12 Sep 2014
We analyzed the cost-effectiveness of using oral DHEA (75 mg/day) on the clinical pregnancy rate (CPR) and live birth rate (LBR) in women with diminished ovarian reserve (DOR/POI/POF) treated with COS/IUI versus IVF/ICSI cycles.
MATERIAL AND METHODS:
In a retrospective cohort study, we compared the results of COS/IUI and IVF/ICSI cycles in women between the ages of 35-43 years old on DHEA supplementation for DOR/POI/POR as per The Bologna Criteria. We divided our patients into 2 age groups: 35-39 years old (group A) and 40-43 years old (group B). All IVF cycles had previously failed IUI cycles up to a maximum of 6 cycles. Primary outcomes were total treatment cost per CPR and LBR, per cycle completed, for each age group. Equality of means was tested using two-sample t-test with unequal variances, Fisher’s exact test was used to test for the association of categorical variables (Stata version 11). Cost results are expressed as mean ± SD. Statistical significance was considered at p<0.05 value.
A total of 325 COS/IUI and 111 IVF/ICSI cycles were included, in group A: 154 COS/IUI and 54 IVF/ICSI cycles, and in group B: 171 COS/IUI and 55 IVF/ICSI cycles. Pregnancy rates per cycle completed were higher in the IVF/ICSI group than in the COS/IUI groups (48.2% vs 14.3%, p<0.001 for group A and 29.1% vs 9.4%, p<0.001 for group B). LBR was higher in the IVF/ICSI than in the COS/IUI group, 38.9% vs 8.4%, p<0.001 for group A and 21.8% vs 5.3%, p<0.001 for group B. The average cost for COS/IUI vs IVF/ICSI cycles was $2,691.8 ± 1,129.6 Can vs $12,485.4 ± 1,385.9 Can, p<0.001 for group A and $3,306.2 ± 1,341.5 Can vs $12,743.7 ± 1,285.3 Can, p<0.001 for group B.
Pregnancy rates were higher in the IVF/ICSI cycles than COS/IUI cycles. However, the cost was 4.6 fold (group A) and 3.8 fold (group B) higher with IVF/ICSI versus COS/IUI. Considering our pregnancy rates for group A and B, using COS/IUI, it is reasonable to suggest trying up to 4 cycles of COS/IUI before proceeding to IVF/ICSI. Since all IVF/ICSI cycles were done following failed COS/IUI cycles, we conclude that COS/IUI cycles are more cost-effective on a cumulative pregnancy rate estimation. This is in agreement with other published data[2-10]. Elzeiny has a contradictory view from his study, but his inclusion criteria were very different. The risk of OHSS and multiple pregnancies has to be carefully considered by patients and doctors in making this decision[12-19].