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Abstract：
The decrease in assisted reproductive technology success among older women, attributed to decreased oocyte quantity and quality, poses a significant challenge. Currently, no consensus on the optimal ovarian stimulation protocol for older women undergoing IVF exists. This retrospectively registered cohort study aimed to compare the cumulative live birth rate (CLBR), time to live birth (TTLB), and cost-effectiveness among women older than 35 years who were receiving either the gonadotropin-releasing hormone agonist (GnRHa) or clomiphene citrate and gonadotropin cotreatment with ovarian stimulation (CC cotreatment) protocol. To compare treatment outcomes, we performed propensity score matching (PSM) on 2871 IVF cycles in women older than 35 years who received either the GnRHa or CC cotreatment protocol, resulting in 375 cycles in each group. Additionally, a decision tree model was utilized to assess the cost-effectiveness of the two protocols. Following PSM, both groups had similar baseline characteristics. The CC cotreatment protocol resulted in a greater rate of cycle cancellation (13.07% vs. 8.00%, p = 0.032), but the groups maintained comparable fertilization rates and embryo quality. Although the TTLB was longer in the CC cotreatment group, the CLBR per initial cycle (41.07% vs. 45.33%, p = 0.269) and delivery outcomes were similar between the two groups at the 24 months follow-up. Additionally, the average cost per live birth in the CC cotreatment group was 21.27% lower than in the GnRHa group (¥32,301.42 vs. ¥39,174.22). In conclusion, for women older than 35 years undergoing IVF, the CC cotreatment protocol offered a comparable CLBR to the GnRHa protocol but with reduced costs, indicating its potential as a viable and cost-effective ovarian stimulation option.Clinical trial registration: https://www.chictr.org.cn/ , identifier [ChiCTR2300076537].
摘要：
老年妇女辅助生殖技术成功率下降，归因于卵母细胞数量和质量的下降，提出了重大挑战。目前,对于接受IVF的老年女性的最佳卵巢刺激方案尚无共识.这项回顾性注册的队列研究旨在比较累积活产率（CLBR），活产时间（TTLB），35岁以上女性接受促性腺激素释放激素激动剂(GnRHa)或克罗米芬和促性腺激素联合治疗(CC联合治疗)卵巢刺激方案的成本效益。为了比较治疗结果，我们对2871个接受GnRHa或CC联合治疗方案的35岁以上女性IVF周期进行了倾向评分匹配（PSM），导致每组375个周期。此外,利用决策树模型评估两种方案的成本效益.在PSM之后,两组的基线特征相似.CC共同处理方案导致更高的周期取消率(13.07%vs.8.00%，p=0.032),但两组的受精率和胚胎质量相当。尽管在CC共处理组中TTLB更长，每个初始周期的CLBR(41.07%与45.33%,p=0.269），在24个月的随访中，两组的分娩结果相似。此外,CC共同治疗组的平均每次活产成本比GnRHa组低21.27%(¥32,301.42vs.¥39,174.22）。总之,对于35岁以上接受试管婴儿的女性，CC共处理协议提供了与GnRHa协议相当的CLBR，但成本较低，表明其作为一种可行且具有成本效益的卵巢刺激选择的潜力。临床试验注册：https://www.chictr.org.cn/,标识符[ChiCTR2300076537]。
