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Hum. Reprod. Advance Access published online on July 8, 2005
Human Reproduction, doi:10.1093/humrep/dei164
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© The Author 2005. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved.
Received December 2, 2004
Revised May 13, 2005
Accepted May 17, 2005

Article

Individualized cost-effective conventional ovulation induction treatment in normogonadotrophic anovulatory infertility (WHO group 2)

Marinus J.C. Eijkemans 1*, Suzanne Polinder 2, Annemarie G.M.G.J. Mulders 3, Joop S.E. Laven 3, J.Dik F. Habbema 2, and Bart C.J.M. Fauser 4

1 Department of Public Health and Division of Reproductive Medicine, Department of Obstetrics and Gynaecology, Erasmus MC University Medical Center, Rotterdam
2 Department of Public Health, Erasmus MC University Medical Center, Rotterdam
3 Division of Reproductive Medicine, Department of Obstetrics and Gynaecology, Erasmus MC University Medical Center, Rotterdam
4 Division of Reproductive Medicine, Department of Obstetrics and Gynaecology, Erasmus MC University Medical Center, Rotterdam and Department of Reproductive Medicine, University Medical Center, Utrecht, The Netherlands

* To whom correspondence should be addressed.
Marinus J.C. Eijkemans, E-mail: m.eijkemans{at}erasmusmc.nl


  Abstract

BACKGROUND: Conventional treatment in normogonadotrophic anovulatory infertility (WHO 2) consists of clomiphene citrate (CC), followed by exogenous gonadotrophins (FSH) and IVF. Response to these treatments may be predicted on the basis of individual patient characteristics. We aimed to devise a patient-tailored, cost-effective treatment algorithm involving the above-mentioned treatment modalities, based on individual patient characteristics. METHODS: Sixteen prognostic groups are defined, according to the presence or absence of: age >30 years, amenorrhea, elevated androgen levels and obesity. The chances of response with each of the three treatments were calculated using prediction models. Treatment costs were based on the data of 240 patients visiting a specialist academic fertility unit. Outcome was an ongoing pregnancy within 12 months after initiation of treatment. The costs per pregnancy of three different strategies were compared, with a threshold for cost-effectiveness of euro10 000. RESULTS: The strategy CC + FSH + IVF compared with FSH + IVF generated more pregnancies against lower costs. Compared with CC + IVF, it also produced more pregnancies, but at higher costs. For <30 years of age with normal androgen levels, costs per pregnancy were less than euro10 000. For women >30 years old, costs per pregnancy were euro25 000 and over euro200 000, when presenting with normal or elevated androgen levels, respectively. CONCLUSIONS: The conventional treatment protocol is efficient for women aged <30 years with normal androgen levels. For women >30 years old with elevated androgen levels, FSH may be skipped.

Keywords: cost-effectiveness/IVF/ovulation induction.
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