Медицинский совет (Apr 2018)
Is it possible to help patients of older reproductive age implement their reproductive function within the framework of IVF and PE programs backed by state support?
Abstract
The effectiveness of the basic in vitro fertilization (IVF) and embryo transfer (PE) programs that were state funded using the funds of the Mandatory Health Insurance Fund (MHIF) was compared with the comprehensive programs that were co-financed (along with the funds of the MHIF, the parallel payment of donor oocytes (DO), donor embryos (DE) (or a donor program from own funds)) in patients of older reproductive age with low ovarian reserve and the forecast of “poor” and reduced ovarian response to controlled ovarian hyperstimulation (COH) on the basis of the Assisted Reproductive Technology (ART) Department of the Moscow Regional Perinatal Center (MRPC). We analysed the outcomes of the programs that have been implemented using the funds of the MHIF on the basis of the ART Department for 2015 and 2016 in patients, who were divided into 2 groups. Group 1 consisted of 69 patients who underwent a basic IVF and PE program in 2015, Group 2 included 60 patients who underwent the basic and comprehensive IVF and PE programs in 2016. In addition, Subgroup 2 has been singled out from Group 2 and included 26 patients out of 60 who underwent the comprehensive IVF and PE programs. The groups were comparable by the main indicators of the ovarian reserve, the average age and the anamnestic data. The embryos were cultivated up to 5 days, their quality was assessed according to the Gardner scale. The number of oocytes obtained (of which mature ones per 1 patient) was (p< 0.05): in Group 1 - 3.7 ± 1.1/2.7 ± 1.8, in Group 2 - 4.7 ± 2.2 / 4.1 ± 1.2, in Group 2a - 7.7 ± 3.4 / 5.7 ± 2.4. The number of embryos received per patient (of which, the highest quality embryos) (p< 0.05): in Group 1 - 2.1 ± 1.1/1.1 ± 0,4, in Group 2 - 2.9 ± 1.4/1.8 ± 0,8; in Group 2a, 4.4 ± 1.8/2.7 ± 1.2. In all patients, the embryos were transferred on Day 5 of the cultivation. In the course of the comprehensive programs, two embryos were transferred: one embryo was obtained by fertilizing the patient’s oocytes with the husband’s semen (of medium or low quality), the other embryo was obtained from a donor by fertilizing with the husband’s sperm (of high quality). In the absence of their own embryos, two high quality DE or embryos obtained by fertilization with the husband’s semen were transferred. The effectiveness of the IVF program (frequency of pregnancy) was as follows: Group 1 - 11.6% per IVF cycle; Group 2 - 21.6% per cycle (13), Group 2a - 38.4% per cycle.
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