ABSTRACT
OBJECTIVE: To determine the cost of achieving pregnancy with different gonadotropin preparations. DESIGN: Cost-minimization analysis of a prospective randomized clinical trial. SETTING: Twenty-two centers in six countries. PATIENT(S): Women 18 to 36 years of age with infertility for more than 1 year who were undergoing IVF or ICSI. INTERVENTION(S): Highly purified hMG or recombinant FSH. RESULT(S): Mean cost of achieving an ongoing pregnancy. The mean cost per patient treatment cycle was estimated to be pound 2423 with highly purified hMG (95% CI, pound 2356 to pound 2495) and pound 2745 with recombinant FSH (95% CI, pound 2658 to pound 2830). The ongoing pregnancy rate was 22% with highly purified hMG and 19% with recombinant FSH. The cost per ongoing pregnancy was pound 10781 with highly purified hMG (95% CI, pound 9056 to pound 12919) and pound 14284 with recombinant FSH (95% CI, pound 11883 to pound 17891). CONCLUSION(S): Highly purified hMG and recombinant FSH are equally effective, but highly purified hMG is less expensive per cycle. Using highly purified hMG instead of recombinant FSH would translate into a 13% increase in the number of cycles that could be offered.
Subject(s)
Drug Costs , Fertility Agents, Female/economics , Fertilization in Vitro , Follicle Stimulating Hormone/economics , Menotropins/economics , Sperm Injections, Intracytoplasmic , Adult , Clinical Trials, Phase III as Topic , Cost Control , Cost-Benefit Analysis , Female , Fertility Agents, Female/isolation & purification , Health Resources/statistics & numerical data , Humans , Menotropins/isolation & purification , Multicenter Studies as Topic , Pregnancy , Randomized Controlled Trials as Topic , Recombinant Proteins/economics , Treatment OutcomeABSTRACT
Current purification processes allow the production of highly purified human menopausal gonadotrophin (HP-HMG), with human chorionic gonadotrophin (HCG) constituting most of its LH-like activity. This retrospective study aimed to compare the effectiveness of HP-HMG to the widely used traditional human menopausal gonadotrophin (HMG) preparation. A total of 174 women undergoing intracytoplasmic sperm injection cycles were allocated to either HMG or HP-HMG for ovarian stimulation. The number of mature oocytes was significantly higher in the HP-HMG group (14.72 +/- 7.81) than in the HMG group (12.15 +/- 11.07) (P < 0.05). However, the number of good quality embryos was not significantly different between both groups (HMG: 1.65 +/- 1.54; HP-HMG: 1.78 +/- 1.41). Similarly, there was no statistically significant difference in number of embryos transferred per woman (HMG: 3.95 +/- 1.87; HP-HMG: 4.27 +/- 1.60). The pregnancy rate per woman was 38.39% versus 51.79% in the HMG- and HP-HMG-treated groups respectively. These findings suggest that HP-HMG produces more mature oocytes than ordinary HMG, but similar pregnancy rates.
Subject(s)
Fertility Agents, Female/isolation & purification , Menotropins/isolation & purification , Ovulation Induction/methods , Sperm Injections, Intracytoplasmic , Adult , Female , Humans , Ovulation Induction/statistics & numerical data , Pregnancy , Retrospective Studies , Treatment OutcomeABSTRACT
Recombinant gonadotrophins have been proposed as the gold standard for current infertility treatment. However, there is little difference between the various available urinary or recombinant gonadotrophins in terms of safety, purity or clinical efficacy. Resources committed to determining an advantage of one gonadotrophin preparation over another would be better spent on research for new treatments.