不同类型卵泡刺激素在IVF/ICSI助孕人群中的疗效分析

Analysis of efficacy of different FSH in IVF/ICSI treatment

目的分析3种不同类型卵泡刺激素(FSH)在IVF/ICSI助孕人群中的治疗效果。方法回顾性分析2018年1月至2020年7月就诊于我中心行首次IVF/ICSI助孕的2456个周期的临床资料。根据FSH类型分为三组:进口重组FSH组(进口rFSH组,n=1445)、国产重组FSH组(国产rFSH组,n=455)、国产尿源性FSH组(国产uFSH组,n=556)。对控制性促排卵结局、促排卵费用及胚胎移植结局进行比较。结果(1)三组间患者基础资料(年龄、BMI、FSH水平、IVF比例、长方案比例、原发性不孕比例)均无统计学差异(P>0.05);(2)三组间Gn启动剂量及Gn总剂量(国产uFSH组>国产rFSH组>进口rFSH组)、可移植囊胚数(国产rFSH组>进口rFSH组>国产uFSH组)及囊胚形成率(国产rFSH组>国产uFSH组>进口rFSH组)均有统计学差异(P<0.05);进口及国产rFSH组的获卵数、MⅡ数及2PN数均显著高于国产uFSH组(P<0.05);三组间Gn天数、卵子成熟率、2PN受精率、HCG日内膜厚度、周期取消率、中重度OHSS率、新鲜及冻融周期着床率、临床妊娠率均无统计学差异(P>0.05);(3)三组间Gn总费用及每囊胚费用(进口rFSH组>国产rFSH组>国产uFSH组)均有统计学差异(P<0.05),进口rFSH组每卵费用显著高于国产rFSH组及国产uFSH组(P<0.05)。结论rFSH(进口及国产)拥有优于uFSH的促排卵效果,但劣于uFSH的经济效益;不同FSH类型的临床妊娠率无统计学差异。

Objective:To analyze the efficacy of three different FSH in the IVF/ICSI assisted pregnancy patients.Methods:The clinical data of 2456 first IVF/ICSI cycles in our center from January 2018 to July 2020 was retrospectively analyzed.According to the FSH type used,the patients were divided into three groups:imported recombinant FSH group(imported rFSH,n=1445),domestic recombinant FSH group(domestic rFSH,n=455),domestic urinary derived FSH group(domestic uFSH,n=556).The outcomes of controlled ovarian stimulation(COS),embryo transfer and the cost of COS were compared among the groups.Results:The basic data(age,BMI,FSH level,proportions of IVF,long protocol&primary infertility)were not significantly different among the three groups(P>0.05).Initiation doses and total dose of gonadotropin(Gn)(domestic uFSH>domestic rFSH>imported rFSH),number of available blastocysts(domestic rFSH>imported rFSH>domestic uFSH)and blastocyst formation rate(domestic rFSH>domestic uFSH>imported rFSH)were significantly different among the three groups(P<0.05).The number of oocytes retrieved,numbers of MⅡoocytes and 2PN embryos in the imported and domestic rFSH groups were significantly higher than those in domestic uFSH group(P<0.05).The Gn duration,mature oocyte rate,2PN fertilization rate,endometrial thickness on HCG day,cycle cancellation rate,moderate to severe OHSS rate,fresh and frozen-thawed embryo implantation rate,and clinical pregnancy rate were not significantly different(P>0.05).The cost of total Gn usage and per blastocyst among the three groups were significantly different(imported rFSH group>domestic rFSH group>domestic uFSH group)(P<0.05).The cost of per oocyte in rFSH group was significantly higher than that in domestic rFSH and uFSH group(P<0.05).Conclusions:both of imported and domestic rFSH have better ovulation induction effect than uFSH,but worse economic benefit than uFSH.No significant difference in pregnancy rate is found among the three groups.