人类辅助生殖技术子代安全性问题

人类辅助生殖技术(ART)日渐成熟,已成为广大不孕不育患者克服疾病困扰获得后代的可靠助孕手段。围绕ART采用的相关医疗手段及对配子和早期胚胎采取的多种实验室干预措施如体外授精、卵胞浆内单精子注射、胚胎植入前遗传学诊断、胚胎冷冻保存及冻融胚胎复苏技术等对ART子代的安全性存在的影响,已成为生殖医学领域研究的重点。研究表明,ART子代和自然妊娠子代的健康状况相似,辅助生殖技术是相对安全的。然而,受ART子代年龄和群体样本量影响,研究只能阐述ART子代出生后早期的随访,尚无权威证据揭示其对子代成年后的远期影响,也无法证明这些研究结论是否与ART适应证、夫妻双方不孕原因、母体年龄、遗传因素、IVF技术本身、IVF相关的不良围产结局等是否存在相关性。对 ART 助孕的子代安全性问题进行综述,讨论ART常规技术与出生缺陷、ART与早产、ART与低体质量儿、ART子代生长发育评估、ART子代的精神健康等问题,为人类ART安全有效的应用提供依据。

Safety of human assisted reproductive technology offspring

With the maturation of assisted reproductive technology(ART), it has become a reliable means for infertile patients to overcome disease and obtain offspring. The effects of a variety of clinical and laboratory interventions in ART process, including in vitro fertilization(IVF), intracytoplasmic sperm injection(ICSI), preimplantation genetic diagnosis(PGD), embryo cryopreservation and freeze-thaw embryo resuscitation, on the safety of ART offspring have become the focus of reproductive medicine research. Present studies have shown that the health status of ART conceived offspring is similar to that of children conceived naturally, and ART is relatively safe. However, influenced by the age of ART offspring and the sample size, those studies only reported the data on the early follow-up of ART offspring after birth. There is no authoritative study to reveal the long-term health outcomes of ART offspring after adulthood, and whether these findings are associated with ART indications, causes of infertility, maternal age, genetic factors, IVF, and adverse perinatal outcomes related to IVF. This article reviews the safety of offspring following ART, and discusses topics on ART and birth defects, ART and preterm birth, ART and low birth weight infants, ART offspring growth and development assessment, and mental health of ART offspring, to provide a basis for the safe and effective application of human ART.