| IVF Speeds Time to Pregnancy and Lowers Costs |
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Patients who come to a fertility specialist want to become pregnant as soon as possible. There are various treatment options now available for infertility; some have higher pregnancy rates and some have lower pregnancy rates. These treatments have markedly different costs and differing levels of complexity. Very commonly patients may start with a less effective treatment because it is easier to do or less expensive. It is not unusual to see a couple first try treatment with clomid , perhaps combined with IUI (intrauterine insemination) for three or four attempts. If not pregnant, they may proceed to using injectable fertility medications , known as gonadotropins, also combined with IUI. In vitro fertilization, IVF , is sometimes viewed as the treatment of last resort despite the fact that it has the highest chance for success. The reason for this is that IVF is the most expensive treatment and the most complex. A randomized clinical trial was recently done to determine whether it would be more beneficial for infertile women aged 21-39 years to shorten the standard infertility procedure protocol. Standard Protocol What is the standard or conventional procedure? In this study, the women going through the conventional treatment had: 3 cycles of clomiphene citrate/ intrauterine insemination (CC)/ IUI 3 cycles of gonadotropin/ intrauterine insemination (FSH/IUI) Up to 6 cycles of In-vitro Fertilization (IVF) This procedure is said to be conventional because of its step-wise fashion. The procedures become more invasive as the treatment is continued. Accelerated Protocol What is the accelerated procedure? Women going through the accelerated treatment had: 3 cycles of clomiphene citrate/ intrauterine insemination (CC)/ IUI Up to 6 cycles of In vitro Fertilization (IVF) The gonadotropin/ intrauterine insemination (FSH/IUI) was completely eliminated from this treatment pattern. Why omit the FSH/IUI? Gonadotropin IUI has historically been a mainstay of infertility treatment before IVF. Its cost and unavoidable multiple births, especially high-order multiples, and the risk of hyperstimulation syndrome have brought this treatment under closer scrutiny. The ability to achieve higher pregnancy rates with fewer embryos transferred through IVF has evoked further questions regarding the role for gonadotropin/IUI.
Main Outcomes Measured:
the ratio of the sum of all health insurance charges for all couples divided by the number of couples delivering at least one live-born baby STUDY RESULTS Time to Pregnancy:
Multiple Birth Rates:
While the rates didn’t differ significantly in this study, others have shown that multiple births do occur more frequently in doing FSH/IUI procedures. Per cycle pregnancy rates:
Cost effectiveness:
DISCUSSION
For all analyses performed regarding charges (i.e., treatment charges per couple and per delivery, total charges per couple and per delivery), the total charges were less for couples in the accelerated compared with the conventional arm. CONCLUSION A randomized clinical trial demonstrated that FSH/IUI treatment was of no added value to the treatment protocol. In states that require comprehensive Insurance coverage, rates of success are higher because there is a lesser dropout rate As clinical practice moves to limiting the number of embryos transferred during IVF procedures in young women to one or two embryos, eliminating gonadotropin/IUI from the step-wise infertility paradigm will result in pregnancies with the lowest possible risk for multiple births. Compared with conventional infertility treatment and when the woman is younger than 40 years, an accelerated approach to IVF that starts with CC/IUI, but eliminates gonadotropin/IUI, results in a shorter time to pregnancy, with fewer treatment cycles, and at a suggested cost savings. |
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| Last Updated ( Wednesday, 14 October 2009 ) |
