作者：Iews M，et al.

翻译：王芳，刘湘源

个人简介：王芳，医学博士，主任医师，教授，博士研究生导师，兰州大学第二医院生殖医学科主任。中国医院协会妇产医院管理分会委员，中国妇幼健康研究会生殖免疫专业委员会常委，甘肃省免疫学会生殖免疫专业委员会主任委员，甘肃省医师协会生殖医学专业委员会副主任委员。

【摘要】

复发性流产是孕期常见的并发症，发病原因尚未完全清楚。对于复发性流产高风险夫妇，如存在结构性染色体异常，为提高活产率和降低流产发生率，常被推荐行移植前基因诊断（PGD，俗称做第三代试管婴儿）。然而，该技术是否为这些患者带来益处并未形成共识，本文总结了已发表的关于做第三代试管婴儿对染色体异常的复发性流产孕妇的妊娠结局影响。

我们详细搜索了通用数据库，共20项研究。由于每项研究的多样性（异质性），我们未行荟萃分析。我们发现，自然怀孕的847对夫妇的活产率为25-71%，而采用第三代试管婴儿的562对夫妇的活产率为26.7-87%（活产率相似），不过，这些研究存在一定的局限性，因缺乏大规模的对照或随机对照研究。

因此，建议有结构性染色体异常的复发性流产患者通过自然怀孕也可能获得良好的妊娠结局，第三代试管婴儿不应该作为一线治疗，因为所获的益处不肯定，可能带来额外的花费和辅助生殖技术相关的潜在并发症。

附原文：

Abstract Recurrent pregnancy loss (RPL) is a common, yet elusive, complication of pregnancy. Among couples at high risk of RPL, such as those carrying a structural chromosomal rearrangement, preimplantation genetic diagnosis (PGD) has been proposed as a tool to improve live birth rates and reduce the incidence of miscarriage; however, no clear consensus has been reached on its benefits in this population. This systematic review summarizes existing published research on the effect of PGD on pregnancy outcomes among carriers of chromosomal abnormalities with RPL. A comprehensive search of common databases was conducted, which yielded 20 studies. Meta-analysis was precluded owing to significant heterogeneity between studies. The primary outcome of interest was live birth rate (LBR), and a pooled total of 847 couples who conceived naturally had a LBR ranging from 25-71% compared with 26.7-87% among 562 couples who underwent IVF and PGD. Limitations of the study include lack of large comparative or randomized control studies. Patients experiencing RPL with structural chromosomal rearrangement should be counselled that good reproductive outcomes can be achieved through natural conception, and that IVF-PGD should not be offered first-line, given the unproven benefits, additional cost and potential complications associated with assisted reproductive technology.

引自：

Iews M, Tan J, Taskin O, et al. Does preimplantation genetic diagnosis improve reproductive outcome in couples with recurrent pregnancy loss owing to structural chromosomal rearrangement? A systematic review. Reprod Biomed Online. 2018 Jun;36(6):677-685. doi: 10.1016/j.rbmo.2018.03.005. Epub 2018 Mar 15.