| 1.Background:Assessed reproductive technology(ART)refers to a technique that uses medical assistive techniques and means to make infertile couples pregnant.In the past 30 years,IVF and its derivative technologies have been gradually improved and popularized,and a stable and high success rate has been obtained.At the same time,we have observed some new phenomena and some new problems brought by new technologies:1.The incidence of repeated pregnancy failure is still high,the reason is not clear,and the influencing factors are many and complicated;some of the embryonic factors(high quality embryos lack or no high quality embryos)may not be suitable for in vitro culture environment;2.With the economic and social pressures brought by the huge group of infertile patients.,how to get as much health economic benefits as possible?The gamete intrauterine transfer(GIUT)may deserve more attention.In 1982,Craft et al.first reported(clinical pregnancy rate 7%,2/31).Over the next 28 years,the relevant literature reported that the proportion of patients with 174 average pregnancies was 17%(13%-44%)(Table 1).Although the current research results show that the success rate of IVF and its derivative technology is higher than that of GIUT,GIUT is simpler and more time-saving than the former,and may have potential health economics value.At present,there is still a lack of large-sample related research.Repeated failure to assist pregnancy is one of the important reasons for reducing the pregnancy rate of assisted reproductive technology.The reasons are complex and unclear.At present,the embryo grade is mainly subjective based on the appearance morphology grade,and the embryo factor needs to be considered after excluding other factors.The formation and development of embryos are affected by many factors such as their own quality,genetics and environment.The uterus and the fallopian tube have tissue homology.It is conceivable that the GIUT directly mixes the egg with the semen and then moves into the uterine cavity,which can avoid the external adverse factors that may be affected by the sperm in vitro fertilization and early embryo development.Studies have shown that for patients with a small number of oocytes after ovulation induction(less than or equal to 5),there is a possibility that in vitro culture can obtain fewer embryos,and GIUT can help prevent long-term exposure of embryos.Under conditions that may be harmful in vitro,treatment results that are very similar to IVF-ET are available[8].In recent years,according to the small sample re-application of the Center,GIUT has a certain effect on patients with multiple cycles of in vitro fertility failure(clinical pregnancy rate 26.1%,6/23)[2],suggesting that the technology still remains a certain application value for such patients.Therefore,it is conceivable that GIUT's potential advantages,ease of operation,and lower medical costs may make it a viable option for patients with multiple cycles of in vitro fertility failure(fertilization disorder,poor embryo development potential,and RIF).2.ObjectiveBased on this,the purpose of this study was to analyze the electronic medical records of patients with GIUT and first-cycle IVF-ET treatment from September of 2016 to February of 2018 in Reproductive Hospital Affiliated to Shandong University,and to explore the clinical application prospects of GIUT in patients with failed multi-cycle(?2 cycles)in vitro and in patients with GIUT in the first cycle of in vitro fertilization,and to assist in the first cycle of GIUT and IVF-ET in vitro.Pregnant patients were evaluated for clinical and health economics using CEA(cost-effectiveness analysis).3.Method(s)The first part uses a complete electronic medical record database to conduct detailed clinical analysis of all women who have undergone GIUT treatment and provided sperm for multiple cycles of in vitro fertility failure in the Reproductive Hospital Affiliated to Shandong University from September 2016 to June 2018.Analysis of baseline characteristics,ovulation induction,and use GIUT outcome to explore the clinical application prospects of GIUT in patients with failed multi-cycle pro-pregnancy.The second part uses a complete electronic medical record database to conduct a detailed clinical analysis of all women who were treated with GIUT in the first cycle of the Reproductive Hospital Affiliated to Shandong University from September 2016 to June 2018,and analyzed their baseline characteristics and ovulation induction situation,GIUT outcome,to explore the new application of GIUT in assisted reproduction.The third part is for the women who received the first cycle of GIUT treatment from the Reproductive Hospital Affiliated to Shandong University from September of 2016 to June of 2018,according to the principles of inclusion and exclusion,screened the obstacles of gamete transmission caused by various reasons of the woman and(Or)male factors were included in the first cycle of GIUT treatment in women.At the same time,a strict matching principle was established,and the same age range(phase difference?1 year)and the same type of infertility(primary)were selected from all women treated with IVF-ET in the first cycle of the hospital with a matching ratio of 1:3.Women with infertility or secondary infertility,the same fallopian tube-related lesions,and the same male factors are paired and excluded as much as possible from other lesions that may affect pregnancy(submucosal uterine fibroids,endometrial polyps,endometriosis,uterine malformations,history of hysteroscopic surgery,etc.).Baseline characteristics of GIUT and IVF-ET women,GIUT cycle treatment parameters,and GIUT/IVF-ET assisted reproductive outcomes were analyzed and health economics were compared.Health Economics Indicators and Analysis:This study used the GIUT and IVF groups to evaluate the health economics and used cost-effectiveness analysis.4.Result(s)The first part is a total of 47 patients with multi-cycle in vitro fertility failure who underwent GIUT treatment,and their average age is larger(34.0±4.5 years old),longer infertility(6.4±3.5 years);previous ART in vitro failure times are many(3.1±1.3 times),including changed to GIUT treatments due to poor fertilization and embryonic development potential are about 76.6%;Other programs in the ovulation induction program(HMG/HCG,etc.)accounted for a large proportion(70.2%),and the average number of transplanted eggs was 3.5±1.3;the main observation indicators were clinical pregnancy rate(21.3%),live birth rate(8.5%),and abortion rate.(8.5%),ectopic pregnancy rate(4.3%);single-cycle average cost is:18156.8 yuan of 47 patients' average,of which the average cost of 10 clinical pregnancy patients is:9448.08 yuan.The second part is 89 women in the first cycle of in vitro assisted pregnancy with GIUT:a satisfactory clinical pregnancy rate(45.0%),but a higher rate of multiple pregnancy(24.7%);analysis of the relationship between the number of transplanted eggs and GIUT outcome:The number of transplanted 4 eggs is better,and the clinical pregnancy rate is significantly higher than that of the number.When the number of transplanted eggs continues to increase,the clinical pregnancy rate does not increase,but the multiple pregnancy rate is significantly increased.The third part is 26 women who underwent sperm-provided GIUT treatment in the first cycle matched 78 women with IVF-ET in the first cycle and were included in the study.Health economics evaluation:(1)The GIUT group fee was significantly lower than the IVF-ET group.There was no significant difference in clinical pregnancy rate,live birth rate,preterm birth rate and abortion rate between the two groups.(2)The first cycle of GIUT treatment cost is 24437.1 yuan for each case of clinical pregnancy,and 26658.7 yuan for each case of live birth.In the first cycle of IVF-ET treatment providing sperm,obtaining a clinical pregnancy costs 3,9418.8 yuan and each case of live birth costs 53653.4 yuan.5.Conclusion(s):1.GIUT is used in patients with multiple cycles of in vitro fertility failure(especially those with poor embryonic development and in vitro fertilization).It has certain clinical application value(Clinical pregnancy rate:21.3%,10/47)and can reduce the economic burden of patients.2.GIUT can still obtain a satisfactory clinical pregnancy rate(45.0%,40/89)for patients who are pregnant in the first cycle.Considering the risk of multiple pregnancy,it is recommended to transplant 4 eggs3.For patients with simple fallopian tube factors and/or male factors,the first-cycle GIUT group has a better cost-effectiveness ratio than the IVF-ET group. |
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