台灣人工生殖法立法前後五年生殖結果的比較

Reproductive outcomes of in vitro fertilisation in the five years before and after the legislation of the Assisted Reproduction Act in Taiwan

目標：利用台灣人工生殖資料庫探進行實證分析，探討2007年台灣人工生殖法頒布前後，對首次執行試管嬰兒治療成果之影響。方法：擷取人工生殖資料庫中法頒布前與後五年紀錄，利用變異數分析與卡方分析，及廣義線性模型之多變項羅吉斯回歸，比較臨床懷孕、活產、流產、子宮外孕等療程結果。結果：研究共納入2002－2012間83,264次試管嬰兒療程。單變項觀察到立法後五年期間，在著床為胚囊、臨床懷孕及活產率，皆較立法前五年顯著提升；發生子宮外孕、減胎、卵巢過度刺激臨床症候群發生率，則在立法後顯著下降。多變項分析上，在著床為胚囊、臨床懷孕，以及成功誕下活產嬰兒上，立法後較立法前勝算顯著增加31－35％；減胎立法後勝算顯著則降低20％。發現相較於單胚胎植入，選擇植入兩個胚胎活產勝算可顯著增加11％。但若植入3顆或4顆胚胎，則可能同時增加活產與死產勝算。結論：本研究為台灣首篇比較施行胚胎植入限制的前後五年的試管嬰兒生殖結果的差異。研究發現法令限制植入胚胎後，試管嬰兒的活產機率增加及減胎機率減少，相關原因有待後續研究。綜整本研究發現與國內其它實證結果，建議台灣可再下修胚胎植入指引。政府更應持續發展人工生殖技術並擴大補助，特別是單胚胎之植入。

Objectives: To compare the outcomes of in vitro fertilisation (IVF) treatment before and after the 2007 IVF regulations in Taiwan by accessing data from the national assisted reproduction database. Methods: Clinical pregnancies (those with the foetal heartbeat detected), live births, miscarriage, fetal reduction, and ectopic pregnancy in the five years before and after the assisted reproduction act were assessed from the national assisted reproduction database. Analysis of variance, Chi-square test, and multivariate logistic regression of the generalized linear model were used to compare the outcomes before and after the implementation of the legislation. Results: A total of 83,264 IVF cycles performed between 2002 and 2012 were included in our analysis. After implementing the legislation, fewer embryos were transferred in IVF cycles, but higher percentages of gestational sacs, clinical pregnancies, and live births were achieved. The rates of miscarriages, ectopic pregnancy, and fetal reduction were significantly less in the post-legislation period than in the pre-legislation period. The multivariate analysis found that the odds of embryos reaching the gestational sacs, clinical pregnancies, and live births per cycle significantly increased by 31-35%; the odds of fetal reduction were decreased by 20%. Compared to single embryo transfer, double embryo transfer increases the odds of live births by 11%. Conclusions: This was the first study to focus on the reproductive outcomes of IVF in the five years before and after the legislation of the assisted reproduction act in Taiwan. The Assisted Reproduction Act limited the number of embryo transfers to four would increase the likelihood of live births and reduce the probability of fetal reduction, and there was still a need for further research to prove. We suggest that the legislation be revised to reduce the maximum number of embryo transfers in an IVF cycle from four to less based on our findings and previous studies. The government can encourage the development of IVF technology and deregulate medical allowances for every IVF cycle to promote fertility in Taiwan.