作者：Iews M，et al.
翻譯：王芳，劉湘源
個人簡介：王芳，醫學博士，主任醫師，教授，博士研究生導師，蘭州大學第二醫院生殖醫學科主任。中國醫院協會婦產醫院管理分會委員，中國婦幼健康研究會生殖免疫專業委員會常委，甘肅省免疫學會生殖免疫專業委員會主任委員，甘肅省醫師協會生殖醫學專業委員會副主任委員。
【摘要】
復發性流產是孕期常見的併發症，發病原因尚未完全清楚。對於復發性流產高風險夫婦，如存在結構性染色體異常，為提高活產率和降低流產發生率，常被推薦行移植前基因診斷（PGD，俗稱做第三代試管嬰兒）。然而，該技術是否為這些患者帶來益處並未形成共識，本文總結了已發表的關於做第三代試管嬰兒對染色體異常的復發性流產孕婦的妊娠結局影響。
我們詳細搜索了通用資料庫，共20項研究。由於每項研究的多樣性（異質性），我們未行薈萃分析。我們發現，自然懷孕的847對夫婦的活產率為25-71%，而採用第三代試管嬰兒的562對夫婦的活產率為26.7-87%（活產率相似），不過，這些研究存在一定的局限性，因缺乏大規模的對照或隨機對照研究。
因此，建議有結構性染色體異常的復發性流產患者通過自然懷孕也可能獲得良好的妊娠結局，第三代試管嬰兒不應該作為一線治療，因為所獲的益處不肯定，可能帶來額外的花費和輔助生殖技術相關的潛在併發症。
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.