В статье, демонстрирующей результаты опубликованных работ, представлены данные о материнских и перинатальных осложнениях многоплодной беременности. Особое внимание уделено многоплодной беременности, наступившей вследствие применения экстракорпорального оплодотворения. Рассмотрены пути снижения частоты осложнений, связанных с многоплодием, путем применения селективного переноса одного эмбриона. Подчеркнута необходимость пересмотра критериев эффективности вспомогательных репродуктивных технологий для оптимизации здоровья матери и ребенка.
Ключевые слова: многоплодная беременность, селективный перенос одного эмбриона, ЭКО и ПЭ, материнские и перинатальные осложнения.
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The article describes the published data about elective single embryo transfer (eSET) impact on reducing the multiple pregnancy which leeds to increase maternal and perinatal complications and influence on social-economic parameters.
Key words: multiple pregnancy, elective single embryo transfer (eSET), IVF, obstetrics and perinatal outcomes.
1. Краснопольский В.И. и др. Современные проблемы многоплодной беременности (доклад на 4-м Всероссийском съезде акушеров-гинекологов. 30.09.2008). Вестник акушера-гинеколога. 2009; 2: 79–82.
2. Martikainen H, Tiitinen A, Thomas C et al. One versus two embryo transfers after IVF and ICSI: a prospective randomized trial. Fertil Steril 2004; 81: 551–5.
3. Тишкевич О.Л., Жабинская А.Б., Алексеева Е.В., Волоханович С.М. Эффективность ЭКО и частота многоплодной беременности в зависимости от числа и качества переносимых эмбрионов у женщин разного возраста. Проблемы репродукции 2008; 2 (2): 8–12.
4. Neubourg DD, Gerris JM, Mangelschots K et al. The obstetrical and neonatal outcome of babies born after single-embryo transfer in IVF. ICSI compares favourably to spontaneously conceived babies. Hum Reprod 2006; 21: 1041–6.
5. Min JK, Claman P, Hughes E et al. Guidelines for the number of embryos to transfer following in-vitro fertilization. Int J Gynaecol Obstet 2008; 102 (2): 203–16.
6. Vilska S, Tiitinen A, Hyden-Granskog C, Hovatta O. Elective transfer of one embryo results in an acceptable pregnancy rate and eliminates the risk of multiple birth. Hum Reprod 1999; 14: 2392–5.
7. Kjellberg AT, Carlsson P, Bergh C. Randomized single versus double embryo transfer: obstetric and paediatric outcome and cost-effectiveness analysis. Hum Reprod 2006; 21: 210–6.
8. Veleva Z, Karinen P, Toma C et al. Elective single embryo transfer cryopreservation improves outcome and diminishes the costs of IVF/ICSI. Hum Reprod 2009; 24 (7): 1632–9.
9. Helmerhorst FM, Perquin DA, Donker D, Keirse MJ. Perinatal outcome of singletons and twins after assisted conception: a systematic review of controlled studies. BMJ 2004; 328: 261.
10. Allen C, Bowdin S, Harrison RF et al. Pregnancy and perinatal outcomes after assisted reproduction: a comparative study. Ir J Med Sci 2008; 177 (3): 233–41.
11. Gissler M, Unkila-Kallio L, Hyden-Granskog C, Tiitinen A. Obstetric and neonatal outcome after single embryo transfer. Hum Reprod 2007; 22 (4): 1073–9.
12. Gleicher N, Weghofer A, Barad D. Update on the comparison of assisted reproduction outcomes between Europe and the USA: the 2002 data. Fertile Steril 2007; 87: 1301–5.
13. Dhont M, De Sutter P, Ruissinck G et al. Perinatal outcome of pregnansies after assisted reproduction: a case-control study. Am J Obstet Gynecol 1999; 181: 688–95.
14. Gerris JM. Single embryo transfer and IVF/ICSI outcome: a balanced appraisal. Hum Reprod Update 2005; 11: 105–21.
15. Chen XK, Wen SW, Bottomley J et al. In vitro fertilization is associated with increased risk of preeclampsia. Hypert Preg 2009; 28 (1): 1.
16. Poikkeus P, Gissler M, Unkila-Kallio L et al. Obstetric and neonatal outcome after single embryo transfer. Hum Reprod 2007; 22 (4): 1073–9.
17. Gleicher N, Barad D. Twin pregnancy, contrary to consensus, is a desirable outcome in infertility. Fertility and Sterility 2009; 91 (6): 2426–31.
18. Pinborg A. IVF/ICSI twin pregnancies: risks and prevention. Hum Reprod Update 2005; 11 (6): 575–93.
19. Pandian Z, Templeton A, Serour G, Bhattacharya S. Number of embryos for transfer after IVF and ICSI: a Cochrane review. Hum Reprod 2005; 20 (10): 2681–7.
20. Kallen B. Maternal morbidity and mortality in in vitro fertilization. Best Pract Clin Obst Gynaecol 2008; 22 (3): 549–58.
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1. Краснопольский В.И. и др. Современные проблемы многоплодной беременности (доклад на 4-м Всероссийском съезде акушеров-гинекологов. 30.09.2008). Вестник акушера-гинеколога. 2009; 2: 79–82.
2. Martikainen H, Tiitinen A, Thomas C et al. One versus two embryo transfers after IVF and ICSI: a prospective randomized trial. Fertil Steril 2004; 81: 551–5.
3. Тишкевич О.Л., Жабинская А.Б., Алексеева Е.В., Волоханович С.М. Эффективность ЭКО и частота многоплодной беременности в зависимости от числа и качества переносимых эмбрионов у женщин разного возраста. Проблемы репродукции 2008; 2 (2): 8–12.
4. Neubourg DD, Gerris JM, Mangelschots K et al. The obstetrical and neonatal outcome of babies born after single-embryo transfer in IVF. ICSI compares favourably to spontaneously conceived babies. Hum Reprod 2006; 21: 1041–6.
5. Min JK, Claman P, Hughes E et al. Guidelines for the number of embryos to transfer following in-vitro fertilization. Int J Gynaecol Obstet 2008; 102 (2): 203–16.
6. Vilska S, Tiitinen A, Hyden-Granskog C, Hovatta O. Elective transfer of one embryo results in an acceptable pregnancy rate and eliminates the risk of multiple birth. Hum Reprod 1999; 14: 2392–5.
7. Kjellberg AT, Carlsson P, Bergh C. Randomized single versus double embryo transfer: obstetric and paediatric outcome and cost-effectiveness analysis. Hum Reprod 2006; 21: 210–6.
8. Veleva Z, Karinen P, Toma C et al. Elective single embryo transfer cryopreservation improves outcome and diminishes the costs of IVF/ICSI. Hum Reprod 2009; 24 (7): 1632–9.
9. Helmerhorst FM, Perquin DA, Donker D, Keirse MJ. Perinatal outcome of singletons and twins after assisted conception: a systematic review of controlled studies. BMJ 2004; 328: 261.
10. Allen C, Bowdin S, Harrison RF et al. Pregnancy and perinatal outcomes after assisted reproduction: a comparative study. Ir J Med Sci 2008; 177 (3): 233–41.
11. Gissler M, Unkila-Kallio L, Hyden-Granskog C, Tiitinen A. Obstetric and neonatal outcome after single embryo transfer. Hum Reprod 2007; 22 (4): 1073–9.
12. Gleicher N, Weghofer A, Barad D. Update on the comparison of assisted reproduction outcomes between Europe and the USA: the 2002 data. Fertile Steril 2007; 87: 1301–5.
13. Dhont M, De Sutter P, Ruissinck G et al. Perinatal outcome of pregnansies after assisted reproduction: a case-control study. Am J Obstet Gynecol 1999; 181: 688–95.
14. Gerris JM. Single embryo transfer and IVF/ICSI outcome: a balanced appraisal. Hum Reprod Update 2005; 11: 105–21.
15. Chen XK, Wen SW, Bottomley J et al. In vitro fertilization is associated with increased risk of preeclampsia. Hypert Preg 2009; 28 (1): 1.
16. Poikkeus P, Gissler M, Unkila-Kallio L et al. Obstetric and neonatal outcome after single embryo transfer. Hum Reprod 2007; 22 (4): 1073–9.
17. Gleicher N, Barad D. Twin pregnancy, contrary to consensus, is a desirable outcome in infertility. Fertility and Sterility 2009; 91 (6): 2426–31.
18. Pinborg A. IVF/ICSI twin pregnancies: risks and prevention. Hum Reprod Update 2005; 11 (6): 575–93.
19. Pandian Z, Templeton A, Serour G, Bhattacharya S. Number of embryos for transfer after IVF and ICSI: a Cochrane review. Hum Reprod 2005; 20 (10): 2681–7.
20. Kallen B. Maternal morbidity and mortality in in vitro fertilization. Best Pract Clin Obst Gynaecol 2008; 22 (3): 549–58.
Авторы
О.Е.Краснощока, В.Ю.Смольникова, Е.А.Калинина
ФГБУ Научный центр акушерства, гинекологии и перинатологии им. акад. В.И.Кулакова Минздравсоцразвития РФ