! u1 y, [4 s. z7 D Y# h8 t 智力低下率有增长但是其绝对差异很小,每年10万人中不到7例。此外,由男性不育引起做第二代试管婴儿ICSI比一般IVF伴有智力迟钝和自闭症的风险有增加,伦敦大学国王学院精神病学斯文桑丁博士说,由于ICSI可能允许受精精子不理想,因为它绕过精子的自然选择,人工地使精子直接注入卵子时可能使得卵子受到物理损坏,同时可能污染培养基中卵细胞的细胞质。试管婴儿治疗仍是为数众多的不孕不育夫妇的生育福音。“我们可以依据现代技术尽早识别潜在危险并进行发育监测以排除障碍,确保他们得到诊断和适时关怀。” / k$ V9 o2 J" p - R$ q+ k2 ^4 E+ `2 y6 P 值得注意的第二代试管婴儿体外受精技术名为卵胞浆内单精子注射(ICSI),这种针对男性不育的技术是将一个精子植入一颗卵子。通过这种技术出生的儿童(无论使用新鲜胚胎还是冷冻胚胎)比采用其他几种体外受精技术的儿童患智障的风险高出很多,因为男性不育大多由于精子问题,仅凭一枚精子受精,由于没受过自然优胜劣汰,风险理所当然风险高出一些。因为如何获取更多优良精子及选择好精子显得非常重要,相对欧洲波兰的ICSI及取精技术走在前列。 2 f/ ]- G3 @' ^+ G b' J
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研究报告作者之一、伦敦大学国王学院精神病学研究所研究员斯文桑丁说:“我们分析了不同的体外受精治疗后发现,‘传统的’体外受精是安全的,但ICSI与智障和孤独症风险增加有关。”研究报告称:“这些障碍症的患病率不高,与体外受精有关的绝对风险也不大。作者: 小丫 时间: 2013-7-11 06:24
据7月3日发表在《美国医学会杂志》上的一则研究披露,一项包括了超过250万名在瑞典出生的孩子的研究显示,与自然受孕相比,任何的体外受精(IVF)治疗都与自闭症的发生没有关系,但与一个小幅却具有统计学意义的智力迟钝风险的增加有关。文章的作者指出,这些疾病的发生率不高,而且与体外受精(IVF)相关的绝对风险的增加幅度不大。6 s2 R* ^- r+ ]( b: Q& E, S
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根据文章的背景资料:“在1978至2012年间,全世界大约有5百万婴儿是通过体外受精出生的。还没有研究对不同的体外受精(IVF)治疗与神经发育之间的关系进行调查,且很少有研究对体外受精(IVF)治疗是否与孩子一年后的神经发育状态有关进行调查。很少有研究对自闭症和智力迟钝——它们是最严重的慢性发育性疾病中的2种——进行过观察;这2种疾病会影响发达国家所有儿童人数的1-3%。”: V& P. Q' x5 z" |$ l! B
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伦敦大学国王学院的Sven Sandin, M.Sc.及其同事对任何体外受精(IVF)的使用及不同的体外受精(IVF)治疗与后代中的自闭症及智力迟钝之间的关系进行了检查。应用瑞典全国卫生登记档案,研究人员对1982年至2007年间出生的且出生后被临床诊断患有自闭症或智力迟钝的患者进行了追踪,直至2009年12月。研究所关心的接触因子是体外受精(IVF),其分类是依据是否使用了针对男性不育所做的卵子胞浆内单精子注射(ICSI),以及胚胎是新鲜的还是冷冻的。; z$ R i# D) K# D% i- z0 G
/ g4 l5 @+ V6 L: A% T' M0 X4 F 总共有2541125个孩子在1岁半时是活着的并具有所有协变量的完整数据;有30959人(1.2%)是在体外受精(IVF)治疗后出生的。在6959个孩子中有103人(1.5%)被诊断患有自闭症,在那些体外受精(IVF)治疗后出生的孩子中,15830个孩子中有180人(1.1%)被诊断患有智力迟钝。这些病例的平均追踪时间为10年,中位数(中点)为14年。 [; z: x- Y: D
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数据分析表明,与自然受孕相比,任何体外受精(IVF)治疗都与自闭症没有关系,但与智力迟钝风险的小幅但具有统计意义的增加有关,然而当数据分析仅限于单胎儿时,该智力迟钝风险的增加不再具有统计学意义。文章的作者写道:“但是,与不用卵子胞浆内单精子注射(ICSI)的体外受精(IVF)相比,这些结果表明,自闭症和智力迟钝与针对父系不孕的特定的ICSI的IVF治疗之间有某种关系。” 8 {$ b' }( e- f5 k2 _2 f/ _ " |8 A7 ?) W/ I% D “这些疾病的发生率不高,与体外受精(IVF)相关的绝对风险的增加幅度也不大。这些相关性应该在其它人群中进行评估。”) _6 w8 T8 A: J1 u, H' X4 x- m5 o" n# e
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研究人员写道:“据我们所知,这项研究是检查特定体外受精(IVF)治疗与自闭症及智力迟钝之间关系的最大规模的研究,它检查了全部的体外受精(IVF)治疗。我们的结果应该适用于大多数的使用体外受精(IVF)及卵子胞浆内单精子注射(ICSI)的国家。虽然各个国家所使用的设备或实验室操作并无重大差异,但各国可能在治疗选择上存在着某些差异。例如,在某些国家(如美国),因为根据推测(但未经证实)会得到更高的效率,ICSI在精子样本正常时也被经常使用。 5 Z5 W) y% _1 U6 y B2 G 9 Y3 [% s$ h4 x胚泡[一种含有一个细胞簇群的胚胎发育的早期结构]转移在瑞典不经常使用但在美国则较常见。”作者: 小丫 时间: 2013-7-11 06:28
JAMA doi:10.1001/jama.2013.7222! \. w4 l( Y. H) C) q; [
3 I. ]. ?' n4 g- W1 u4 s$ aAutism and Mental Retardation Among Offspring Born After In Vitro Fertilization - z; l7 v0 c& c* [, q; K ) ^# N# b' {# R- M2 j6 B: YSven Sandin; Karl-G?sta Nygren; Anastasia Iliadou; Christina M. Hultman; Abraham Reichenberg& P) \- [- o* x' g" o
2 _# A: K5 {. t+ }( ^Importance Between 1978 and 2010, approximately 5 million infants were born after in vitro fertilization (IVF) treatments. Yet limited information on neurodevelopment after IVF exists, especially after the first year of life.* ]0 n+ @# p G. j( e3 o
! y* N$ e; y. B3 gObjective To examine the association between use of any IVF and different IVF procedures and the risk of autistic disorder and mental retardation in the offspring. ' x. p" v2 r/ G+ a, X9 I3 p1 S$ q1 K/ h. A9 m
Design, Setting, and Participants A population-based, prospective cohort study using Swedish national health registers. Offspring born between 1982 and 2007 were followed up for a clinical diagnosis of autistic disorder or mental retardation until December 31, 2009. The exposure of interest was IVF, categorized according to whether intracytoplasmic sperm injection (ICSI) for male infertility was used and whether embryos were fresh or frozen. For ICSI, whether sperm were ejaculated or surgically extracted was also considered.) }7 E9 ^! N+ h, i
8 ]. k7 g& x0 ~% p% y9 Q' ^! eMain Outcomes and Measures Relative risks (RRs) for autistic disorder and mental retardation and rates per 100?000 person-years, comparing spontaneously conceived offspring with those born after an IVF procedure and comparing 5 IVF procedures used in Sweden vs IVF without ICSI with fresh embryo transfer, the most common treatment. We also analyzed the subgroup restricted to singletons. 0 R3 C7 o/ B! h7 C( V - N' h0 g+ d2 @, q' j4 BResults Of the more than 2.5 million infants born, 30?959 (1.2%) were conceived by IVF and were followed up for a mean 10 (SD, 6) years. Overall, 103 of 6959 children (1.5%) with autistic disorder and 180 of 15?830 (1.1%) with mental retardation were conceived by IVF. The RR for autistic disorder after any procedure compared with spontaneous conception was 1.14 (95% CI, 0.94-1.39; 19.0 vs 15.6 per 100?000 person-years). The RR for mental retardation was 1.18 (95% CI, 1.01-1.36; 46.3 vs 39.8 per 100?000 person-years). For both outcomes, there was no statistically significant association when restricting analysis to singletons. Compared with IVF without ICSI with fresh embryo transfer, there were statistically significantly increased risks of autistic disorder following ICSI using surgically extracted sperm and fresh embryos (RR, 4.60 [95% CI, 2.14-9.88]; 135.7 vs 29.3 per 100?000 person-years); for mental retardation following ICSI using surgically extracted sperm and fresh embryos (RR, 2.35 [95% CI, 1.01-5.45]; 144.1 vs 60.8 per 100 000 person-years); and following ICSI using ejaculated sperm and fresh embryos (RR, 1.47 [95% CI, 1.03-2.09]; 90.6 vs 60.8 per 100 000 person-years). When restricting the analysis to singletons, the risks of autistic disorder associated with ICSI using surgically extracted sperm were not statistically significant, but the risks associated with ICSI using frozen embryos were significant for mental retardation (with frozen embryos, RR, 2.36 [95% CI, 1.04-5.36], 118.4 vs 50.6 per 100?000 person-years]; with fresh embryos, RR, 1.60 [95% CI, 1.00-2.57], 80.0 vs 50.6 per 100?000 person-years).5 D" o( X; a6 b- f7 i" Y
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Conclusions and Relevance Compared with spontaneous conception, IVF treatment overall was not associated with autistic disorder but was associated with a small but statistically significantly increased risk of mental retardation. For specific procedures, IVF with ICSI for paternal infertility was associated with a small increase in the RR for autistic disorder and mental retardation compared with IVF without ICSI. The prevalence of these disorders was low, and the increase in absolute risk associated with IVF was small.