广州医药 ›› 2023, Vol. 54 ›› Issue (6): 61-67.DOI: 10.3969/j.issn.1000-8535.2023.06.011

• 论著 • 上一篇    下一篇

不同分期的子宫内膜异位症患者采用卵泡期长方案行IVF-ET助孕结局与成本效果分析

罗小欢, 夏薇, 苏宁, 李海霞, 蔡美虹   

  1. 广州市第一人民医院生殖健康与不孕症专科(广州 510180)
  • 收稿日期:2022-09-29 出版日期:2023-06-20 发布日期:2023-07-27
  • 通讯作者: 夏薇,E-mail:rose-xw@163.com
  • 基金资助:
    广州市卫生健康科技西医类一般引导项目(20201A011006)

The outcome and cost-effectiveness analysis of IVF-ET assisted pregnancy for patients in different stages of endometriosis with follicular phase long protocol

LUO Xiaohuan, XIA Wei, SU Ning, LI Haixia, CAI Meihong   

  1. Department of Reproductive Health and Infertility,Guangzhou First People's Hospital,Guangzhou 510180,China
  • Received:2022-09-29 Online:2023-06-20 Published:2023-07-27

摘要: 目的 探讨不同分期的子宫内膜异位症(EMs)患者行体外受精-胚胎移植(IVF-ET)助孕结局与成本效果分析。方法 回顾性分析2016年1月—2022年1月Ⅰ~Ⅱ期、Ⅲ~Ⅳ期EMs患者应用卵泡期长方案及同期因“输卵管因素”患者采用黄体期长方案行IVF-ET的助孕结局以及成本费用。结果 EMs各组的启动日LH、E2以及hCG日E2水平低于对照组(P<0.05),Ⅲ~Ⅳ期EMs组的可利用胚胎数、着床率、临床妊娠率、活产率明显低于对照组及Ⅰ~Ⅱ期EMs组(P<0.05),其流产率偏高,但组间比较差异无统计学差异(P>0.05)。各组间的Gn剂量、Gn天数、hCG日的LH水平、hCG日≥14 mm卵泡数、hCG日子宫内膜厚度、获卵数、受精率、卵裂率比较差异无统计学意义(P>0.05)。成本效果分析提示:各组平均周期总成本无明显差异,Ⅰ~Ⅱ期EMs组患者患者获得一例妊娠所花费的成本与对照组相当,而Ⅲ~Ⅳ期EMs组患者获得一例妊娠所花费的成本最高。结论 对于不同分期的EMs,Ⅰ~Ⅱ期患者应用卵泡期长方案的患者可获得良好的妊娠结局,其妊娠率及成本与传统方案相当,而Ⅲ-Ⅳ期的患者妊娠率偏低,获得妊娠的成本更高,可能与该疾病严重程度及方案选择有关。

关键词: 子宫内膜异位症, 体外受精-胚胎移植, 卵泡期长方案, 成本效果分析

Abstract: Objective To analyze the outcome and cost-effectiveness of invitrofertilization-embryotransfer(IVF-ET)assisted pregnancy in endometriosis(EMs)patients with different stages.Methods The outcomes and costs of patients with stageⅠ-Ⅱ and Ⅲ-Ⅳ EMs treated with follicular phase long protocol and patients treated with luteal phase long protocol due to“tubal factors” during the same time from January 2016 to January 2022 were retrospectively analyzed.Results The levels of LH,E2 on initiation day and the levels of E2 on hCG day in EMs groups were lower than those in control group(P<0.05),the number of available embryos,implantation rate,clinical pregnancy rate and live birth rate in stage Ⅲ-Ⅳ EMs group were significantly lower than those in control group and stageⅠ-Ⅱ EMs group(P<0.05),and the abortion rate was higher.But there was no significant difference between groups(P>0.05).There were no significant differences in the dosage of Gn,duration of Gn,the levels of LH on hCG day,the number of follicles with diamete≥14 mm on hCG day,endometrial thickness on hCG day,number of oocytes retrieved,fertilization rate and cleavage rate among the three groups(P>0.05).Conclusions For different stages of endometriosis,patients in stageⅠ-Ⅱ who apply the follicular phase long protocol can achieve good pregnancy outcomes,and their pregnancy rate and cost are comparable to the traditional regimen,while patients in stage Ⅲ-Ⅳ have a low pregnancy rate,and the cost of pregnancy is higher,which should be related to the severity of the disease and the choice of regimen.

Key words: endometriosis, invitrofertilization-embryotransfer, follicular phase long protocol, cost-effectiveness analysis