Division of Reproductive Endocrinology & Infertility, Department of Obstetrics & Gynecology, University of Pennsylvania, 3701 Market Street, Suite 800, Philadelphia, PA, 19104, USA.
Division of Reproductive Endocrinology & Infertility, Department of Obstetrics & Gynecology, University of Michigan Medical School, L4000 UH-South, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA.
J Assist Reprod Genet. 2017 Sep;34(9):1207-1215. doi: 10.1007/s10815-017-0968-5. Epub 2017 Jun 27.
The purpose of this study was to compare baseline characteristics and ovarian stimulation outcomes between patients presenting for medically indicated vs. elective fertility preservation consultation and to determine the impact of the 2013 ASRM guidelines on oocyte cryopreservation on the patient population presenting for fertility preservation consultation.
Retrospective cohort study conducted at an academic center. Study population included 332 patients presenting for medically indicated fertility preservation consultation and 210 patients presenting for elective consultation.
Patients presenting for elective fertility preservation consultation were more likely to be of advanced age, non-Caucasian, highly educated, single, nulligravid, and meet criteria for diminished ovarian reserve (DOR). Additionally, patients presenting electively were more likely to have fertility insurance benefits. A higher percentage of patients with insurance benefits for oocyte cryopreservation proceeded to stimulation. There were no differences in stimulation parameters or number of retrieved oocytes between the groups when adjusted for age. Following release of the ASRM guidelines on oocyte cryopreservation, there was no difference in the percentage of patients in the medical group who proceeded with stimulation; however, a higher percentage of patients presenting electively underwent ovarian stimulation.
Although the populations presenting for medical compared with elective fertility preservation differ at baseline, ovarian stimulation parameters and outcomes are similar when adjusted for age. Insurance benefits for fertility preservation are not comprehensive and impact the decision to proceed with stimulation in all patients. The publication of the ASRM guidelines on oocyte cryopreservation increased utilization of this technology among patients presenting electively; however, they remained at an advanced age and with decreased ovarian reserve parameters.
本研究旨在比较因医学指征就诊与因选择性生育力保存就诊的患者的基线特征和卵巢刺激结局，并确定 2013 年 ASRM 关于卵母细胞冷冻保存指南对因生育力保存就诊的患者人群的影响。
在学术中心进行的回顾性队列研究。研究人群包括 332 例因医学指征就诊的生育力保存患者和 210 例因选择性就诊的患者。
因选择性生育力保存就诊的患者更可能年龄较大、非白种人、受过高等教育、单身、未生育过且符合卵巢储备功能降低（DOR）标准。此外，因选择性就诊的患者更有可能有生育保险福利。有生育保险的患者进行刺激的比例更高。调整年龄后，两组间的刺激参数或获取的卵母细胞数量无差异。ASRM 关于卵母细胞冷冻保存的指南发布后，接受刺激的医学组患者比例无差异；然而，更多的选择性就诊患者接受了卵巢刺激。
尽管因医学原因就诊的患者与因选择性生育力保存就诊的患者在基线水平上存在差异，但调整年龄后，卵巢刺激参数和结局相似。生育力保存保险并不全面，会影响所有患者进行刺激的决定。ASRM 关于卵母细胞冷冻保存的指南的发布增加了选择性就诊患者对该技术的应用；然而，他们的年龄仍然较大，卵巢储备功能参数也较低。
