title: Cost-effectiveness comparison between pituitary down-regulation with a gonadotropin-releasing hormone agonist short regimen on alternate days and an antagonist protocol for assisted fertilization treatments.
abstract: OBJECTIVE
  To compare cost-effectiveness between pituitary down-regulation with a GnRH agonist (GnRHa) short regimen on alternate days and GnRH antagonist (GnRHant) multidose protocol on in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) outcome.
  
  
  METHODS
  Prospective, randomized.
  
  
  METHODS
  A private center.
  
  
  METHODS
  Patients were randomized into GnRHa (n = 48) and GnRHant (n = 48) groups.
  
  
  METHODS
  GnRHa stimulation protocol: administration of triptorelin on alternate days starting on the first day of the cycle, recombinant FSH (rFSH), and recombinant hCG (rhCG) microdose. GnRHant protocol: administration of a daily dose of rFSH, cetrorelix, and rhCG microdose.
  
  
  METHODS
  ICSI outcomes and treatment costs.
  
  
  RESULTS
  A significantly lower number of patients underwent embryo transfer in the GnRHa group. Clinical pregnancy rate was significantly lower and miscarriage rate was significantly higher in the GnRHa group. It was observed a significant lower cost per cycle in the GnRHa group compared with the GnRHant group ($5,327.80 ± 387.30 vs. $5,900.40 ± 472.50). However, mean cost per pregnancy in the GnRHa was higher than in the GnRHant group ($19,671.80 ± 1,430.00 vs. $11,328.70 ± 907.20).
  
  
  CONCLUSIONS
  Although the short controlled ovarian stimulation protocol with GnRHa on alternate days, rFSH, and rhCG microdose may lower the cost of an individual IVF cycle, it requires more cycles to achieve pregnancy.
  
  
  BACKGROUND
  NCT01468441.
authors: Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University, São Paulo, Brazil. science@sapientiae.org.br
authors: Luiz Guilherme Louzada
authors: LG
authors: Maldonado
authors: José Gonçalves
authors: JG
authors: Franco
authors: Amanda Souza
authors: AS
authors: Setti
authors: Assumpto
authors: A
authors: Iaconelli
authors: Edson
authors: E
authors: Borges
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis; D015536:Down-Regulation / Q000187:drug effects* / Q000502:physiology; D004334:Drug Administration Schedule; D004624:Embryo Transfer / Q000191:economics* / Q000379:methods; D005260:Female; D005307:Fertilization in Vitro / Q000191:economics / Q000379:methods; D005640:Follicle Stimulating Hormone / Q000008:administration & dosage / Q000191:economics; D005500:Follow-Up Studies; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists* / Q000037:antagonists & inhibitors*; D006801:Humans; D010902:Pituitary Gland / Q000187:drug effects* / Q000378:metabolism*; D011247:Pregnancy; D011446:Prospective Studies; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000191:economics; D016896:Treatment Outcome; D017329:Triptorelin Pamoate / Q000008:administration & dosage / Q000191:economics
chemical_list: D011994:Recombinant Proteins; D017329:Triptorelin Pamoate; D007987:Gonadotropin-Releasing Hormone; D005640:Follicle Stimulating Hormone