自然周期联合黄体期卵巢刺激助孕和双重刺激助孕效果的对比分析

A comparative analysis of the effects of natural cycle combined with luteal ovarian stimulation and dual ovarian stimulation

目的探讨自然周期联合黄体期卵巢刺激(NLPS)和双重刺激方案(DuoS)助孕结局和费效比。方法本研究为回顾性队列研究,共纳入356例患者的376周期治疗,分为137个NLPS周期组和239个DuoS周期组。比较两组患者基本特征、治疗过程、结局变量、单周期花费和每获得一个优质胚胎的费效比,并进一步比较黄体期和卵泡期阶段结局和费效比。结果 NLPS组与DuoS组获卵数(P=0.41)、两个原核(2PN)数(P=0.74)、优质胚胎数(P=0.10)、临床妊娠率(P=0.08)差异均无统计学意义,NLPS组单周期花费更低(P<0.01),但DuoS组每获得一个优质胚胎的费效比更低。黄体期获卵数、2PN数和优质胚胎数均高于卵泡期(3.47±4.26 vs 1.13±1.21,Z=-8.59,P<0.01;2.03±2.59 vs 0.62±0.87,Z=-7.77,P<0.01;0.80±1.27 vs 0.24±0.50,Z=-6.52,P<0.01),单周期花费也较高(P<0.01),但费效比更优。结论 NLPS可获得与DuoS相同的临床结局,单周期花费更少,但DuoS费效比更优。联合LPS治疗时LPS对最终结局贡献更大,费效比也更优。

Objective To compare the pregnancy outcome and cost-effectiveness of nature cycle with luteal phase stimulation(NLPS) and dual ovarian stimulation(DuoS). Methods A total of 376 cycles in 356 patients were enrolled in this retrospective cohort study, including 137 cycles using NLPS and 239 cycles using DuoS protocols. Basic characteristics of patients, treatment variables, outcomes, average cost per cycle, and the cost-effectiveness for one good quality embryo were compared between the two groups. The luteal phase and follicular phase outcomes and cost-effectiveness ratio were also compared. Results There were no differences between NLPS and DuoS groups in the numbers of oocyte retrieval(P=0.41), two pronuclei(2 PN)(P=0.74), good quality embryos(P=0.10), and the rate of clinical pregnancy(P=0.08). The cost per cycle was lower in NLPS(P<0.01), but the cost-effectiveness for one good quality embryo was better in DuoS. The numbers of oocyte retrieval, 2 PN, and good quality embryos were higher after LPS(3.47±4.26 vs 1.13±1.21, Z=-8.59, P<0.01;2.03±2.59 vs 0.62±0.87, Z=-7.77, P<0.01;0.80±1.27 vs 0.24±0.50, Z=-6.52, P<0.01). The cost per cycle was higher in LPS, but the cost-effectiveness was also better(P<0.01). Conclusion NLPS shows same clinical outcome compared with DuoS, but has lower cost per cycle. DuoS has better cost-effective to obtain one good quality embryo. LPS contributes more to the final outcome and is more economical compared to follicular phase stimulation within the same cycle.