Affordable ART for developing countries: a cost benefit comparison of low dose stimulation versus high dose GnRH antagonist protocol
Objective Low dose stimulation (LS) is emerging as an alternative regime in assisted reproductive technology (ART). This study aimed to compare the cost-effectiveness of LS to the high dose GnRH antagonist (Atg) regime. Methods An observational prospective study conducted at an academic inferti...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Springer Science+Business Media
2008
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| Subjects: | |
| Online Access: | http://irep.iium.edu.my/4177/ http://irep.iium.edu.my/4177/ http://irep.iium.edu.my/4177/ http://irep.iium.edu.my/4177/1/fulltext_minimal_stimulation2008.pdf |
| Summary: | Objective Low dose stimulation (LS) is emerging as an
alternative regime in assisted reproductive technology
(ART). This study aimed to compare the cost-effectiveness
of LS to the high dose GnRH antagonist (Atg) regime.
Methods An observational prospective study conducted at
an academic infertility unit from January to June 2007.
Outcome measures included the numbers of follicles,
oocytes and embryos, morphological quality of oocytes
and embryos, clinical pregnancy (PR) and complication
rate.
Result Ninety five first attempt ICSI cycles consisting of
54 LS and 41 Atg were analyzed. Subjects in both groups
had comparable sociodemographics and reproductive
characteristics. LS generated significantly fewer follicles,
total oocytes, mature oocytes (all p<0.0005) and immature
oocytes ( p=0.009) than Atg but the number of excellent
quality oocytes was similar. Significantly fewer embryos
were available in LS although the proportion of usable
embryos was higher, 83.2% vs. 67.0% for Atg. Mean
embryos per transfer was 2.0±1.1 vs. 2.6±1.0 ( p=0.02) for
a clinical PR per transfer of 43.2% vs. 50.0% for LS and
Atg respectively. LS regime had a shorter gonadotrophin
administration period with resultant COH cost one third of
the Atg protocol (both, p<0.0005). The cost per live birth
per started cycle worked out to be USD 13,200 and 24,900
for LS and Atg respectively. Furthermore, LS had fewer
incidences of OHSS compared to the Atg regime, 3.7% vs.
12.2%.
Conclusion LS cost benefits included lower amounts of
gonadotrophin used and fewer injections. It is a viable
alternative regime in producing comparable clinical PR at
lower cost and less complication in ART. |
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