改良长方案联合国产HMG的控制性促排卵方案的临床结局与经济性评价

目的探讨改良长方案降调节联合国产人绝经期促性腺激素(HMG)的控制性促排卵(COH)方案对体外受精-胚胎移植(IVF-ET)助孕的有效性与经济性。方法回顾性研究改良长方案的9 063个IVF-ET新鲜胚胎移植周期。根据促排卵药启动日血清黄体生成素(LH)水平及促排卵过程中卵泡生长速度及LH水平变化决定患者使用何种促性腺激素(Gn)药物。最终根据患者使用Gn的剂型将患者分为两组:仅使用重组卵泡刺激素(rFSH)为rFSH组;使用HMG或HMG和rFSH联合使用者为HMG组。比较两组促排卵药物的效果及助孕结局。结果比较两组最终结果:rFSH组患者年龄较轻、不育年限较短(P<0.05)。HMG组Gn使用天数及使用总量多,但费用[(2935.28±1 711.64)元vs.(8 413.78±2 049.22)元]明显低(P<0.001)。rFSH组的获卵数、胚胎数增多,但中重度OHSS发生率(2.62%vs.5.09%)也增高(P<0.01)。两组间HCG日子宫内膜厚度、受精率、优质胚胎数、临床妊娠率、胚胎种植率及早期流产率均无统计学差异(P>0.05)。结论使用GnRH-a降调节后,当血清LH≤1U/L时,使用国产HMG促排卵也可以获得较好的临床效果,并且减少促排卵药物的费用。

Clinical outcomes and economic evaluation of a modified long down-regulation combined with domestic HMG in controlled ovarian hyperstimulation of IVF-ET

Objective:To investigate the effectiveness and economical efficiency of controlled ovarian hyperstimulation (COH) by using a modified long down-regulation protocol combined with domestic HMG in IVF-ET.Methods:The data of 9 063 IVF-ET fresh embryo transfer cycles with modified long regimens were retrospectively analyzed.What kind of Gn would be used is according to the serum LH level on gonadotropin(Gn) starting day,the follicle growth velocity and the changes of LH levels during ovulation induction process.The patients were divided into two groups according to the type of Gn used:the patients used only recombinant FSH(rFSH) in rFSH group;the patients administrated HMG or the combination of HMG and rFSH in HMG group.The effectiveness of two kinds of ovulation induction regimens and clinical outcome were compared between the two groups.Results:Compared the two groups,the patients in rFSH group were younger and had shorter infertile duration(P＜0.05).The duration and dosage of Gn used were more(P＜0.05),but the cost of Gn was significantly less[(2 935.28±1 711.64) vs.(8 413.78±2 049.22) RMB]in HMG group(P＜0.001).The number of oocytes retrieved and embryos was significantly higher,however,the incidence of moderate and severe OHSS was significantly increased in rFSH group(P＜0.01).There were no significant differences in endometrial thickness on HCG day,fertilization rate,high quality embryos,clinical pregnancy rate,implantation rate and early abortion rate between two groups(P＞0.05).Conclusions:After GnRH-a down-regulation,Usage of domestic HMG for ovarian hyperstimulation can get better clinical outcome and reduce the cost of Gn when LH≤1 U/L.