ARTにおける多胎妊娠予防のための工夫(生殖)

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To avoid multiple pregnancies without compromising pregnancy rates is a challenge in assisted reproductive technology (ART). Multiple gestation leads to an increased risk of complications in both the fetuses and the mother. In 1990, Japan society of obstetrics and gynecology (JSOG) started the annual survey of ART, stated the increasing concern about the incidence of multiple pregnancies. To ensure the incidence of this iatrogenic complication of treatment as minimum, in 1995, JSOG released the recommendation that the number of embryos to be transferred should be no more than three in each cycle. Even though this recommendation have been kept in many ART center in Japan, the increasing number of multiple pregnancies (including twin) is faced to great concerns. Thus, reducing the number of embryos transferred is an essential goal for ART programs and their patients. To avoid triplet pregnancy, many Japanese ART center are accepting the policy of transferring only two embryos. However, the twin pregnancy rate after two-embryo transfer is still high as 30-40%. Recently, elective Single Embryo Transfer (eSET) for women at particular risk of multiple pregnancies was proposed in many European ART center and achieved reasonable pregnancy rate. For eSET, the ability to identify the embryo with a very high implantation potential is important. Many clinical trials to identify "top-quality embryo" in pronuclear stage, early cleavage stage, or blastcyst stage were reported. Characterization of pronuclear stage embryo (pronuclear orientation and alignment) is one of visible indications of developmental competence of embryo. There reported the classification of pronuclear stage embryo and difference of clinical pregnancy rate among them. Early cleavage of zygote also reported to predict the implantation potential. Blastcyst itself was considered as a competent embryo and blastcyst transfer showed high implantation rate. While two-embryo or one embryo transfer should be seriously discussed, on the other hand, we also need to study other issues related to ART. Cryopreservation of embryo provides further possibility of pregnancy. Implantation rate of embryo will be improved after the knowledge accumulations about human embryo implantation and endometrial acceptability. Although a further fine-tuning of both embryo and patient characteristics relating to avoid multiple pregnancy including twin, two-embryo or one embryo transfer should be introduced carefully, progressively and surely in each ART program from now. Careful counseling is of importance and perinatal medical care and public insurer will have to join in the discussion.
2003-08-01

ARTにおける多胎妊娠予防のための工夫(生殖)

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