自然周期联合黄体期卵巢刺激助孕和双重刺激助孕效果的对比分析

doi:10.6040/j.issn.1671-7554.0.2021.0708

摘要/Abstract

摘要： 目的探讨自然周期联合黄体期卵巢刺激(NLPS)和双重刺激方案(DuoS)助孕结局和费效比。方法本研究为回顾性队列研究,共纳入356例患者的376周期治疗,分为137个NLPS周期组和239个DuoS周期组。比较两组患者基本特征、治疗过程、结局变量、单周期花费和每获得一个优质胚胎的费效比,并进一步比较黄体期和卵泡期阶段结局和费效比。结果 NLPS组与DuoS组获卵数(P=0.41)、两个原核(2PN)数(P=0.74)、优质胚胎数(P=0.10)、临床妊娠率(P=0.08)差异均无统计学意义,NLPS组单周期花费更低(P<0.01),但DuoS组每获得一个优质胚胎的费效比更低。黄体期获卵数、2PN数和优质胚胎数均高于卵泡期(3.47±4.26 vs 1.13±1.21,Z=-8.59, P<0.01;2.03±2.59 vs 0.62±0.87,Z=-7.77,P<0.01;0.80±1.27 vs 0.24±0.50,Z=-6.52,P<0.01),单周期花费也较高(P<0.01),但费效比更优。结论 NLPS可获得与DuoS相同的临床结局,单周期花费更少,但DuoS费效比更优。联合LPS治疗时LPS对最终结局贡献更大,费效比也更优。

关键词: 黄体期刺激, 双刺激, 体外受精, 临床妊娠, 费效比

Abstract: Objective To compare the pregnancy outcome and cost-effectiveness of nature cycle with luteal phase stimulation(NLPS)and dual ovarian stimulation(DuoS). Methods A total of 376 cycles in 356 patients were enrolled in this retrospective cohort study, including 137 cycles using NLPS and 239 cycles using DuoS protocols. Basic characteristics of patients, treatment variables, outcomes, average cost per cycle, and the cost-effectiveness for one good quality embryo were compared between the two groups. The luteal phase and follicular phase outcomes and cost-effectiveness ratio were also compared. Results There were no differences between NLPS and DuoS groups in the numbers of oocyte retrieval(P=0.41), two pronuclei(2PN)(P=0.74), good quality embryos(P=0.10), and the rate of clinical pregnancy(P=0.08). The cost per cycle was lower in NLPS(P<0.01), but the cost-effectiveness for one good quality embryo was better in DuoS. The numbers of oocyte retrieval, 2PN, and good quality embryos were higher after LPS(3.47±4.26 vs 1.13±1.21, Z=-8.59, P<0.01; 2.03±2.59 vs 0.62±0.87, Z=-7.77, P<0.01; 0.80±1.27 vs 0.24±0.50, Z=-6.52, P<0.01). The cost per cycle was higher in LPS, but the cost-effectiveness was also better(P<0.01). Conclusion NLPS shows same clinical outcome compared with DuoS, but has lower cost per cycle. DuoS has better cost-effective to obtain one good quality embryo. LPS contributes more to the final outcome and is more economical compared to follicular phase stimulation within the same cycle.

Key words: Luteal phase stimulation, Dual ovarian stimulation, In vitro fertilization, Clinical pregnancy, Cost-effectiveness

中图分类号:

R711.6

陈伟,郭情情,徐金,方园,孙梅,盛燕. 自然周期联合黄体期卵巢刺激助孕和双重刺激助孕效果的对比分析[J]. 山东大学学报 (医学版), 2021, 59(8): 61-66.

CHEN Wei, GUO Qingqing, XU Jin, FANG Yuan, SUN Mei, SHENG Yan. A comparative analysis of the effects of natural cycle combined with luteal ovarian stimulation and dual ovarian stimulation[J]. Journal of Shandong University (Health Sciences), 2021, 59(8): 61-66.

参考文献

[1] Kuang Y, Chen Q, Hong Q, et al. Double stimulations during the follicular and luteal phases of poor responders in IVF/ICSI programmes(Shanghai protocol)[J]. Reprod Biomed Online, 2014, 29(6): 684-691.
[2] Vaiarelli A, Cimadomo D, Ubaldi N, et al. What is new in the management of poor ovarian response in IVF?[J]. Curr Opin Obstet Gynecol, 2018, 30(3): 155-162.
[3] Qin N, Chen Q, Hong Q, et al. Flexibility in starting ovarian stimulation at different phases of the menstrual cycle for treatment of infertile women with the use of in vitro fertilization or intracytoplasmic sperm injection[J]. Fertil Steril, 2016, 106(2): 334-341.
[4] Wang N, Wang Y, Chen Q, et al. Luteal-phase ovarian stimulation vs conventional ovarian stimulation in patients with normal ovarian reserve treated for IVF: a large retrospective cohort study[J]. Clin Endocrinol(Oxf), 2016, 84(5): 720-728.
[5] Zhang W, Wang M, Wang S, et al. Luteal phase ovarian stimulation for poor ovarian responders[J]. JBRA Assist Reprod, 2018, 22(3): 193-198.
[6] Guo Z, Xu X, Zhang L, et al. Endometrial thickness is associated with incidence of small-for-gestational-age infants in fresh in vitro fertilization-intracytoplasmic sperm injection and embryo transfer cycles[J]. Fertil Steril, 2020, 113(4): 745-752.
[7] Chen ZJ, Shi Y, Sun Y, et al. Fresh versus Frozen Embryos for Infertility in the Polycystic Ovary Syndrome[J]. N Engl J Med, 2016, 375(6): 523-533.
[8] Man Y, Bian Y, Zhao S, et al. The effect of different endometrial preparations on women with polycystic ovary syndrome undergoing initial frozen embryo transfer: a historical cohort analysis[J]. Acta Obstet Gynecol Scand, 2021, 100(6): 1116-1123.
[9] Gougeon A, Lefèvre B. Evolution of the diameters of the largest healthy and atretic follicles during the human menstrual cycle[J]. J Reprod Fertil, 1983, 69(2): 497-502.
[10] Adams GP, Singh J, Baerwald AR. Large animal models for the study of ovarian follicular dynamics in women[J]. Theriogenology, 2012, 78(8): 1733-1748.
[11] Ginther OJ. The mare: a 1000-pound guinea pig for study of the ovulatory follicular wave in women[J]. Theriogenology, 2012, 77(5): 818-828.
[12] Baerwald AR, Adams GP, Pierson RA. Ovarian antral folliculogenesis during the human menstrual cycle: a review[J]. Hum Reprod Update, 2012, 18(1): 73-91.
[13] 李冬宏, 卢淑庄, 林彤, 等. 黄体期促排卵在卵巢低反应高龄患者中的应用效果研究[J].生殖医学杂志, 2017, 26(10): 1041-1043.
[14] Li D, Liu Q, Chen X, et al. Analysis of embryo quality with luteal phase ovarian stimulation after failed in vitro fertilization-embryo transfer with long or ultra-long protocol[J]. J Gynecol Obstet Hum Reprod, 2019, 48(7): 527-529.
[15] Kansal Kalra S, Ratcliffe S, Gracia CR, et al. Randomized controlled pilot trial of luteal phase recombinant FSH stimulation in poor responders[J]. Reprod Biomed Online, 2008, 17(6): 745-750.
[16] Ubaldi FM, Capalbo A, Vaiarelli A, et al. Follicular versus luteal phase ovarian stimulation during the same menstrual cycle(DuoStim)in a reduced ovarian reserve population results in a similar euploid blastocyst formation rate: new insight in ovarian reserve exploitation[J]. Fertil Steril, 2016, 105(6): 1488-1495.
[17] Lu BJ, Lin CJ, Lin BZ, et al. ART outcomes following ovarian stimulation in the luteal phase:a systematic review and meta-analysis[J]. J Assist Reprod Genet, 2021, 25. https://doi.org/10.1007/s10815-021-02237-7
[18] Jin B, Niu Z, Xu B, et al. Comparison of clinical outcomes among dual ovarian stimulation, mild stimulation and luteal phase stimulation protocols in women with poor ovarian response[J]. Gynecol Endocrinol, 2018, 34(8): 694-697.
[19] Luo Y, Sun L, Dong M, et al. The best execution of the DuoStim strategy(double stimulation in the follicular and luteal phase of the same ovarian cycle)in patients who are poor ovarian responders[J]. Reprod Biol Endocrinol, 2020, 18(1):102.
[20] 韦立红, 马文红, 李忻琳, 等. 卵泡期联合黄体期促排卵对卵巢低反应患者活产率的影响[J]. 生殖医学杂志, 2019, 28(1): 36-40. WEI Lihong, MA Wenhong, LI Xinlin, et al. Effect of ovulation induction during follicular phase combined with luteal phase on live-birth rate in poor ovarian responder[J]. Journal of Reproductive Medicine, 2019, 28(1): 36-40.
[21] Sfakianoudis K, Simopoulou M, Maziotis E, et al. Evaluation of the second follicular wave phenomenon in natural cycle assisted reproduction: a key option for poor responders through luteal phase oocyte retrieval[J]. Medicina(Kaunas), 2019, 55(3): 68. https://doi.org/10.3390/medicina55030068
[22] Vaiarelli A, Cimadomo D, Trabucco E, et al. Double stimulation in the same ovarian cycle(DuoStim)to maximize the number of oocytes retrieved from poor prognosis patients: a multicenter experience and SWOT analysis[J]. Front Endocrinol(Lausanne), 2018, 9: 317. https://doi.org/10.3389/fendo.2018.00317
[23] Rashtian J, Zhang J. Luteal-phase ovarian stimulation increases the number of mature oocytes in older women with severe diminished ovarian reserve[J]. Syst Biol Reprod Med, 2018, 64(3): 216-219.
[24] Moffat R, Pirtea P, Gayet V, et al. Dual ovarian stimulation is a new viable option for enhancing the oocyte yield when the time for assisted reproductive technnology is limited[J]. Reprod Biomed Online, 2014, 29(6): 659-661.
[25] Madani T, Hemat M, Arabipoor A, et al. Double mild stimulation and egg collection in the same cycle for management of poor ovarian responders.[J]. J Gynecol Obstet Hum Reprod, 2019, 48(5): 329-333.

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