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「治療」を提供する医師でありたい~臍帯血輸血に思う(2)

の続き。

assisted hatchingにエビデンスは無い、というのは、本ブログでも過去に解説しました。
(CPR:clinical pregnancy rateは上昇させるのは確かだが、LBR:live birth rateを上昇させるというエビデンスが無い。赤ちゃん抱けなきゃ意味がない、逆に流産+多胎増やしているかも?でした。)


この論文にも、同じことが書いてあります。
Assisted hatching

In Cohen et al. (1990), proposed that making a breach in the zona pellucida may help implantation in some patients. Assisted hatching (AH)is usually performed on Day 3, 5 or 6 of embryo development using anon-contact laser, but mechanical or acidic solutions have also been used (Balaban et al., 2002). Clinics use AH for patients of advanced maternal age, smokers or patients with a raised FSH, or when transfer-ring embryos that have been cryopreserved.Three meta-analyses on AH have found a significant increase in CPR but no evidence for a difference in LBR. Martins et al. (2011) found a significant difference in CPR using frozen thawed embryos in unselected women and for patients with repeated IVF failure, but no evidence of benefit for subgroups of either older women or those with a good prognosis. They concluded that there were too few studies looking at LBR to draw conclusions. The Cochrane review by Carney et al. (2012)looked at 31 trials including 1992 clinical pregnancies in 5728 women.Nine of the 31 RCTs included data on LBR. There was no evidence of difference between the LBR in the AH and control groups. Li et al.(2016) looked at 36 RCTs with 6459 participants and found that AH gave a significant increase in CPR and multiple pregnancy rate but in the15 RCTs that looked at LBR, there was no evidence of difference between the AH and control groups.The National Institute for Clinical Excellence (NICE) guidelines(2013) state that assisted hatching is not recommended because it has not been shown to improve pregnancy rates.

まあ、そんなわけで、体外受精の過程にもいろんな「おまけ」が付けられることがあるわけですが、この「おまけ」が「臍帯血投与」と同じ構図だとしたら・・・。
「グ〇コのおまけつき」の「おまけ」の方が、まだ楽しめるだけマシなわけです。

で、最後の一文
NICEのガイドラインでは、Assisted hatchingは推奨されてないと書かれています。
これを見ていきましょう!

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ドクターI

Author:ドクターI
武蔵境生息、(自称)不妊屋「ドクターI」、自己流生殖医療を語ります。

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