IVF/ICSI周期中不同移植方案的临床结局及经济学分析

Analysis of the clinical outcomes and economic evaluation of different transferring scheme in IVF/ICSI cycle

目的:探讨IVF/ICSI周期中第三天可利用胚胎为5枚以上的患者选择不同移植方案的临床结局及经济学评价。方法:选取2014年1月至2015年12月于郑州大学第三附属医院生殖医学中心行IVF/ICSI-ET治疗不孕症的1400例周期,按移植方案分为3组:移植D3胚胎(A组,1109个周期),非选择性囊胚移植组(B组,160个周期),选择性(单)囊胚移植组(C组,131个周期)。分析各组的临床结局和经济学成本。结果:A组患者的获卵数和种植率均明显低于B组和C组,差异均有统计学意义(P<0.05);3组患者的2PN受精率、卵裂率、可移植胚胎率、优质胚胎率、临床妊娠率和流产率比较,差异均无统计学意义(P>0.05)。A组患者的多胎率明显高于B组和C组(P均=0.000),且B组明显高于C组(P=0.000)。C组患者移植的成本效果比最小。结论:3组移植方案的临床妊娠率相似;选择性单囊胚移植明显提高胚胎种植率,降低多胎率,治疗成本效果比最小,是相对最佳的移植方案。

Objective：To explore the clinical outcomes and economic evaluation of the different transferring scheme for the patients who has more than five available embryos on the third day in the IVF/ICSI cycles.Methods：1400 patients who underwent in-vitro fertilization and intracytoplasmic sperm injection（IVF/ICSI） were analyzed retrospectively between Jan.2014 and Dec.2015 in our center,they were divided into three groups according to the different transfer scheme：group A was for transferring D3 embryo 1109 cycles,group B was for transferring nonselective blastocyst 160 cycles and group C was for selective blastocyst transferring 131 cycles,the clinical outcomes and economic evaluation of three groups were analysed.Results：The number of oocytes and implantation rate of group A were lower than group B and C（P〈0.05）.There were no statistical differences with the indexes of 2PN fertilization rate,cleavage rate,available embryo rate,good quality embryo rate,clinical pregnancy rate and abortion rate among the three groups.The multiple pregnancy rate of group A was higher than that of group C and group B （P=0.000）,group B was obviously higher than group C （P=0.000）.Group C patients had the relatively less rate of cost effect.Conclusion：The clinical pregnancy rate of three transferring scheme was similar.Selective single blastocyst transfer can obviously increase the rate of embryo of implantation while reduce multiple pregnancy rate,and it had the least rate of cost effect in fresh cycle,it was a relatively optimal transfer scheme.