Herndon Christopher N, Anaya Yanett, Noel Martha, Cakmak Hakan, Cedars Marcelle I
Center for Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California; Alta Bates IVF Program, Berkeley, California.
Center for Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California; Houston Fertility Specialists, Houston, Texas.
Fertil Steril. 2017 Oct;108(4):642-649.e4. doi: 10.1016/j.fertnstert.2017.06.035. Epub 2017 Sep 2.
To report on outcomes from a university-based low-cost and low-complexity IVF program using mild stimulation approaches and simplified protocols to provide basic access to ART to a socioculturally diverse low-income urban population.
Retrospective cohort study.
Academic infertility center.
PATIENT(S): Sixty-five infertile couples were enrolled from a county hospital serving a low-resource largely immigrant population.
INTERVENTIONS(S): Patients were nonrandomly allocated to one of four mild stimulation protocols: clomiphene/letrozole alone, two clomiphene/letrozole-based protocols involving sequential or flare addition of low-dose gonadotropins, and low-dose gonadotropins alone. Clinical fellows managed all aspects of cycle preparation, monitoring, oocyte retrieval, and embryo transfer under an attending preceptor. Retrieval was undertaken without administration of deep anesthesia, and laboratory interventions were minimized. All embryo transfers were performed at the cleavage stage.
MAIN OUTCOME MEASURE(S): Sociomedical demographics, treatment response, and pregnancy outcomes were recorded.
RESULT(S): From August 2010 to June 2016, 65 patients initiated 161 stimulation IVF cycles, which resulted in 107 retrievals, 91 fresh embryo transfers, and 40 frozen embryo transfer cycles. The mean age of patients was 33.3 years, and mean reported duration of infertility was 5.3 years; 33.5% (54/161) of cycles were cancelled before oocyte retrieval, with 13% due to premature ovulation. Overall, cumulative live birth rates per retrieval including subsequent use of frozen embryos was 29.0%; 44.6% (29/65) of patients enrolled in the program achieved pregnancy.
CONCLUSION(S): Use of mild stimulation protocols, simplified monitoring, and minimized laboratory handling procedures enabled access to care in a low-resource socioculturally diverse infertile population.
报告一项基于大学的低成本、低复杂度体外受精（IVF）项目的结果，该项目采用温和刺激方法和简化方案，为社会文化背景多样的低收入城市人群提供基本的辅助生殖技术（ART）服务。
回顾性队列研究。
学术性不孕不育中心。
从一家为资源匮乏的大量移民人群服务的县医院招募了65对不孕夫妇。
患者被非随机分配到四种温和刺激方案中的一种：单独使用克罗米芬/来曲唑，两种基于克罗米芬/来曲唑的方案，包括序贯或激发添加低剂量促性腺激素，以及单独使用低剂量促性腺激素。临床研究员在指导教师的指导下负责周期准备、监测、取卵和胚胎移植的各个方面。取卵时不进行深度麻醉，实验室干预降至最低。所有胚胎移植均在卵裂期进行。
记录社会医学人口统计学、治疗反应和妊娠结局。
2010年8月至2016年6月，65例患者开始了161个刺激IVF周期，其中107次取卵，91次新鲜胚胎移植，40次冷冻胚胎移植周期。患者的平均年龄为33.3岁，平均报告不孕时间为5.3年；33.5%（54/161）的周期在取卵前取消，其中13%是由于过早排卵。总体而言，包括随后使用冷冻胚胎在内，每次取卵的累积活产率为29.0%；参与该项目的患者中有44.6%（29/65）实现了妊娠。
使用温和刺激方案、简化监测和最小化实验室操作程序，使得在资源匮乏、社会文化背景多样的不孕人群中能够获得治疗。
