来曲唑联合促卵泡素在PCOS患者IVF-ET中的应用及效价分析

Cost-effectiveness of Aromatase Inhibitor Co-treatment for Controlled ovarian Stimulation IVF-ET in Patients with PCOS

目的:探讨来曲唑(LE)联合FSH在多囊卵巢综合征(PCOS)患者IVF-ET或ICSI中的应用及效价分析。方法:回顾性分析接受IVF-ET/ICSI治疗的170名PCOS不孕患者,分为LE组(LE-FSH组,n=59)与对照组(GnRHa-FSH组,n=111)。比较组间促排卵、妊娠结局、每周期治疗费用及药物效价比。结果:LE组和对照组FSH用药天数分别为6.3±1.9 d vs 13.0±2.3、用药量为615.6±284.6 IU vs l 504.9±424.9 IU,组间比较有显著性差异(P<0.01);hCG注射日E2值分别为1 965.3±1119.7 pmol/L vs 12 660.2±7 254.2 pmol/L,获卵数分别为6.5±3.3 vs16.6±7.9,组间比较均有显著性差异(P<0.01);受精率、胚胎种植率分别为66.1%vs71.6%,25.58%vs 23.63%,临床妊娠率为49.12%vs 34.48%,组间比较无显著性差异(P>0.05);中-重度OHSS发生率分别为O%和6.89%,组间比较差异有显著性(P<0.01)。LE组每刺激周期药费(2 877±1 240元)及每妊娠周期药费(3 014±1581元)显著低于对照组(6 561±1 852元、8774±1970元)(P<0.01),治疗效价比分别为5 959元vs 30 067元。结论:LE联合促卵泡素可有效运用于PCOS患者的IVF-ET中,较传统的GnRHa-FSH促排卵相比,无OHSS的发生、费用低、效价比高,且不影响妊娠率和种植率。

Objective： To explore the clinical results and the cost-effectiveness of using the aromatase inhibitor, letrozole （LE）, in conjunction with FSH for controlled ovarian stimulation in patients with PCOS undergoing IVF-ET. Methods： A total of 170 infertile patients with PCOS who underwent IVF-ET/ICSI treatment were selected for the retrospective study. The patients were divided into two groups according to the treatments： letrozole-FSH group （LE group, n=59） and long GnRH agonist-FSH group （GnRHa group or control group, n=111）. A retrospectively analysis was proformed between the two groups with dose of FSH used per cycle, the number of oocytes retrieved, fertilization rate, embryo implantation rate, clinical pregnancy rate and the occurrence of ovarian hyperstimulation syndrome （OHSS） and cost-effectiveness ratio per pregnancy. Results： Compared with control group, the LE group received a significantly lower total dose of FSH （615.6 ± 284.6 IU vs 1 504.9 ± 424.9 IU, P〈0.01） and had significantly decreased levels of terminal E2 （1 965.3 ±1119.7 pmol/L vs 12 660.2 ± 7 254.2 pmol/L, P〈0.01）. Significantly less oocytes were retrieved （6.5 ± 3.3 vs 16.6 ± 7.9）, but the fertilization rate （66.1% vs 71.6%）, the implantation rate （25.58% vs 2 3.63%） and the clinical pregnancy rate （49.12% vs 34.48%） did not differ when compared with control group. The difference of the occurrence of OHSS was significant （0% vs 6.89%） between the two groups. The cost for per cycle and per pregnant cycle were significantly lower in the LE group compared with control group （2 877±1240 RMB vs 6 561 ±1 852 RMB, 3 014 ±1 581 RMB vs 8 774 ± 1 970 RMB, P〈0.01）. The cost-effectiveness ratio was 5959 RMB in the letrozole group and 30 067 RMB in control group. Conclusion： A letrozole-FSH combination could be an effective ovarian stimulation protocol with PCOS patients in IVF/ICSI cycles. The incidence of OHSS can be controlled effectively. It is more cost-effective than long GnRH agonist/FSH protocol.