基础窦卵泡数与高生育年龄患者IVF/ICSI-ET结局的关系及经济学评价

目的:探讨40岁以上女性进行体外受精/单精子卵胞浆内注射-胚胎移植(IVF/ICSI-ET)时基础窦卵泡数(bAFC)预测助孕结局的价值及所需的医疗成本。方法:将2007年1月至2010年5月于本院行IVF/ICSI-ET治疗不孕症的101例高生育年龄女性按bAFC分为3组:A组(bAFC<6个),B组(6个≤bAFC<10个)和C组(bAFC≥10个),回顾性分析各组的助孕结局及治疗成本。结果:A组45例,47个周期;B组35例,41个周期;C组21例,24个周期。3组患者的年龄、不孕年限、体重指数、促性腺激素总量、促性腺激素刺激时间和流产率比较,差异无统计学意义(P>0.05);C组的基础卵泡刺激素较低、促性腺激素启动剂量较小,人绒毛膜促性腺激素日血清E2水平较高,而获卵数、2原核期个数(2PN)、成熟卵子个数、优质胚胎数和移植胚胎数明显增加,周期临床妊娠率和着床率明显升高,与A组和B组比较,差异有统计学意义(P<0.05)。3组患者首次助孕的各项治疗费用及总费用比较,差异均无统计学意义(P>0.05)。结论:bAFC对高生育年龄女性的助孕结局具有一定的预测价值,bAFC≥10个具有较好的临床结局,而不同bAFC个数的治疗费用相似。

Relationships Among Basal Antral Follicle Count, Clinical Outcomes and Economic Evaluation in Patients with Advanced Reproductive Age Undergoing IVF/ICSI-ET

Objective:To investigate the predictive value of basal antral follicle count(AFC) on clinical outcomes and medical costs in women above 40 year-old undergoing in vitro fertilization/intracytoplasmic sperm injection-embryo transfer(IVF/ICSI-ET).Methods:All 101 women with advanced age,who underwent IVF/ICSI-ET from Jan 2007 to May 2010 in our hospital were divided into 3 groups according to the number of basal antral follicle count,including:group A(bAFC<6),group B(6≤bAFC<10) and group C(bAFC≥10).Clinical outcomes and treatment costs were formed retrospectively analyzed among these groups.Results:45 cases with 47 cycles were in group A.35 cases with 41 cycles were in group B.There were no significant difference among these groups in the age,infertile duration,body mass index,total gonadotrophin doses,duration of gonadotrophin stimulation and abortion rate(P>0.05).In group C,basal follicle stimulation hormone and gonadotrophin initial doses were lower,serum estradiol level on day of HCG administration was higher,and the numbers of oocyte retrieved,two pronucleus,mature oocytes,good quality embryos and embryos replaced per cycle were markedly elevated.Furthermore,both clinical pregnancy rate and implantation rate were significantly higher in group C.The difference among them showed statistically significant when compared with group A and B(P<0.05).There were also no significant difference among these groups in every treatment costs when the patient received IVF/ICSI-ET for the first time(P>0.05).Conclusions:bAFC has predictive value on clinical outcomes in advanced reproductive-age women,and when bAFC≥10,the clinical outcomes are best.The treatment costs about different bAFC counts are similar.