title: Oral ovulation induction agents combined with low-dose gonadotropin injections and intrauterine insemination: cost- and clinical effectiveness.
abstract: OBJECTIVE
  To compare the efficacy and cost-effectiveness of different induction protocols involving gonadotropins with intrauterine insemination (IUI).
  
  
  METHODS
  We performed a retrospective chart review of 648 IUI cycles. Some patients had gonadotropin injections alone before human chorionic gonadotropin (hCG) and IUI (human menopausal gonadotropin protocol); others were given oral medications, then gonadotropins before hCG and IUI (combination protocol). Outcomes included pregnancy rates, multiple birth rates, endometrial thickness, number of ovarian follicles, injection days, ampules of gonadotropins and cost.
  
  
  RESULTS
  The combination protocol was more cost-effective. In first cycles, pregnancy rates, multiple birth rates, number of large follicles produced and cancellation rates were similar. The combination group had fewer days of injections and fewer ampules used. When all cycles were analyzed, the multiple birth rate was lower in the combination group. Comparing the different oral medications in the combination protocols, letrozole yielded higher pregnancy rates than tamoxifen or clomiphene. Multiple birth rates were similar for all oral medications.
  
  
  CONCLUSIONS
  Combination protocols are less costly and equally effective, with potentially fewer multiple births than with gonadotropins alone. Letrozole may be more effective than clomiphene and tamoxifen in a combination protocol.
authors.affiliation: Division of Reproductive Endocrinology and Infertility, University of Iowa Roy J. and Lucille A. Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City 52242, USA.
authors.forename: Ginny L
authors.initials: GL
authors.lastname: Ryan
authors.forename: Victoria
authors.initials: V
authors.lastname: Moss
authors.forename: William A
authors.initials: WA
authors.lastname: Davis
authors.forename: Amy E T
authors.initials: AE
authors.lastname: Sparks
authors.forename: Anuja
authors.initials: A
authors.lastname: Dokras
authors.forename: Bradley J
authors.initials: BJ
authors.lastname: Van Voorhis
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000704:Analysis of Variance; D002996:Clomiphene / Q000008:administration & dosage / Q000191:economics; D003362:Cost-Benefit Analysis; D005260:Female; D005300:Fertility Agents, Female / Q000008:administration & dosage* / Q000191:economics; D006801:Humans; D007246:Infertility / Q000628:therapy; D007267:Injections; D007315:Insemination, Artificial / Q000191:economics* / Q000379:methods; D000077289:Letrozole; D008596:Menotropins / Q000008:administration & dosage* / Q000191:economics; D009570:Nitriles / Q000008:administration & dosage / Q000191:economics; D010062:Ovulation Induction / Q000191:economics* / Q000379:methods*; D011247:Pregnancy; D018873:Pregnancy Rate; D012189:Retrospective Studies; D013629:Tamoxifen / Q000008:administration & dosage / Q000191:economics; D014230:Triazoles / Q000008:administration & dosage / Q000191:economics
chemical_list: D005300:Fertility Agents, Female; D009570:Nitriles; D014230:Triazoles; D013629:Tamoxifen; D002996:Clomiphene; D008596:Menotropins; D000077289:Letrozole