高龄合并卵巢储备功能低下患者三种促排卵方案的临床结局比较

Comparison of the clinical outcomes of three ovulation induction protocols in elderly patients with decline in ovarian reserve

目的分析体外受精-胚胎移植(IVF-ET)中使用3种不同促排卵方案对于高龄合并卵巢储备功能低下患者的临床结局和费效比,探讨经济有效的促排卵方案。方法回顾性分析2017年1月至2018年10月期间宁波市妇女儿童医院生殖中心高龄同时合并卵巢储备功能低下(按照POSEIDON标准,属于第4组)的低预后患者,行IVF-ET助孕,根据其使用的促排卵方案的不同,分为3组:拮抗剂方案组(A组,169个周期),微刺激方案组(B组,57个周期),高孕激素状态下促排卵(PPOS)组(C组,59个周期),分析3种促排卵方案的临床结局及费效比。结果A组获卵数(4.46±1.45)多于B组(2.42±1.12)和C组(3.28±1.62)(P=0.013,P=0.021);累积临床妊娠率A组(35.50%)高于B组(21.43%)、C组(23.73%)(P=0.012,P=0.021);周期取消率A组(0.95%)最低;每获一卵所需费用A组[(3817±1450)元]明显低于B组[(5868±1820)元]、C组[(4484±1678)元](P=0.011,P=0.214);每获一枚可利用胚胎所需费用A组[(7276±2329)元]低于B组[(7978±2560)元]和C组[(7466±2175)元](P=0.001,P=0.012),每获一临床妊娠所需费用A组[(47957±22388)元]低于B组[(67450±35210)元]、C组[(61984±33463)元],组间比较差异均有统计学意义(P=0.012,P=0.021)。结论对于35周岁以上、刺激前卵巢储备功能低下患者,从临床结局及费效比方面综合考虑,拮抗剂方案优于微刺激、PPOS,是比较理想的促排卵方案。

Objective To analyze the clinical outcomes and cost-effectiveness ratio of the patients with ovarian reserve dysfunction in three different ovulation induction protocols during in vitro fertilization-embryo transfer(IVF-ET),and to explore a cost-effective ovulation induction protocol.Methods A retrospective analysis was made on the low prognosis in IVF-ET of elderly patients with low ovarian reserve function(according to POSEIDON criteria,group 4)in Reproductive Center of Ningbo Women&Children Hospital during January 2017 to October 2018.According to the different ovarian stimulation protocols used,they were divided into three groups:antagonist group(group A,169 cycles),micro-stimulation group(group B,57 cycles),and progestin-primed ovarian stimulation(PPOS)group(group C,59 cycles).The clinical outcome and cost-effectiveness of three ovulation-promoting protocols were analyzed.Results In group A,compared with group B and group C,both the number of obtained eggs[4.46±1.45,2.42±1.12,3.28±1.62,respectively in the three groups(P=0.013,P=0.021)]and the cumulative clinical pregnancy rate were higher(35.50%,21.43%,23.73%,respectively in the three groups)(P=0.012,0.021).In group A,the rate of cycle cancellation was the lowest in the three groups(0.95%,21.05%,15.24%,respectively).In group A,the average cost of each egg acquisition was the lowest[(3817±1450)yuan,(5868±1820)yuan,(4484±1678)yuan,respectively in the three groups](P=0.001,P=0.012,P=0.017),and the cost of each available embryo was the lowest too[(7276±2329)yuan,(7978±2560)yuan,(7466±2175)yuan,respectively in the three groups](P=0.001,P=0.021,P=0.033).The cost per clinical pregnancy was lower in group A than in group B and group C[(47957±22388)yuan,(67450±35210)yuan,(61984±33463)yuan,respectively in the three groups](P=0.012,P=0.021).Conclusion For patients aged over 35 years with poor ovarian reserve before stimulation,antagonist protocol was superior to micro-stimulation and PPOS,considering the clinical outcome and cost-effectiveness ratio,and it was an ideal ovary stimulation protocol.