IVF with planned single-embryo transfer versus IUI with ovarian stimulation in couples with unexplained subfertility: an economic analysis.
Couples with unexplained subfertility are often treated with intrauterine insemination (IUI) with ovarian stimulation, which carries the risk of multiple pregnancies. An explorative randomized controlled trial was performed comparing one cycle of IVF with elective single-embryo transfer (eSET) versus three cycles of IUI-ovarian stimulation in couples with unexplained subfertility and a poor prognosis for natural conception, to assess the economic burden of the treatment modalities. The main outcome measures were ongoing pregnancy rates and costs. This study randomly assigned 58 couples to IVF-eSET and 58 couples to IUI-ovarian stimulation. The ongoing pregnancy rates were 24% in with IVF-eSET versus 21% with IUI-ovarian stimulation, with two and three multiple pregnancies, respectively. The mean cost per included couple was significantly different: €2781 with IVF-eSET and €1876 with IUI-ovarian stimulation (P<0.01). The additional costs per ongoing pregnancy were €2456 for IVF-eSET. In couples with unexplained subfertility, one cycle of IVF-eSET cost an additional €900 per couple compared with three cycles of IUI-ovarian stimulation, for no increase in ongoing pregnancy rates or decrease in multiple pregnancies. When IVF-eSET results in higher ongoing pregnancy rates, IVF would be the preferred treatment. Couples that have been trying to conceive unsuccessfully are often treated with intrauterine insemination (IUI) and medication to improve egg production (ovarian stimulation). This treatment carries the risk of multiple pregnancies like twins. We performed an explorative study among those couples that had a poor prognosis for natural conception. One cycle of IVF with transfer of one selected embryo (elective single-embryo transfer, eSET) was compared with three cycles of IUI-ovarian stimulation. The aim of this study was to assess the economic burden of both treatments. The Main outcome measures were number of good pregnancies above 12weeks and costs. We randomly assigned 58 couples to IVF-eSET and 58 couples to IUI-ovarian stimulation. The ongoing pregnancy rates were comparable: 24% with IVF-eSET versus 21% with IUI-ovarian stimulation. There were two multiple pregnancies with IVF-eSET and three multiple pregnancies with IUI-ovarian stimulation. The mean cost per included couple was significantly different, €2781 with IVF-eSET and €1876 with IUI-ovarian stimulation. The additional costs per ongoing pregnancy were €2456 for IVF-eSET. In couples with unexplained subfertility, one cycle of IVF-eSET costed an additional €900 per couple compared to three cycles of IUI-ovarian stimulation, for no increase in ongoing pregnancy rates or decrease in multiple pregnancies. We conclude that IUI-ovarian stimulation is the preferred treatment to start with. When IVF-eSET results in a higher ongoing pregnancy rate (>38%), IVF would be the preferred treatment.
Department of Obstetrics and Gynecology, Catharina Medical Center, Michelangelolaan 2, 5623EJ Eindhoven, The Netherlands; Centre for Reproductive Medicine, Academic Medical Centre, Amsterdam, The Netherlands. Electronic address: Minouche.v.rumste@catharinaziekenhuis.nl.
Minouche M E
MM
van Rumste
Centre for Reproductive Medicine, Academic Medical Centre, Amsterdam, The Netherlands.
Inge M
IM
Custers
Centre for Reproductive Medicine, Academic Medical Centre, Amsterdam, The Netherlands.
Madelon
M
van Wely
Department of Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, The Netherlands.
Carolien A
CA
Koks
Department of Obstetrics and Gynaecology, University Medical Centre St. Radboud, Nijmegen, The Netherlands.
Hans G I
HG
van Weering
Department of Obstetrics and Gynaecology, Erasmus Medical Centre, Rotterdam, The Netherlands.
Nicole G M
NG
Beckers
Department of Obstetrics and Gynaecology, Gelre Ziekenhuis, Apeldoorn, The Netherlands.
Gabrielle J
GJ
Scheffer
Department of Obstetrics and Gynaecology, University Medical Centre, Utrecht, The Netherlands.
Frank J M
FJ
Broekmans
Department of Obstetrics and Gynaecology, VU University Medical Centre, Amsterdam, The Netherlands.
Peter G A
PG
Hompes
Centre for Reproductive Medicine, Academic Medical Centre, Amsterdam, The Netherlands.
Monique H
MH
Mochtar
Centre for Reproductive Medicine, Academic Medical Centre, Amsterdam, The Netherlands.
Fulco
F
van der Veen
Centre for Reproductive Medicine, Academic Medical Centre, Amsterdam, The Netherlands; Department of Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, The Netherlands.
Ben W J
BW
Mol
D003365:Costs and Cost Analysis; D005260:Female; D005307:Fertilization in Vitro / Q000191:economics* / Q000379:methods; D006801:Humans; D007246:Infertility / Q000628:therapy*; D008297:Male; D010062:Ovulation Induction; D011247:Pregnancy; D011256:Pregnancy Outcome; D018873:Pregnancy Rate; D056826:Single Embryo Transfer
IUI; IVF; economic analysis; randomized pilot study; single-embryo transfer; unexplained subfertility