臨床婦人科産科76巻4号

2022年04月発行

増刊号 最新の不妊診療がわかる！―生殖補助医療を中心とした新たな治療体系

第2章　生殖補助医療とその手技 胚移植と子宮内環境―良好な子宮内環境に受精卵を確実に移植する

胚移植失敗の原因と回避―移植胚数と胚移植の基本的手技

著者： 佐藤卓¹ 水口雄貴²

所属機関： ¹荻窪病院虹クリニック ²慶應義塾大学医学部産婦人科学教室

ページ範囲：P.77 - P.82

文献概要

▶わが国においては，日本産科婦人科学会の会告により移植胚の数は原則として1つと定められているのだが，本来であれば患者の特性や過去の治療成績などを考慮した個別化された対応が望まれる．
▶胚移植の実施上で留意すべき事項として，超音波ガイド下での実施およびソフト・カテーテルの使用が強く推奨される．また，移植後のbed restは推奨されない．

参考文献

1）日本産科婦人科学会：生殖補助医療における多胎妊娠防止に関する見解．1996http://fa.kyorin.co.jp/jsog/readPDF.php?file =73/8/073080915.pdf#page=24

2）Harbottle S, et al : Elective single embryo transfer : an update to UK best practice guidelines. Hum Fertil（Camb） 18 : 165-183, 2015

3）Bissonnette F, et al : Working to eliminate multiple pregnancies : a success story in Québec. Reprod Biomed Online 23 : 500-504, 2011

4）日本産科婦人科学会 : 令和2年度倫理委員会登録・調査小委員会報告．2021　http://fa.kyorin.co.jp/jsog/readPDF.php?file =73/9/073091089.pdf

5）Kushnir VA, et al : Systematic review of worldwide trends in assisted reproductive technology 2004-2013. Reprod Biol Endocrinol 15 : 6, 2017

6）Gleicher N : Eliminating multiple pregnancies : an appropriate target for government intervention? Reprod Biomed Online 23 : 403-406, 2011

7）Practice Committee of the American Society for Reproductive, Medicine, et al : Guidance on the limits to the number of embryos to transfer : a committee opinion. Fertil Steril 116 : 651-654, 2021

8）Forman EJ, et al : In vitro fertilization with single euploid blastocyst transfer : a randomized controlled trial. Fertil Steril 100 : 100-107.e1, 2013

9）Forman EJ, et al : Obstetrical and neonatal outcomes from the BEST trial : single embryo transfer with aneuploidy screening improves outcomes after in vitro fertilization without compromising delivery rates. Am J Obstet Gynecol 210 : 157.e1-6, 2014

10）Munné S, et al : Preimplantation genetic testing for aneuploidy versus morphology as selection criteria for single frozen-thawed embryo transfer in good-prognosis patients : a multicenter randomized clinical trial. Fertil Steril 112 : 1071-1079.e7, 2019

11）Yan J, et al : Live birth with or without preimplantation genetic testing for aneuploidy. N Engl J Med 385 : 2047-2058, 2021

12）Lopez MJ, et al : Individualized embryo transfer training : timing and performance. Hum Reprod 29 : 1432-1437, 2014

13）Dessolle L, et al : How soon can I be proficient in embryo transfer? Lessons from the cumulative summation test for learning curve（LC-CUSUM）. Hum Reprod 25 : 380-386, 2010

14）Practice Committee of the American Society for Reproductive Medicine : performing the embryo transfer : a guideline. Fertil Steril 107 : 882-896, 2017

15）Brown J, et al : Ultrasound versus‘clinical touch’ for catheter guidance during embryo transfer in women. Cochrane Database Syst Rev （1） : CD006107, 2010

16）Cozzolino M, et al : Ultrasound-guided embryo transfer : summary of the evidence and new perspectives. A systematic review and meta-analysis. Reprod Biomed Online 36 : 524-542, 2018

17）Eskandar MA, et al : Removal of cervical mucus prior to embryo transfer improves pregnancy rates in women undergoing assisted reproduction. Reprod Biomed Online 14 : 308-313, 2007

18）Visschers BA, et al : Removal of cervical mucus : effect on pregnancy rates in IVF/ICSI. Reprod Biomed Online 15 : 310-315, 2007

19）Buckett WM : A review and meta-analysis of prospective trials comparing different catheters used for embryo transfer. Fertil Steril 85 : 728-734, 2006

20）Abou-Setta AM, et al : Soft versus firm embryo transfer catheters for assisted reproduction : a systematic review and meta-analysis. Hum Reprod 20 3114-3121, 2005

21）Jamal W, et al : Successful pregnancy following novel IVF protocol and transmyometrial embryo transfer after radical vaginal trachelectomy. Reprod Biomed Online 18 : 700-703, 2009

22）Gaikwad S, et al : Bed rest after embryo transfer negatively affects in vitro fertilization : a randomized controlled clinical trial. Fertil Steril 100 : 729-735, 2013

23）Kücük M : Bed rest after embryo transfer : Is it harmful? Eur J Obstet Gynecol Reprod Biol 167 : 123-126, 2013