title: Cost-effectiveness analysis comparing continuation of assisted reproductive technology with conversion to intrauterine insemination in patients with low follicle numbers.
abstract: OBJECTIVE
  To compare the cost effectiveness of proceeding with oocyte retrieval vs. converting to intrauterine insemination (IUI) in patients with ≤4 mature follicles during assisted reproductive technology (ART) cycles.
  
  
  METHODS
  Probabilistic decision analysis. The cost effectiveness of completing ART cycles in poor responders was compared to that for converting the cycles to IUI.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Cost-effectiveness analysis.
  
  
  METHODS
  Cost effectiveness, which was defined as the average direct medical costs per ongoing pregnancy.
  
  
  RESULTS
  In patients with 1-3 mature follicles, completing ART was more cost effective if the cost of a single ART cycle was between $10,000 and $25,000. For patients with 4 mature follicles, if an ART cycle cost<$18,025, it was more cost effective to continue with oocyte retrieval than to convert to IUI.
  
  
  CONCLUSIONS
  In patients with ≤4 mature follicles following ovarian stimulation in ART cycles, it was on average more cost effective to proceed with oocyte retrieval rather than convert to IUI. However, important factors, such as age, prior ART failures, other fertility factors, and medications used in each individual case need to be considered before this analysis model can be adapted by individual practices.
authors.affiliation: Department of Obstetrics, Gynecology & Women's Health, Albert Einstein College of Medicine, Bronx, New York. Electronic address: boyumich2@gmail.com.
authors.forename: Bo
authors.initials: B
authors.lastname: Yu
authors.affiliation: Epidemiology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland.
authors.forename: Sunni
authors.initials: S
authors.lastname: Mumford
authors.affiliation: Program in Reproductive Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland.
authors.forename: G Donald
authors.initials: GD
authors.lastname: Royster
authors.affiliation: Program in Reproductive Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland.
authors.forename: James
authors.initials: J
authors.lastname: Segars
authors.affiliation: Program in Reproductive Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland.
authors.forename: Alicia Y
authors.initials: AY
authors.lastname: Armstrong
mesh_terms: D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D003663:Decision Trees; D016527:Drug Costs; D005260:Female; D005300:Fertility Agents, Female / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics*; D017048:Health Care Costs; D006801:Humans; D007246:Infertility / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D007315:Insemination, Artificial / Q000009:adverse effects / Q000191:economics*; D018803:Models, Economic; D054315:Oocyte Retrieval / Q000191:economics; D006080:Ovarian Follicle / Q000187:drug effects*; D010060:Ovulation / Q000187:drug effects*; D010062:Ovulation Induction / Q000009:adverse effects / Q000191:economics*; D011247:Pregnancy; D018873:Pregnancy Rate; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D005300:Fertility Agents, Female
keywords: Poor responders; assisted reproductive technologies; cost effectiveness; intrauterine insemination