The use of clomiphene citrate/human menopausal gonadotrophins in conjunction with GnRH antagonist in an IVF/ICSI program is not a cost effective protocol.
OBJECTIVE
To evaluate the cost effectiveness of a clomiphene citrate (CC)/human menopausal gonadotropin (hMG)/GnRH antagonist protocol versus a long-acting GnRH agonist/hMG protocol.


METHODS
One hundred eighty nine couples having their first trial of ICSI for male factor infertility were divided into two groups. Group I (no = 33) received CC 100-150 mg/day for five days starting from day 2 of the cycle and 150 IU of hMG/day on days 6-10. GnRH antagonist (Centrorelix) 0.25 mg/day was started when the leading follicle reached 16 mm in the absence of an LH surge. Group II (no = 156) received 0.1 mg Deacapeptyl/day as our standard long protocol.


RESULTS
Clinical pregnancy was observed in 8 out of the 33 cases in group I (24%) while in group II, 92 out of 156 achieved clinical pregnancy (59%), the difference was statistically significant (P = 0.019). The cost of medications/cycle was estimated to be 1110+/-492 E.P in group I, while it was 1928+/-456 E.P. in group II. However, the total cost per pregnancy was 19653 EP in group I and 10047 EP in group II.


CONCLUSIONS
The use of the clomid/hMG/antagonist protocol is not a cost effective strategy and should not be recommended in IVF-ICSI cycles.
Mansour
Ragga
R
The Egyptian IVF-ET Center, Maadi, Egypt. ivf@link.net
Aboulghar
Mohammed
M
Serour
Gamal I
GI
Al-Inany
Hesham G
HG
Fahmy
Ibrahim
I
Amin
Yehia
Y
D000328:Adult; D006063:Chorionic Gonadotropin / Q000008:administration & dosage / Q000191:economics; D002996:Clomiphene / Q000008:administration & dosage / Q000191:economics*; D003362:Cost-Benefit Analysis; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D005300:Fertility Agents, Female / Q000008:administration & dosage / Q000191:economics*; D005307:Fertilization in Vitro / Q000191:economics* / Q000379:methods; D007987:Gonadotropin-Releasing Hormone / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000191:economics*; D006727:Hormone Antagonists / Q000008:administration & dosage / Q000191:economics*; D006801:Humans; D008297:Male; D008596:Menotropins / Q000008:administration & dosage / Q000191:economics; D011247:Pregnancy; D018873:Pregnancy Rate; D020554:Sperm Injections, Intracytoplasmic / Q000191:economics* / Q000379:methods; D017329:Triptorelin Pamoate / Q000008:administration & dosage / Q000191:economics
D006063:Chorionic Gonadotropin; D005300:Fertility Agents, Female; D006727:Hormone Antagonists; D017329:Triptorelin Pamoate; D002996:Clomiphene; D007987:Gonadotropin-Releasing Hormone; D008596:Menotropins; C062876:cetrorelix