结构化咨询与IVF周期取消及患者依从性的关联
该回顾性队列研究纳入阿联酋三级中心8084例启动IVF治疗的女性，比较接受与未接受结构化刺激前咨询者的周期取消率和依从性。结果显示咨询组卵巢刺激期间取消率更低（6.4% vs 23.0%，aRR 0.31，95%CI 0.27-0.36），可预防取消和不依从行为也减少；但冻胚移植内膜准备期间取消率无差异。
要点
- 结构化刺激前咨询与卵巢刺激周期取消率降低相关（aRR 0.31）。
- 咨询组可预防取消（患者决定和用药错误）及不依从行为更少。
- 冻胚移植内膜准备周期取消率在咨询与否组间无差异。
核心结论
- 结构化咨询与卵巢刺激期间可预防取消减少和依从性改善相关。
- 冻胚移植内膜准备期间取消率未显示与咨询相关。
- 拒绝咨询的患者可能与接受者有系统性差异。
研究设计与样本
- 回顾性队列研究，纳入8084例在阿联酋三级中心启动IVF治疗的女性。
- 分析2015年6月至2025年8月首次卵巢刺激周期及2017年1月至2025年7月首次冻胚移植内膜准备周期。
- 暴露为治疗启动前完成结构化咨询，咨询组6813例，非咨询组1271例。
- 采用改良泊松回归估计调整相对风险（aRR）。
主要发现
- 卵巢刺激期间取消率咨询组6.4% vs 非咨询组23.0%，aRR 0.31（95%CI 0.27-0.36）。
- 可预防取消（患者决定和用药错误）咨询组2.9% vs 非咨询组13.3%，aRR 0.23（95%CI 0.19-0.29）。
- 卵巢刺激期间不依从行为咨询组3.6% vs 非咨询组14.8%，P=0.001。
- 冻胚移植激素替代周期取消率咨询组27.8% vs 非咨询组30.2%，aRR 0.96（95%CI 0.79-1.16）。
- 冻胚移植自然周期取消率咨询组37.8% vs 非咨询组43.5%，aRR 0.86（95%CI 0.72-1.01）。
临床怎么用
- 在卵巢刺激前提供结构化咨询可能有助于减少可预防的周期取消并改善依从性。
- 冻胚移植内膜准备前的咨询效果需进一步研究，当前未显示与取消率降低相关。
局限性
- 回顾性设计，拒绝咨询的患者可能与接受咨询者存在系统性差异。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
RESEARCH QUESTION: Is structured pre-stimulation counselling associated with reduced cycle cancellation and improved patient adherence during ovarian stimulation and endometrial preparation for frozen embryo transfer (FET)? DESIGN: This retrospective cohort study included 8084 women initiating IVF treatment at a tertiary centre in the United Arab Emirates. First ovarian stimulation cycles performed between June 2015 and August 2025 and first endometrial preparation cycles for FET between January 2017 and July 2025 were analysed. Exposure was defined as completion of a structured pre-stimulation counselling session before treatment initiation. Outcomes were compared between counselled (n = 6813) and non-counselled (n = 1271) women. Modified Poisson regression models were used to estimate adjusted relative risks (aRR). RESULTS: During ovarian stimulation, cancellation rates were lower among counselled women compared with non-counselled women (6.4% versus 23.0%), corresponding to an aRR of 0.31 (95% CI 0.27-0.36). Preventable cancellations (patient decision and medication errors) were also reduced (2.9% versus 13.3%; aRR 0.23, 95% CI 0.19-0.29). Non-adherence behaviours during ovarian stimulation were less frequent among counselled women (3.6% versus 14.8%; P = 0.001). In contrast, cancellation rates during endometrial preparation for FET did not differ between counselled and non-counselled women (27.8% versus 30.2%; aRR 0.96, 95% CI 0.79-1.16 for hormone replacement therapy cycles; 37.8% versus 43.5%; aRR 0.86, 95% CI 0.72-1.01 for natural cycles). CONCLUSIONS: Structured counselling was associated with reduced preventable cancellations and improved adherence during ovarian stimulation. However, patients who declined counselling may differ systematically from those who accepted counselling.
引用
- Selim S, Lawrenz B, Samir S, et al. Structured counselling and its association with IVF cycle cancellations and patient adherence. Reprod Biomed Online. 2026. PMID: 42400997. doi:10.1016/j.rbmo.2026.105801
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。