臺灣地區經人工協助生殖產下單胞胎新生兒健康結果的分析 Analysis on Health Outcome of the Singleton Newborn Conceived by Assisted Reproductive Technology in Taiwan
中文摘要
本研究資料取自行政院衛生署國民健康局1998 年至 2005 年人工協助生殖技術資料庫。研究目 的為不孕症病人經過人工協助生殖對懷孕及單胞胎新生兒健康結果之影響。
本研究將夫妻的年齡、不孕期間、不孕原因、曾經施行人工生殖的次數、使用卵巢刺激藥物、使用 精、卵來源、殖入冷凍胚胎卵、殖入胚胎受精卵數、使用顯微操作、人工協助生殖方法後懷孕所生 出的單胞胎新生兒其健康狀況等作為本研究之重點。
本研究採用SPSS for window 10.0 版電腦軟體進行資料分析，資料統計採描述性統計、單變 項及雙變項進行分析。本研究之人工協助生殖技術為重覆測量的資料庫，共有43137 治療週期 個案，其中夫妻施行人工生殖技術IVF-ET 有效資料有 33554 治療週期個案，有懷孕者的治療 週期個案數為12683（37.8%），產下單胞胎新生兒有 5119（40.36%）治療週期個案數，
其中正常有4948（96.70%）個案數，異常有 171（3.3%）個案數。
本研究施行人工生殖技術IVF-ET 治療夫的平均年齡為 36.05 歲，妻的平均年齡為 32.68 歲，
單胞胎新生兒的性別方面男嬰佔53.90%，女嬰佔 46.10%，平均妊娠週數為 37.90 週、平均 體重為3033.48gm，身體異常為 3.3%。
本研究發現，施行人工協助生殖夫的年齡?40 歲可能降低懷孕率，妻的年齡?35 歲可能降低懷 孕率及可能生出低體重新生兒，不孕期間?7 年較不易懷孕及會生出低體重新生兒，多種原因引 起的不孕問題較不易懷孕及會生出低體重、低週數的新生兒，不明原因引起的不孕症較容易引 起新生兒身體其他方面的異常，曾經治療?3 次以上的不孕症較不易懷孕，有中度或重度的卵巢 藥物刺激反應可能影響新生兒外觀明顯先天缺陷，使用顯微操作技術中的協助孵化或顯微精蟲 注射與協助孵化合併使用時可能增加新生兒身體其他方面的異常等，以上的結果在迴歸分析均 達顯著。
針對上述結果對衛生主管機關、醫療人員及對不孕症夫妻者的提出建議：（一）將施行人工協 助生殖醫療費用納入健保給付及制定醫療品質標準，使全體國民享有公平的醫療服務及讓不孕 夫妻在無經濟負擔下儘早治療，以於適當生育年齡生產，以提高懷孕率、降低生出低體重新生 兒，進而減少住新生兒加護病房，降低新生兒健保費用，達到全體國民與健保機構雙贏局面。
（二）把握適當生育年齡及有不孕原因的危險因子存在時，宜儘早治療以提高懷孕率、降低生 出低體重新生兒、降低新生兒健保費用。
英文摘要
This research is based on the data from the Assisted Reproductive Technology
treatment cycles, provided by the Bureau of health promotion , Department of Health, Taiwan. year1998-2005 section as secondary and repeated measurements data for the analysis base.
The purpose of this research was to measure the influence of paternal age , maternal
age, cause of infertility, previous procedures involving ART, micromanipulation, type of procedure, ovarian stimulatory durgs and number of embryo transfer factors toward the health outcome of singleton ART newborns.
During 1998-2005, in Taiwan, more than 33554 IVF-ET treatment cycles were performed resulting in the birth of more than 5119 singleton newborns.
This research used SPSS 10.0 windows for analysis. Pregnancy outcomes and neonatal outcomes were analyzed using the Chi-squared test and logistic regression, with p less then 0.05 defining a significant difference.
This research reveals that the clinical pregnancy rate was 37.8%, there being 40.36%
singleton ART newborns, the mean birth weight was 3033.48gm and malformation rate was 3.3%.
There was statistical significance of the clinical pregnancy rate related to paternal age, maternal age, primary cause of infertility, previous procedures involving ART, proceeding to micromanipulation , type of procedure , proceeding to ovarian stimulatory durgs and number of embryo transfer.
There was statistical significance of the health outcome of the singleton newborns related to maternal age, unexplained infertility, length of infertility, proceeding to micromanipulation and moderate degree of ovarian hyperstimulation syndrome.
The research brings forth the following suggestions about the new policy: 1) The Medication Bureau should re-exam its policy, we suggest that IVF-ET should be supported by the national health insurance ; 2) The quality of medical service should be promoted; 3) Reporting system for birth of IVF-ET should be established; 4) Early treatment is the best way for infertility to reduce adverse neonatal outcome and financial cost.
