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目的探索在玻璃化冷冻技术基础上IVF周期中克罗米芬促排卵方案的临床效果及经济效益分析。方法 2006年度101个病例在知情同意下随机分为两组,CC组为国产克罗米芬、HMG并辅以GnRH拮抗剂预防LH峰的促排卵方案;GnRHa组为以常规的GnRHa降调和果纳芬、辅以少量国产HMG的促排卵方案为主;所获胚胎根据子宫内膜条件实施鲜胚移植或玻璃化冷冻复苏后移植,每个病例追踪到孩子出生或所有胚胎用完或本人放弃为止;分析两组得卵数、受精率、2PN率、卵裂率、优良胚胎率、取卵周期活婴分娩率、促排卵药费、周期平均总费用以及每获得一次活婴分娩的平均费用等参数。结果 CC和GnRHa组平均得卵数分别为7.46±4.04和10.19±3.95枚,有极显著性差异;IVF/ICSI受精率分别为85.1%/88.3%和68.3%/76.0%,有极显著性差异;促排卵药费、周期平均总费用以及每获得一次活婴分娩的平均费用分别为1779.65±1123.59元、11008.81±2987.36元、27447.67±7164.10元和9241.62±2883.20元、19393.87±3297.55元、48946.43±8322.38元,组间有极显著性差异,差异因素来源于促排卵药费;2PN率、卵裂率、优良胚胎率、冻胚移植胚胎植入率、取卵周期活婴分娩率分别为84%、97.4%、85.4%、29.1%、37.5%和79%、96.5%、83.3%、34.7%、39.6%,两组间无显著性差异;两组均无熟前LH峰和严重并发症发生事件。结论 IVF中使用克罗米芬联合HMG和GnRH拮抗剂促排卵,结合胚胎玻璃化冷冻技术是一种安全、高效和经济的治疗策略。
Objective To explore the clinical effect and economic benefit analysis of clomiphene and ovulation induction in IVF cycle based on vitrification technique. Methods In 2006, 101 cases were randomly divided into two groups with informed consent. CC group was domestic clomiphene citrate, HMG supplemented with GnRH antagonist to prevent LH peak ovulation induction program; GnRHa group with conventional GnRHa down regulation and fruit satisfied Fen , Supplemented by a small amount of domestic ovulation induction HMG program; the embryo under the conditions of endometrial implantation of fresh embryo transfer or vitrification after transplantation, tracking each case of children born or all embryos run out or I give up so far; Analysis of the two groups of parameters such as the number of eggs, fertilization rate, 2PN rate, cleavage rate, excellent embryo rate, ovulation rate of live births, ovulation drug costs, the average total cost of the cycle and the average cost of each live birth and other parameters . Results The average numbers of oocytes in the CC and GnRHa groups were 7.46 ± 4.04 and 10.19 ± 3.95, respectively. The IVF / ICSI fertilization rates were 85.1% / 88.3% and 68.3% / 76.0%, respectively, with significant difference ; Ovulation drug costs, the average total cost of the cycle and the average cost of each live birth was 1779.65 ± 1123.59 yuan, 11008.81 ± 2987.36 yuan, 27447.67 ± 7164.10 yuan and 9241.62 ± 2883.20 yuan, 19393.87 ± 3297.55 yuan, 48946.43 ± 8322.38 The differences between the two groups were significant. The differences were from the ovulation drug costs. The rates of 2PN, cleavage rate, excellent embryo rate, frozen embryo transfer embryo implantation rate and live fetus delivery rate were 84% 97.4%, 85.4%, 29.1%, 37.5% and 79%, 96.5%, 83.3%, 34.7% and 39.6%, respectively. There was no significant difference between the two groups. Conclusions IVF is a safe, effective and economical strategy for clotting ovulation induced by clomiphene in combination with HMG and GnRH antagonist in combination with embryo vitrification.