What is the most relevant standard of success in assisted reproduction? The next step to improving outcomes of IVF: consider the whole treatment
What is the most relevant standard of success in assisted reproduction? The next step to improving outcomes of IVF: consider the whole treatment
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DOI：
10.1093/humrep/deh368
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发表时间：
2004-09-01
影响因子：
6.1
通讯作者：
Fauser, BCJM
中科院分区：
文献类型：
--
作者：
Heijnen, EMEW;Macklon, NS;Fauser, BCJM
改变定义成功的试管受精治疗的方式提供了一种工具，可以在降低治疗成本和并发症的同时提高疗效。这种范式转变的关键是不再从单个试管受精周期的角度考虑结果，而是转向开始整体试管受精治疗。我们建议试管受精成功的信息最多的终点是在患者不适、并发症和费用的总体背景下，每次开始试管受精治疗(或每给定时间段)的单胎出生率。这些终点不仅对患者很重要，而且对临床医生、健康经济学家和政策制定者也很重要。这种方法将鼓励开发对患者友好、更便宜、压力更小、不适和副作用更小的刺激方案。温和的卵巢刺激和单胚胎移植相结合，可以在相同的时间内实现相同的总妊娠率，同时以相似的直接成本实现，但减少了患者的压力和不适，几乎完全消除了多胎妊娠。这将带来重大的健康和间接的成本效益。如果试管受精成功率以每次试管受精治疗(或在特定治疗期间)产下一个足月单胎婴儿来表示，将有助于大规模引入单胚胎移植。
Changing the way in which successful IVF treatment is defined offers a tool to improve efficacy while reducing costs and complications of treatment. Crucial to this paradigm shift is the move away from considering outcomes in terms of the single IVF cycle, and towards the started IVF treatment as a whole. We propose the most informative end-point of success in IVF to be the term singleton birth rate per started IVF treatment (or per given time period) in the overall context of patient discomfort, complications and costs. These end-points are important not only for patients, but also for clinicians, health economists and policy makers. Such an approach would encourage the development of patient-friendly and cheaper stimulation protocols with less stress, discomfort and side effects. The combination of mild ovarian stimulation with single embryo transfer may provide the same overall pregnancy rate per total IVF treatment, achieved in the same amount of time for similar direct costs, but with reduced patient stress and discomfort, and the near complete elimination of multiple pregnancies. This would offer major health and indirect cost benefits. If IVF success rates were to be expressed in terms of delivery of a term single baby per IVF treatment (or in a given treatment period), the introduction of single embryo transfer on a large scale would be facilitated.