不同黄体支持方案在自然周期冻融胚胎移植中的临床疗效及成本分析

Effects and cost analysis of different luteal supports protocols on pregnancy outcomes in nature cycles of frozen-thawed embryo transfer

目的探究不同黄体支持方案对自然周期冻融胚胎移植(FET)妊娠结局的影响及成本差异,以期为寻找成本-效果比更优的黄体支持方案提供参考。方法回顾性分析2017年7月至2020年10月在山东大学附属生殖医院行自然周期FET助孕治疗的不孕患者(共6840个治疗周期)的临床资料。根据黄体支持方案不同,分为口服黄体酮胶囊组(A组,n=1693)和口服地屈孕酮组(B组,n=5147),比较两组患者的妊娠结局及成本-效果比。结果两组患者的移植年龄、体质量指数(BMI)、基础性激素水平、不孕类型等一般资料比较均无显著性差异(P>0.05)。两组患者排卵日子宫内膜厚度、可用囊胚数、移植囊胚数、临床妊娠率、胚胎种植率、多胎妊娠率、异位妊娠率、早期流产率及继续妊娠率等指标比较亦无显著性差异(P>0.05)。A组的成本-效果比显著优于B组(6.94 vs.13.80)(P<0.05)。结论对于自然周期FET患者,口服黄体酮胶囊可以获得与口服地屈孕酮相似的妊娠结局,且一定程度上降低了患者的医疗成本,可作为临床工作中一种可选的适宜方案。

Objective:To explore the effects of different luteal support protocols on pregnancy outcomes and the costs difference in natural cycle of frozen-thawed embryo transfer(FET),in order to provide reference for finding luteal support protocol with better cost-effectiveness ratio.Methods:The clinical data of 6840 natural FET cycles performed in Reproductive Hospital Affiliated to Shandong University from July 2017 to October 2020 were retrospectively analyzed.According to different luteal support protocols,the patients were divided into oral progesterone capsule group(group A,n=1693)and oral didroxyprogesterone group(group B,n=5147).The pregnancy outcomes and cost-effectiveness ratio were compared between the two groups.Results:There was no significant difference in transplantation age,body mass index(BMI),basic sex hormone level and infertility type between the two groups(P>0.05).There were no significant differences in endometrial thickness on the ovulation day,number of available blastocysts,number of blastocysts transferred,clinical pregnancy rate,embryo implantation rate,multiple pregnancy rate,ectopic pregnancy rate,early abortion rate,ongoing pregnancy rate between the two groups(P>0.05).However,the cost-effectiveness ratio in group A was better than that in group B(6.94 vs.13.80)(P<0.05).Conclusions:Oral progesterone capsule can obtain the pregnancy outcome similar to oral didroxyprogesterone,and reduce the medical cost of patients in a certain extent.It can be used as an optional and appropriate protocol in clinical work.