中国妇女体外受精-胚胎移植累计活产率分析

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摘要目的基于大样本量的体外受精-胚胎移植(IVF-ET)累计活产率的计算,探讨多周期IVF-ET的治疗方案选择。方法选取2009年1月1日至2015年12月31日所有在北京大学第三医院生殖医学中心首次进行IVF-ET治疗的56 499对夫妇,中心常规使用的治疗方案以刺激方案为主,根据患者的不同情况,对部分患者选择自然周期取卵或微刺激方案进行治疗。根据治疗用药的不同,分为GnRH激动剂方案和GnRH拮抗剂方案。假设随访至最后一个周期末活产者的最终结局为无活产和与继续治疗者相同,计算累计活产率的保守估计值和乐观估计值,分析累计活产与促排卵方案的关系。结果研究共包括106 740周期。计算得到累计活产率的保守估计值和乐观估计值分别为52.2%和90.7%,并且随着女方年龄的增高而降低。应用Logistic回归分析,排除影响活产的因素,得到第二(P<0.001)和第三(P=0.001)新鲜周期选择GnRH激动剂方案的累计活产率会显著地高于GnRH拮抗剂方案。结论年龄是影响IVF-ET治疗结果的重要因素。为了达到更好的治疗效果,在患者第二和第三次促排卵治疗中,可根据患者的情况,优先选择激动剂方案。

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	陈立雪
	李蓉
	叶荣伟

关键词 ：体外受精-胚胎移植, 累计活产率, GnRH拮抗剂方案, GnRH激动剂方案

Abstract：Objective To discuss the protocols in multiple IVF-ET cycles based on a large population of Chinese women who received ART treatment.Methods A total of 56,499 women who commenced IVF treatment using their autologous oocytes in our center during Jan 2009 and Dec 2015 were included. Conventional controlled ovarian stimulation (COS) protocols or minimal ovarian stimulation protocols were applied according to the patients' individual conditions. Crude live birth rate (CLBR) was calculated based on the assumption that those who did not return for further treatment did not have a live birth; when expected CLBR was calculated we assumed that they would have similar live-birth rates with those receiving further treatment. The relationships between CLBR and COS protocols were analyzed.Results A total of 106740 cycles were included in this study. Crude and expected CLBR was 52.2% and 90.7%, respectively. Both rates decreased with women’s age. Binary logistic regression analysis indicated that CLBR was significantly higher in GnRH agonist group than in GnRH antagonist group in the second (P<0.001) and third (P=0.001) complete cycles.Conclusion Our data demonstrated that CLBR was reversely correlated with age. In addition, GnRH agonist tended to be a superior choice in the second and third complete cycles.

Key words： In vitro fertilization and embryo transfer Cumulative live birth rates GnRH antagonist protocol GnRH agonist protocol

收稿日期: 2017-01-24

通讯作者: 叶荣伟(yerw@bjmu.edu.cn)

引用本文:

陈立雪,李蓉,叶荣伟. 中国妇女体外受精-胚胎移植累计活产率分析[J]. 中国生育健康杂志, 2017, 28(2): 101-105.
CHEN Lixue, LI Rong, YE Rongwei. Cumulative live birth rate in vitro fertilization in China: A population-based study. Chinese Journal of Reproductive Health, 2017, 28(2): 101-105.

链接本文:

http://cjrh.bjmu.edu.cn/CN/ 或 http://cjrh.bjmu.edu.cn/CN/Y2017/V28/I2/101

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