不同黄体支持方案在激素替代周期冻胚移植中的临床疗效及成本分析

Clinical efficacy and cost-effectiveness analysis in patients with hormone replacement for frozen-thawed embryo transfer under different luteal support scheme

目的探究不同黄体支持方案对激素替代周期冻融胚胎移植(hormone replacement therapy for frozen-thawed embryo transfer,HRT-FET)妊娠结局的影响及成本差异,寻找具有高成本-效果比的黄体支持方案。方法采用回顾性队列研究,选取2017年10月至2019年4月期间在山东大学附属生殖医院行HRT-FET患者,共1009个周期,按照移植后不同黄体支持方案分为口服黄体酮胶囊组(A组,504个周期)和黄体酮阴道缓释凝胶+地屈孕酮组(B组,505个周期),比较两种黄体支持方案患者的妊娠结局、成本-效果比。结果两组临床妊娠率、胚胎种植率、多胎妊娠率、异位妊娠率、早期流产率、晚期流产率、早产率、活产率、妊娠期并发症发生率、新生儿缺陷率、新生儿出生体质量,差异均无统计学意义(均P>0.05);A组的早期出血率明显低于B组[6.0%(30/504)比10.3%(52/505),P=0.015];A组成本-效果比明显优于B组(17.76比77.30)。结论在HRT-FET周期中,口服黄体酮胶囊在取得和黄体酮阴道凝胶联合地屈孕酮相同的妊娠结局的同时,可以减少患者阴道出血,降低了患者的医疗成本,因此临床上可以作为一种黄体支持方案。

Objective To evaluate the differences in pregnancy outcomes of patients and cost variance with hormone replacement therapy for frozen-thawed embryo transfer(HRT-FET)under different luteal support scheme.Methods A retrospective cohort study was performed.A total of 1009 cycles of HRT-FET from October 2017 to April 2019 were collected and the patients were recruited from Reproductive Hospital Affiliated to Shandong University.According to different luteal support protocol,patients in group A(n=504)were treated with oral progesterone capsule while patients in group B(n=505)were treated with progesterone vaginal sustained release gel and dydrogesterone.The pregnancy outcomes,pregnancy complications and cost-effectiveness ratio were compared between the two groups.Results There were no significant differences in embryo implantation rate,clinical pregnancy rate,multiple pregnancy rate,ectopic pregnancy rate,early and late abortion rate,premature birth rate,live birth rate,incidence of pregnancy complications and birth defect rate between the two groups(all P>0.05).But the incidence of vaginal bleeding in group B was significantly higher than that in group A[6.0%(30/504)vs.10.3%(52/505),P=0.015],cost-effectiveness ratio(C/E)in group A was better than that in group B(17.76 vs.77.30).Conclusion For patients undergoing HRT-FET cycles,oral progesterone capsule can reduce vaginal bleeding and medical cost,while achieving a pregnancy outcome similar to that of progesterone vaginal sustained release gel and dydrogesterone,so it can be used as a luteal support scheme in clinic.