摘要
目的比较不同促排卵方案应用于多囊卵巢综合征(PCOS)患者的助孕结局及经济花费,为临床方案选择提供参考。方法回顾性分析2017年6月至2019年6月在本院生殖中心因PCOS或输卵管因素合并PCOS行IVF/ICSI-ET助孕患者的临床资料(共575个周期),根据促排卵方案不同分为3组:拮抗剂方案组(112个周期),改良超长方案组(60个周期),长效长方案组(403个周期)。比较3组患者的基本情况、促排卵情况、妊娠结局及经济花费。结果3组间比较,拮抗剂方案组Gn天数最短、Gn总量最少、移植日内膜厚度最薄、全胚冷冻率最高、新鲜周期移植率最低,与其他两组比较均有显著性差异(P<0.05);3组间鲜胚移植周期及全胚冷冻后首次冻融胚胎移植(FET)周期的胚胎着床率、临床妊娠率、流产率比较均无显著性差异(P>0.05)。拮抗剂方案组鲜胚移植周期中重度卵巢过度刺激综合征(OHSS)发生率显著低于长效长方案组(P<0.05)。单个取卵周期花费、达到首次妊娠花费均为拮抗剂方案最高,改良超长方案最低,3组间比较均有显著性差异(P<0.05)。结论拮抗剂方案、改良超长方案、长效长方案3种方案应用于PCOS患者能获得相似的妊娠结局;拮抗剂方案能明显降低OHSS发生风险;结合卫生经济学指标综合比较,改良超长方案对于PCOS患者来说是一个较好的选择方案。
Objective:To compare the pregnancy outcomes and economic costs of different ovulation induction protocols for the patients with polycystic ovarian syndrome(PCOS),and provide references for the selecting clinical protocol.Methods:The clinical data of patients(575 cycles)who underwent IVF/ICSI-ET due PCOS or fallopian tube factor combined with PCOS in our reproductive center from June 2017 to June 2019 were retrospectively analyzed.According to the different ovulation induction protocols,the patients were divided into three groups:antagonist protocol group(112 cycles),modified ultra-long protocol group(60 cycles)and long protocol group(403 cycles).The basic information,ovulation induction status,pregnancy outcome and economic cost were compared among the three groups.Results:Comparing the three groups,the antagonist protocol group had the shortest gonadotropin(Gn)days,the least total Gn doses,the thinnest endometrial thickness,the highest whole embryo freezing rate,and the lowest fresh cycle transfer rate.There were significant differences compared with other two groups(P<0.05).There were no significant differences in embryo implantation rate,clinical pregnancy rate and abortion rate of the fresh embryo transfer cycle and the first FET cycle after whole embryo freezing among the three groups(P>0.05).The incidence of severe ovarian hyper-stimulation syndrome(OHSS)in the antagonist protocol group was significantly lower than that in the long protocol group(P<0.05).The cost of a single oocyte retrieval cycle and the cost of reaching the first pregnancy were the highest in antagonist protocol group,and the lowest in modified ultra-long protocol.The differences were significant among the three groups(P<0.05).Conclusions:Application of antagonist protocol,modified ultra-long protocol or long protocol for PCOS patients can obtain similar pregnancy outcomes.Among them,the antagonist protocol and the modified ultra-long protocol can significantly reduce the incidence of OHSS.Combined with the comprehensive comparison of health economics,the modified ultra-long program is a better choice for PCOS patients.
作者
戴芳芳
郑波
郭钰英
王寅
郭影
霍志欣
刘彦民
DAI Fang-fang;ZHENG Bo;GUO Yu-ying;WANG Yin;GUO Ying;HUO Zhi-xin;LIU Yan-min(Xingtai Infertility Specialized Hospital,Xingtai 054001)
出处
《生殖医学杂志》
CAS
2020年第9期1156-1161,共6页
Journal of Reproductive Medicine
关键词
多囊卵巢综合征
拮抗剂方案
改良超长方案
长方案
Polycystic ovary syndrome
Antagonist protocol
Modified ultra-long protocol
Long protocol
作者简介
通讯作者:戴芳芳,女,河北邢台人,硕士,副主任医师,生殖医学专业。
