体外受精一胚胎移植中三种不同的促排方法临床疗效和经济性的比较分析

Comparison of clinical efficacy and cost-effectiveness of IVF-ET cycles with three different protocols of controlled ovarian hyperstimulation

目的比较体外受精-胚胎移植(IVF-ET)控制性超排卵(COH)中三种不同促排卵方法的疗效及经济性。方法回顾性分析2012年1～12月在我院生殖中心行IVF/卵胞浆内单精子注射(ICSI)常规长方案治疗的不孕症患者共242个治疗周期,根据COH中不同促排方法分为三组,重组卵泡刺激素组(rFSH,果纳芬)102例,高纯度尿源性卵泡刺激素组(uFSH,丽申宝)82例,高纯度尿源性卵泡刺激素+人绝经期促性腺激素(uFSH+HMG)58例。比较三组患者促性腺激素(Gn)用量、Gn天数、人绒毛膜促性腺激素(HCG)注射日雌二醇(E_2)水平、获卵数、受精率、卵裂率、可移植胚胎数、妊娠率、种植率、流产率、卵巢过度刺激综合征(OHSS)发生率及促排卵药品的费用。结果三组患者Gn促排卵天数、HCG注射日E_2水平、获卵数、受精率、卵裂率、可移植胚胎数、妊娠率、种植率、流产率、OHSS发生率均无显著差异(P>0.05);uFSFH+HMG组Gn用量及费用显著少于其余两组(P<0.05)。结论 uFSH与rFSH超排卵效果相当,在IVF-ET长方案促排后期适当地加用HMG可取得更好的超排效果,且可降低患者的医药费用。

Objective： To compare the clinical efficacy and the cost-effectiveniss of in vitro fertilization embryo- transfer（IVF-ET）with three different protocols for controlled ovarian hyperstimulation. Methods： A total of 242 IVF/ICSI-ET cycles in infertility patients who received their treatment in our reproductive centre from January to November 2012 were analyzed retrospectively. They were divided into three groups according to ovarian stimulation protocol： rFSH group（gonal-F group, 102 patients）, uFSH group （urofollitropin group, 82 patients） and uFSH ＋ HMG group（urofollitropin＋ HMG group, 58 patients）. The clinical outcomes were compared among the three groups. Results： The duration of gonadotropin stimulation,estradiol levels on HCG day,numbers of retrieved oocytes, fertilization rate, the number of transferable embryos, clinical pregnancy rate, implantation rate, abortion rate and incidence of ovarian hyperstimulation syndrome were not significantly different among the three groups（P〈0.05）. The total gonadotropin dose and the overall cost of gonadotropin in uFSH＋HMG group were significantly less than those in the other two groups（P〈0.05）. Conclusions： The u-FSH and r-FSH have the same effectiveness in ovarian stimulation in IVF-ET cycles. When u-FSH is used in combination with HMG,the clinical effectiveness is improved and the cost isreduced.