ABSTRACT
RESEARCH QUESTION: How do costs and effects of in-vitro maturation (IVM) compare to IVF in women with a high antral follicle count (AFC)? DESIGN: This cost-effectiveness analysis (CEA) was based on data of a previous retrospective cohort study at IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam. Between July 2015 and December 2017, 608 women underwent IVM and 311 women IVF. The effectiveness measure for the CEA was cumulative live birth rate (LBR) after one completed cycle including subsequent cryo-cycles within 12 months of inclusion. Data were collected on resource use related to treatment, medication and pregnancy from the case report forms. The mean costs and effects, average cost differences and incremental cost-effectiveness ratios (ICER) were calculated using non-parametric bootstrap resampling to assess the effect of uncertainty in the estimates. RESULTS: Cumulative LBR after one completed cycle were 239/608 (39.3%) in the IVM group versus 155/311 (49.8%) in the IVF group (adjusted odds ratio 0.52, 95% confidence interval [CI] 0.30-0.89). Ovarian hyperstimulation syndrome (OHSS) did not occur in the IVM group versus 11/311 (3.5%) in the IVF group. The mean costs per couple were 4300 (95% CI 1371-18,798) for IVM and 6493 (95% CI 2204-20,136) for IVF. The ICER per additional live birth with IVF was 20,144 (95% CI 9116-50,418). Results were robust over a wide range of assumptions. CONCLUSIONS: IVM is less expensive than IVF in women with a high AFC undergoing treatment with assisted reproductive technology, while leading to a slightly lower effectiveness in terms of cumulative LBR.
Subject(s)
Fertilization in Vitro/economics , In Vitro Oocyte Maturation Techniques/economics , Adult , Birth Rate , Cost-Benefit Analysis , Female , Humans , Male , Pregnancy , Retrospective StudiesABSTRACT
OBJECTIVE: In this study, we report an experience of 59 natural-cycle IVF combined with in vitro oocyte maturation (IVF/M) cycles in patients with PCOS requiring IVF recruited based on limitations to afford a conventional IVF treatment in a 9-years period. Results of IVF/M were compared with 164 cycles of IVF in PCOS patients. MATERIAL AND METHODS: In IVF/M cycles only hCG priming was used before oocyte recovery, with in vitro maturation of immature oocytes in a commercial medium. In conventional IVF group, recombinant FSH (rFSH) and GnRH agonist/antagonist for ovarian stimulation were used. In both groups, fertilization was achieved by intracytoplasmic sperm injection (ICSI) of mature oocytes and fresh embryos transferred at day 2 or day 3. RESULTS: In all IVF/M cycles oocytes and transferable quality embryos were obtained, only in 6 IVF/M cycles mature oocytes were obtained at oocyte capture day. Clinical pregnancy rate per cycle was 39.0% vs 53.6% (p = 0.0682) and delivery rate per cycle was 30.5% vs 42.6% (p = 0.1209) in IVF/M and conventional IVF respectively. Patients with ovarian hyperstimulation syndrome (OHSS) were 0% in IVF/M vs 6.7% in conventional IVF (p = 0.0399). CONCLUSION: Our experience in a private clinic in Mexico suggests that IVF/M can be a useful initial strategy to treat PCOS patients requiring IVF with comparable delivery rates to conventional IVF and a decreased risk of ovary hyperstimulation. IVF/M may be indicated to patients with limited resources paying without insurance for their infertility treatment.
Subject(s)
Fertilization in Vitro/methods , In Vitro Oocyte Maturation Techniques/methods , Infertility, Female/therapy , Adult , Female , Humans , In Vitro Oocyte Maturation Techniques/economics , Infertility, Female/etiology , Oocyte Retrieval/methods , Ovulation Induction/methods , Polycystic Ovary Syndrome/complications , Polycystic Ovary Syndrome/diagnosis , Pregnancy , Pregnancy Rate , Young AdultABSTRACT
OBJETIVOS: Determinar el número de ovocitos en metafase II que se necesitan para lograr una óptima tasa de blastulación y conseguir una mejor tasa de gestación. DISEÑO: Estudio Retrospectivo. Institución: Unidad de Fertilidad -Hospital Alcivar Guayaquil (Ecuador). PARTICIPANTES: Mujeres con diagnóstico de infertilidad. INTERVENCIONES: Fueron 110 Mujeres en las que se les realizo FIV-ICSI, excluyendo transferencia día 3 y ciclos cancelados. previa estimulación ovárica controlada, El cultivo continúa a blastocistos. Principales medidas de resultados: Tasa de ovocitos en metafase II, Tasa de embarazo. Edad Promedio de las pacientes, Técnica FIV-ICSI. RESULTADOS: Edad promedio de las pacientes 33,41. Técnica FIV: 73 pacientes 66,4 % ICSI: 37 pacientes 33,6 %. Embarazo: Si Gestación: 57,3 %, No gestación: 42,7 %. Tasa de Ovocitos en Metafase II: Una Media de 7,5. CONCLUSIÓN: La tasa de gestación que coincide con los resultados del centro (50 a 60 %), la alcanzamos a partir de 7 ovocitos maduros. La tasa de blastulacion promedio fue de 39,2 %
OBJECTIVES: Determine the number of metaphase II oocytes that are needed for optimum rate blastulation and get a better rate of gestation. DESIGN: Retrospective study. Institution: Fertility Unit -Hospital Alcivar Guayaquil (Ecuador). PARTICIPANTS: Women diagnosed with infertility. INTERVENTIONS: There were 110 women in which they are performed IVF-ICSI, excluding 3rd and transfer canceled cycles. After controlled ovarian stimulation, cultivation continues to blastocysts. Main outcome measures: Rate of metaphase II oocytes, pregnancy rate. Average age of patients, IVF-ICSI technique. RESULTS: Mean age of the patients 33,41. IVF technique: 66.4% ICSI 73 patients: 37 patients 33.6%. Pregnancy: If pregnancy: 57.3% No pregnancy: 42.7% .Tasa of oocytes in metaphase II: A Media 7.5. CONCLUSION: The pregnancy rate coincides with the center's results (50-60%), the reach from 7 mature oocytes. The average rate was 39.2% blastulation