treatment group was set up as observation group and IUI treatment group was set as control group.The first part: 3236 cases of follow-up infertility,2686 cases of IVF / ICSI group,550 cases of IUI group,follow-up of pregnant women after weekly pregnancy,asked the birth defects of the offspring;the second part: to meet the inclusion criteria of 2829 Patients were followed up for infertility,1796 in the IVF / ICSI group and371 in the IUI group.Follow-up to January 31,2017,asked the patient’s systemic systemic malignancy.Explore the experience of IVF / ICSI progeny after birth defects and the incidence of malignant tumors in pregnant women is elevated.Results1、IVF-ET and offspring birth defects(1)The study included 4593 IVF-ET cycles,rate of pregnancy is 43.07%,rate of labor induction is 17.11%,live birth 78.63%,1986 born births,64 birth defects(including: cardiovascular malformations,urinary system malformations,neurological malformations,etc.),birth defects rate of 2.71%,IUI cycle 1090,born infants 189,birth defects in 2 cases(all atrioventricular septal defect),birth defects rate of 1.06%.There was no statistically significant difference between the two groups(p = 0.105).(2)In the IVF / ICSI group,there were 866 infants with births,31 birth defects,3.6% birth defects,1123 single birth cycles,23 birth defects,and 2.0% birth defects.There were significant differences in the rate of birth defects between the two groups(P = 0.037).The mean birth weight was 36.58 weeks and the birth weight was2830.14 g.The birth weight was 37.65 weeks and the birth weight was 3046.30 g,the difference was statistically significant(p=0.000)(p=0.006).It was significantly higher than that in OHSS group(6.3%/2.5%),and the difference was statistically significant(p = 0.027)(3)There were 1207 fresh birth cycles newborn,32 birth defects(2.7%),782 refrigeration cycles newborn and 22 birth defects(2.8%)in IVF / ICSI group.There was no significant difference in birth defects between the two groups(P = 0.828).ICSI-ET in fresh cycle There were 449 newborn defects,23 birth defects,748IVF-ET birth cycle newborn,21 birth defects(2.8%),and no significant difference in the rate of birth defects(P = 0.378);in vitro fertilization-embryo transfer Type of pregnancy,menstruation is the law,both chromosomal abnormalities did not affect the incidence of offspring birth defects(P> 0.05).(4)The rate of birth defects in the center IVF / ICSI was 2.71% higher than that in Tianjin from 2008 to 2010,and the difference was statistically significant(P = 0.000).The average birth defect rate in the IVF/ICSI group is 1.93%,It is higher when compared with 2012 China birth defects prevention and treatment report of the national perinatal birth defects rate(1.53%)of 2011,and average annual birth defect(1.56%)of 2008-2010 in Tianjin.2、IVF-ET and female tumors(1)This article were included in 2167 cases of infertility patients,IVF / ICSI group of 2279 people,followed up 1796 people,follow-up response rate,78.8%,10 cases of malignant tumors,the prevalence rate of 0.557%;IUI group of 550 patients,follow-up 371,follow-up(0.331%)of breast cancer,4 cases(0.111%)of thyroid carcinoma,and 6 cases(0.111%)of thyroid carcinoma,and 6 cases(0.111%)of thyroid carcinoma.The incidence of all kinds of tumors in the IVF / ICSI group was 0.651%,Endometrial cancer in 1 case(50%,simultaneous follow-up of a total of 2patients,one of them suffering from endometrial cancer,the incidence of non-reference),1 case of malignant lymphoma(0.694%).1 case(2.857%)of breast cancer,1 case of thyroid carcinoma(1.667%)and 1 case of endometrial carcinoma(2.174%).Compared with the data of China’s cancer registration in 2013 and 2009(0.042% of breast cancer,0.016% of thyroid cancer,0.007% of endometrial carcinoma and 0.004% of malignant lymphoma),the incidence of each tumor was increased(2)Compared with IUI patients,IVF / ICSI had significant difference(P <0.05),but there was significant difference between the two groups(P <0.05).The dosage of hormone in the process of booster pregnancy,including GN dose(53.90/2.31),the amount of progesterone in the corpus luteum(estrogen 106.26/19.33 mg,progesterone3843.12/577.00 mg)was statistically significant(p> 0.05).However,there was no significant difference in the incidence of tumor events between the two groups(0.557% / 0.809%,P = 0.746).(3)IVF / ICSI group of women with tumors than non-tumor women,the average age(40.69 /37.01 years old)is higher,and the difference was statistically significant(P= 0.005);Infertility age is longer(5.44/3.62 years),the difference was statistically significant(P = 0.011);The proportion of primary infertility increased(62.5% / 60%),the difference was statistically significant(P = 0.046);There was no significant difference between the amount of gonadotropin(GN),the amount of progestin in the corpus luteum,the occurrence of OHSS and the outcome of pregnancy supplementation(pregnancy rate12.5%/23.1%,abortion rate13.1%/7.7% and live birth rate74.4%/69.2%).Conclusion1、The birth defects rate of ART assisted population in this center was higher than that of Tianjin Maternal and Child Health Hospital.2、OHSS occurs,multiple pregnancy is a risk factor for offspring birth defects;Birth defects fetal birth have lighter weight and smaller gestational age;Fresh cycle and freezing cycle,ICSI and IVF,the mother’s infertility type,infertility, menstruation is the law,the number of egg cycle,both chromosomes abnormalities did not affect the incidence of offspring birth defects.3、The average incidence of breast cancer,thyroid cancer,endometrial cancer and malignant lymphoma in infertile women who were pregnant in the center was higher than the national level.Compared with IUI,IVF / ICSI did not increase the incidence of cancer.4、The age of the patients,infertility long is a risk factor for malignant tumors.IVF / ICSI during the use of GN in the amount of pregnancy,corpus luteum to support the amount of estrogen and progesterone,assisted and occurred in the occurrence of OHSS and contribute to the outcome does not affect the occurrence of malignant tumors.5、The infertility-ralated tumors have low degree of malignancy,and sensitive to treatment and the prognosis is better. |
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