基于体外受精（IVF）及促性腺激素结合IVF治疗原发性不孕症医疗成本的决策分析

1 删憎-蛐姗 n ‘峭 i l l_I I I I ! l 1 I l f i i ： f I 1 1 { { l ， i i ， 【l 1 outcome in terms of implantation rate and its relation to the number of visible mononucleate blastomeres(MNBs)，the degree of fragmentation，and equality of blastomeres．In— tervention(s)：Li ght microscopic evaluation of preembryos before transfer on day 2．Main Outeome Measure(s)：Im- plantation rate． Result(s)：The number of MNBs was found to be related to implantation，whereas blastomere e quality and rate of embryo fragmentation were not． The implantation rate was statistically significantly higher in cycles where a four cell preembryo with four MNBs was transferred than after transfer of a four—celI preembryo with zero to three MNBs(42％ versus 22％)．In a logistic re— gression analysis． nucleation of all blastomeres was the only morphologic parameter that was associated with the implantation rate．℃onclusion(s)：Evaluation of nuclear status of four—cell preembryos is important in predicting implantation potentia1． Visual【ization of four MNBs in a four—cell preembryo predicted a statistically significant hi【小er implantation rate than in cases where not all four blast0meres were mononuc】eate． 体外受精治疗周期中四细胞前胚胎的核状态预测 着床能力 目的：评估单胚移植(SET)中常规筛查第2天四细 胞前胚胎核状态预测着床能力的价值。设计 ：回顾性分 析。机构：私人体外受精(IVF)中心。患者：2002年 1月 至 2004年 11月间第 2天或第 3天胚胎移植前的新鲜 受精卵 1985例 ，其中 1295例(65．2％)为 SET。根据着 床率、可见单核卵裂球(MNBs)数 目、断裂程度及卵裂球 均匀程度回顾性分析所有 SET周期 (n=861)第 2天 移植前的四细胞前胚胎。干预：光镜下评估第 2天胚胎 移植前的前胚胎状况。主要观察指标：着床率。结果： MNBs数 目与着床率相关，但与卵裂球均匀程度及胚胎 断裂率无关。具有 4个 MNBs的四细胞前胚胎其着床率 显著高于具有 0～3个 MNBs的四细胞前胚胎 (42％ 傩 22％)。logistic回归分析提示卵裂球的成核现象是与着 床率相关的唯一形态学参数。结论：评估四细胞前胚胎 的核状态是预测着床能力的重要因素。具有 4个 MNBs 的四细胞前胚胎其着床率显著高于无 4个 MNBs的四 细胞前胚胎。 0053． In vitro fertilization (IVF)versus go- nadotropins followed by IVF as treatment for primary infertility： A cost-based deci- sion analysis Kansal—Kalra S．／Milad P_／Grobman A_【Dr． S．Kansal—Kalra。Department of Reproductive Endocrinolo— gY and Infe~ility．Hospital of University of Pennsylvania。 3701 Market Street． Philadelphia． PA 19104． United States]一FERTIL．STERIL．2005．84／3(600—604) Objective：To compare the economic consequences of pro- ceeding directly to IVF to those of proceeding with go— nadotropins followed by IVF in patients<35 years of age with unexplained infertility． Design： A decision-tree- mode1． Th e model incorporated the cost and SUCCESS of each infertility regimen as well as the pregnancy associated costs of singleton or multiple gestations and the risk and cost of cerebral palsy．Main Outcome Measure(s)：Cost per live birth．Resuh(s)：Both treatment arnls resulted in a> 80％ chance of birth．The gonadotropin arIn was over four times more likely to result in a high—order multiple pregnancy (HOMP)．Despite this，when the base case estimates were utilized．immediate IVF emerged a8 more costly per live birth．In sensitivity analysis，immediate IVF became less costly per live birth when IVF was more likely to achieve birth(55．1％)or cheaper($1 1，432)than our base case assumptions．Conclusion(s)：After considering the risk and cost of HOMP，immediate IVF is more costly per live birth than a trial of gonadotropins prior to IVF． 基于体外受精 (IVF)及促性腺激素结合 IVF治疗 原发性不孕症医疗成本的决策分析 目的：比较年龄 <35岁不明原因不孕症患者直接 体外受精(IVF)与应用促性腺激素类药物后再行 IVF两 种 方案 气瓶 现场处置方案 .pdf气瓶 现场处置方案 .doc见习基地管理方案.doc关于群访事件的化解方案建筑工地扬尘治理专项方案下载 的医疗成本差别。设计：设计一种决策树模型。该 模型综合分析每种不孕症治疗方案的医疗成本；妊娠成 功率、单胎或多胎妊娠相关的医疗成本、脑瘫发生风险 及相关医疗成本。主要观察指标：每例单活胎所需医疗 成本。结果：两种治疗方案的活产率均 >80％。注射促 性腺激素组导致多胎妊娠 (HOMP)的发生率高于直接 IVF组 4倍多。尽管如此，与制定的基本医疗成本比较 后发现直接行 IVF，每例单活胎所需医疗成本更高。敏 感度分析提示直接行 IVF，每例单活胎所需医疗成本降 低，并且更易获得活产 (55．1％)，其每例单活胎所需医 疗成本(1l 432美元)低于制定的基本医疗成本。结论： 鉴于发生 HOMP的风险及高医疗成本，直接 IVF者每 例单活胎所需医疗成本高于应用促性腺激素后再行体 外受精者。 0054．In vitro fertilization in Sweden：Child mor- bldity including cancer risk 维普资讯 http://www.cqvip.com