拮抗剂方案与高孕激素下促排卵方案的效果及成本分析

Analysis of efficacy and cost of GnRH antagonist protocol and progestin-primed ovarian stimulation protocol in IVF

目的探讨分析促性腺激素释放激素(GnRH)拮抗剂方案与高孕激素下促排(PPOS)方案的效果及成本。方法回顾性分析2016年1月至2020年2月期间在西北妇女儿童医院生殖中心先后行拮抗剂方案与PPOS方案的160位不孕症患者进行自身对照研究,比较分析两组的效果及成本;并根据基础窦卵泡数(AFC)分为AFC≤5和AFC>5组,比较分析拮抗剂方案和PPOS方案的促排卵效果及成本。结果两种不同促排卵方案的患者基础资料比较无统计学意义(P>0.05)。与PPOS方案比较,拮抗剂方案Gn使用时间、Gn总量、成本显著增加(P<0.05),而HCG日LH、E 2水平,获卵数、优胚数、可移植胚胎数、流产率在两种方案间均无显著性差异(P>0.05);PPOS方案的临床妊娠率(34.37%vs.28.13%)有增高的趋势,但无统计学差异(P>0.05)。AFC≤5的患者:与PPOS方案比较,拮抗剂方案Gn使用时间、Gn总量、成本显著增加(P<0.05),而HCG日LH、E 2、可移植胚胎数、优胚数、FET临床妊娠率、流产率两种方案间均无统计学差异(P>0.05);AFC>5的患者:与PPOS方案比较,拮抗剂方案Gn总量、成本显著增加(P<0.05),而HCG日LH、E 2、可移植胚胎数、优胚数、FET临床妊娠率、流产率两种方案间均无统计学差异(P>0.05)。多因素Logistic回归分析结果显示:两种促排卵方案及患者的年龄、不孕年限、AFC、基础FSH水平、Gn使用时间、Gn总量对临床妊娠的影响均无统计学意义(P>0.05);不同AFC患者(AFC≤5和AFC>5)中,促排卵方案、年龄、不孕年限、基础FSH、Gn使用时间、Gn总量对临床妊娠的影响均无统计学意义(P>0.05)。结论与拮抗剂方案相比,PPOS方案成本低,获卵数、可移植胚胎数等相当,FET临床妊娠率有增高趋势。

Objective:To analyze the effect and cost of GnRH antagonist protocol and progestin-primed ovarian stimulation(PPOS)protocol.Methods:The data of 160 infertile patients who received the antagonist protocol and PPOS protocol in a self-controlled manner in the Reproductive Center of Northwest Women’s and Children’s Hospital from January 2016 to February 2020 were retrospectively analyzed.The effects and costs of the two groups were compared.According to the basic antral follicles count(AFC),they were divided into AFC≤5 and AFC>5 groups,and the effect and cost of the ovulation induction were compared between the antagonist protocol and PPOS protocol.Results:There was no significant difference in the basic data between the patient with antagonist protocol and PPOS protocol(P>0.05).Compared with PPOS protocol,the duration&total doses of Gn used and the cost of the antagonist protocol were increased significantly(P<0.05),while there was no significant difference in the level of LH and E 2 on HCG day,the number of oocytes retrieved,the number of high-quality embryos,the number of transferable embryos,and the abortion rate(P>0.05).The clinical pregnancy rate of the PPOS protocol(34.37%vs.28.13%)tended to increase,but there was no significant difference(P>0.05).In patients with AFC≤5:compared with the PPOS protocol,the duration&total doses of Gn used and cost of the antagonist protocol increased significantly(P<0.05),while there was no significant difference in the level of LH and E 2 on HCG day,the number of transferable embryos&high-quality embryos,FET clinical pregnancy and the abortion rate(P>0.05).In patients with AFC>5:compared with the PPOS protocol,the duration&total doses of Gn used and cost of the antagonist protocol increased significantly(P<0.05),while there was no significant difference in the level of LH and E 2 on HCG day,the number of transferable embryos&high-quality embryos,FET clinical pregnancy and the abortion rate(P>0.05).The results of multivariate logistic regression analysis showed that patients’age,infertility years,AFC,basic FSH level,the duration&total doses of Gn used have no significant effect on clinical pregnancy rate(P>0.05).The ovulation induction protocol,age,infertility years,basic FSH level,the duration&total doses of Gn used also have no significant effect on clinical pregnancy rate in different AFC patients(AFC≤5 or AFC>5)(P>0.05).Conclusions:Compared with the antagonist protocol,the cost is lower,the number of oocytes retrieved and the number of transferable embryos are comparable,and the clinical pregnancy rate of frozen-thawed transfer(FET)has a tendency to increase in the PPOS protocol.