人工協助生殖科技的資料登錄與健康監測：跨國比較研究

National registries and health surveillance of assisted reproductive technologies: a comparative study

目標：全國性的資料登錄以及公共報告，是監測人工協助生殖科技健康風險的重要策略。本文透過跨國比較研究，探討各國登錄制的特性，母嬰健康風險的重視程度，以及資料使用的公共性。方法：本文選取英、美、瑞典、日本以及台灣，透過檔案資料與二手文獻進行制度比較，並針對台日參與政策制定的相關行動者進行深度訪談，作為補充資料。結果：英美瑞台都透過國家法令建立強制登錄制，日本則由醫學會主管，近年已達成100%的通報率。登錄內容逐漸趨向重視母嬰健康指標，而非僅是以成功率展示技術能力。英美瑞日台都十分重視體外授精的多胚胎植入數目以及多胞胎孕產率，有些並已提出「選擇性單一胚胎植入比例」，「足月、正常體重、單胞胎活產率」等新興指標。英美瑞在報告資料的詮釋與可讀性，提出創新設計；日台則僅限於專業社群閱讀，缺乏公共溝通性。結論：台灣是世界上少數全面長期追蹤人工協助生殖科技資料的國家，但是在母嬰健康風險指標的精進，以及公眾溝通的品質上仍十分不足，建議參考國際趨勢進行改革。

Objectives: A national registry and public data reporting have together become an important strategy for health surveillance of assisted reproductive technologies (ARTs). We have analyzed the development of registry systems, the tendency to highlight maternal and infant health risk, and the formats for public reporting based on a cross-national comparison. Methods: We selected the UK, US, Sweden, Japan, and Taiwan as countries for comparison. Archival data, secondary literature, and in-depth interviews of relevant policy-makers in Japan and Taiwan were included. Results: The UK, US, Sweden, and Taiwan have achieved compulsory registry through legal requirement. The Japan Society of Obstetrics and Gynecology has adopted a voluntary reporting system, and has recently achieved a 100% reporting rate. Most countries gradually focus on the health risk for mothers and infants, rather than merely display the technical competence by calculating success rates. The number of multiple embryos transferred during IVF, and multiple pregnancy and live birth rates were shown to serve as important indicators of health risk surveillance. Some countries report new indicators, such as ＂elective single embryo transfer rate＂ and ＂term, normal weight, and singleton＂ live birth rate. The UK, US, and Sweden provide innovative formats to make reporting data accessible, readable, and useful for the general public. Taiwan and Japan limit its readership to professionals and lack efforts for broader public communication. Conclusions: Taiwan has one of the most complete ART registry systems in the world, but the surveillance on maternal and infant health and the quality of public reporting remains inadequate. To build evidence-based policy-making and to improve ART safety, surveillance reporting in Taiwan needs to meet the global standard.