Published Research > Edward Ryan, Sonia Blanco Mejia, Anne Claessens. The cost-effectiveness of controlled ovarian stimulation with intra uterine insemination (COS/IUI) versus IVF with intra cytoplasmic injection (IVF/ICSI) in 434 dehydroepiandrosterone (DHEA) supplemented cycles. 2014 Canadian Fertility and Andrology Society (CFAS) Annual Meeting. September 12th, 2014.

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.



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[1]. 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[11]. The risk of OHSS and multiple pregnancies has to be carefully considered by patients and doctors in making this decision[12-19].