IVF与IUI助孕成本效益比较的初步探讨

Cost-effectiveness of IVF versus intrauterine insemination

目的回顾性分析本中心宫腔内人工授精(IUI)或体外受精(IVF)助孕周期的临床资料,初步探讨IVF与IUI助孕的成本效益,以期为临床诊治提供参考。方法回顾性分析2016年期间在本中心行IUI助孕的113个周期(IUI组)以及进行IVF助孕治疗的121个取卵周期(IVF组)的临床资料。观察两组的临床妊娠率、多胎妊娠率、早期流产率、异位妊娠率及卵巢过激刺激综合征(OHSS)发生情况,记录两组的药物使用费用、手术费用等,计算患者的临床妊娠成本;同时对IUI组中连续进行3次IUI的患者亦进行相关成本计算和比较。结果IUI组和IVF组的患者年龄、体重指数(BMI)、不育年限、原发不孕比例、男方精液浓度比较,差异均无统计学意义(P>0.05);不育原因构成比中,两组患者存在一定差异(P<0.05)。IVF组的临床妊娠率(63.64%)及多胎妊娠率(25.97%)显著高于IUI组(分别为7.08%、12.50%)(P<0.05);两组间中重度OHSS发生率、早期流产率、异位妊娠率比较无显著性差异(P>0.05)。IVF组的Gn费用、手术费用及总费用均显著高于IUI组(P<0.05)。IUI组中,每1名患者成功妊娠所花费的成本是46 595.60元,高于IVF组中每例患者成功妊娠所花费的34 163.40元,但尚无显著性差异(P>0.05);3次IUI组中,每1名患者成功妊娠所花费的成本为33 341.00元,低于IVF组和IUI组,但亦无显著性差异(P>0.05)。结论对于有IVF指征、拟行IUI助孕的患者来说,进行一个完整周期的IVF助孕比单次行IUI助孕的妊娠成本更低、更划算;对已经进行IUI助孕的患者,连续3次行IUI助孕能有效降低妊娠成本。但由于本次纳入的样本量相对较小且研究设计存在一定局限性,仍需更多的大样本前瞻性研究进一步探索。

Objective:To retrospectively analyze of the clinical data of intrauterine insemination(IUI)and IVF assisted pregnancy cycle,and compare the cost and benefit between IVF and IUI,in order to provide reference for clinical diagnosis and treatment.Methods:The clinical data of 113 IUI cycles and 121 IVF cycles in our clinical center in 2016 were retrospectively analyzed.The clinical pregnancy rate,multiple pregnancy rate,early abortion rate,ectopic pregnancy rate and ovarian hyperstimulation syndrome(OHSS)in the two groups were observed.The cost of drug used,surgery cost,etc.were recorded and the clinical pregnancy cost per patient was calculated.At the same time,the related costs were calculated for patients performed IUI for three times.Results:The female age,BMI,duration of infertility,the proportion of primary infertility and sperm concentration had no significant difference between the two groups.There was a significant difference in the proportions of infertility causes between the two groups(P<0.05).The clinical pregnancy rate(63.64%)and multiple pregnancy rate(25.97%)in the IVF group were significantly higher than those in the IUI group(7.08%and 12.50%respectively)(P<0.05).There was no significant difference in the incidence of moderate to severe OHSS,early abortion rate and ectopic pregnancy between the two groups(P>0.05).The cost of gonodotropin used,surgery cost and total cost of the IVF group were significantly higher than those of the IUI group(P<0.05).In the IUI group,the cost of successful pregnancy per patient(46595.60RMB)was higher than that in the IVF group(34163.40RMB),but there was no significant difference(P>0.05).The cost of successful pregnancy for each patient in the three times IUI group(33341.00RMB)was lower than that of the IVF group and the IUI group,but there was no significant difference(P>0.05).Conclusions:The cost-effectiveness per clinical pregnancy of one IVF full cycle treatment is lower than that of once IUI cycle.However,the cost-effectiveness per clinical pregnancy can effectively be reduced while couples undergoing three consecutive IUI cycles.However,due to the relatively small sample size and limitation of the research design,more large-scale prospective studies are needed to further investigation.