高龄患者两种体外受精方案自身病例对照与经济学分析

Self-control and economic analysis of two types of IVF in elderly patients

目的探讨高龄卵巢储备功能下降(diminished ovarian reserve,DOR)患者行双刺激方案失败后1年内改行高孕激素方案助孕结局的自身对照与经济学分析。方法选择2014年1月至2017年1月在安徽医科大学附属省立医院生殖中心接受常规体外受精/卵胞浆内单精子注射技术治疗的高龄DOR患者41例为研究对象,均于双刺激方案移植失败后1年之内改行高孕激素下超促排卵(progestin-primed ovarian stimulation,PPOS)方案,分别记为双刺激方案组和PPOS方案组。结果两组年龄、不孕年限、基础卵泡生成激素、黄体生成激素、雌二醇水平及基础窦卵泡数差异无统计学意义(P>0.05);双刺激方案组促排天数、治疗总费用、促排药物费较PPOS方案组高且差异均有统计学意义(P<0.05);双刺激方案组平均促性腺激素用量、获卵数、2PN数、可利用胚胎数大于PPOS方案组,优质胚胎数少于PPOS方案组,但差异均无统计学意义(P>0.05)。PPOS方案组周期取消率、可利用胚胎率、生化妊娠率、临床妊娠率大于双刺激方案组,其获卵率、流产率小于双刺激方案组,差异均无统计学意义(P>0.05),其优质胚胎率大于双刺激方案组且差异有统计学意义(P<0.05)。结论 PPOS方案相对于双刺激方案能提高优质胚胎率,获取更好的妊娠结局,缩短治疗时间,有更高的经济学效益,高龄DOR患者可优先选择。

Objective Analyze self - control and cost - effectiveness of two protocols in elderly patients with diminished ovarian reserve（DOR） within a year, after the failure of the freze -thaw embryo transfer in double stimulations protocol ovulation induction transfer to progestin- primed ovarian stimulation（PPOS）. Methods Selected single in vitro fertilization/cytoplasmic transplantation （IVF/ICSI- ET） from January 2014 to january 2017 in Anhui Provincical Hospital in anvanced age patients with DOR. After the failure of the freze - thaw embryo transfer in double stimulations protocol ovulation induction transfer to PPOS. Double stimulations protocol（ group A, n = 41 ）, progestin primed ovarian stimulation （ group B, n = 41 ）. Results There were no statistical difference in age, duration of the basic levels of FSH, LH and E2 among the two groups （ P 〉 0. 05 ）. The day of gonadotropin used, total cost of treatment, gonadotropin cost per cycle in group A were significantly higher than group B （P 〈 0. 05 ）. The average dose of gonadotropin, number of retrieved oocytes, 2PN, available embryos, high -quality embryos, the cycle cancellation rate, biochemical pregnancy and clinical prenancy had no significant differences among the two groups but high - quality embryos rate in group B was significant higher than that in group A （ P 〈 0. 05 ）. Conclusion PPOS can improve the high - quality embryos to obtain better pregnancy outcome, with shorten treatment time as well as higher economic benifit relative to double stimulations protocol. It may be a preference choice to elderly patients with DOR.