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2019年冠状病毒病大流行期间的生育力保存:虽有调整但不打折扣。

Fertility Preservation During the COVID-19 Pandemic: Modified But Uncompromised.

作者信息

Trawick Emma, Babayev Elnur, Potapragada Nivedita, Elvikis Jennifer, Smith Kristin, Goldman Kara N

机构信息

Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.

出版信息

Womens Health Rep (New Rochelle). 2022 Jan 31;3(1):31-37. doi: 10.1089/whr.2021.0107. eCollection 2022.

Abstract

Throughout COVID-19, our clinic remained operational for patients requiring urgent fertility preservation (FP). This study aimed to characterize changes to clinical protocols during the first wave of COVID-19 and compare outcomes to historical controls. We performed a retrospective cohort study at a university fertility center examining all patients who underwent medically indicated FP cycles during the American Society for Reproductive Medicine (ASRM) COVID-19 Task Force-recommended suspension of fertility treatment (March 17-May 11, 2020) and patients from the same time period in 2019. FP care was modified for safety during the first wave of COVID-19 with fewer monitoring visits and infection control measures. FP cycle characteristics and outcomes were compared across years. The volume of cycles was nearly 30% higher in 2020 versus 2019 (27 vs. 19). Diagnoses, age, and anti-Mullerian hormone were similar between cohorts. More patients elected to pursue embryo cryopreservation over oocyte cryopreservation in 2020 versus 2019 (45.8% vs. 5.2%,  < 0.005). Patients managed during COVID-19 had fewer monitoring visits (5 ± 1 vs. 6 ± 1,  = 0.02), and 37.5% of cycles utilized a blind trigger injection. There was no difference in total days of ovarian stimulation (11 ± 1 vs. 11 ± 2,  > 0.05), but 2020 cycles utilized more gonadotropin (4770 ± 1480 vs. 3846 ± 1438,  = 0.04). There was no difference in total oocytes retrieved (19 ± 14 vs. 22 ± 12,  > 0.05) or mature oocytes vitrified (15 ± 12 vs. 17 ± 9,  > 0.05) per cycle. FP continued during COVID-19, and more cycles were completed in 2020 versus 2019. Despite minimized monitoring, outcomes were optimal and equivalent to historical controls, suggesting FP care can be adapted without compromising outcomes.

摘要

在整个新冠疫情期间,我们的诊所一直为有紧急生育力保存(FP)需求的患者提供服务。本研究旨在描述新冠疫情第一波期间临床方案的变化,并将结果与历史对照进行比较。我们在一家大学生育中心进行了一项回顾性队列研究,调查了在美国生殖医学学会(ASRM)新冠疫情特别工作组建议暂停生育治疗期间(2020年3月17日至5月11日)接受医学指征性FP周期治疗的所有患者,以及2019年同一时期的患者。在新冠疫情第一波期间,为了安全起见,对FP护理进行了调整,减少了监测访视次数并采取了感染控制措施。对不同年份的FP周期特征和结果进行了比较。2020年的周期数量比2019年增加了近30%(27个 vs. 19个)。两组患者的诊断、年龄和抗苗勒管激素水平相似。与2019年相比,2020年选择胚胎冷冻保存而非卵母细胞冷冻保存的患者更多(45.8% vs. 5.2%,P < 0.005)。在新冠疫情期间接受治疗的患者监测访视次数更少(5 ± 1次 vs. 6 ± 1次,P = 0.02),37.5%的周期采用了盲法触发注射。卵巢刺激的总天数没有差异(11 ± 1天 vs. 11 ± 2天,P > 0.05),但2020年的周期使用了更多的促性腺激素(4770 ± 1480单位 vs. 3846 ± 1438单位,P = 0.04)。每个周期回收的总卵母细胞数量(19 ± 14个 vs. 22 ± 12个,P > 0.05)或玻璃化的成熟卵母细胞数量(15 ± 12个 vs. 17 ± 9个,P > 0.05)没有差异。在新冠疫情期间FP治疗仍在继续,2020年完成的周期比2019年更多。尽管监测最少,但结果是最佳的,且与历史对照相当,这表明FP护理可以在不影响结果的情况下进行调整。

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