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Clomiphene IUI

Gonadotropin IUI

Summary


Home : IVM : Comparing costs to IUI

Comparing costs of achieving pregnancy
with IUI to IVM

 

On this web page, we will try to present some information help individuals assess the relative value of selected infertility treatments. Unfortunately, no one knows absolutely that a particular treatment will work for someone in a given number of tries.   Is it better to plan to be able to do a number of “lower cost treatments” or a fewer number of “more effective higher cost treatments”?   One way of looking at the financial value of a treatment is to compare the cost of what would be required for different treatments to have a given probability of achieving pregnancy.

(It would be better to be able to talk about achieving a particular probability of delivery and this data exists for IVF/IVM, but is less certain for IUI, etc.  It is expected that 15% of recognized (clinical) pregnancies will result in miscarriage so one can work backwards from the data presented.)

Our analysis uses assumptions about success rates that come from the medical literature and from our program.  To apply it to your situation, you need to assume that your program produces similar results.  You also need to try to understand if you are a good, average, or poor candidate for succeeding with a particular treatment.  (For example, if a pregnancy rate with clomid has the highest results for patients with PCO and you have PCO and male factor, then your probability of pregnancy generally will be lower.)  Of course, the analysis only makes sense if you have correct information on the cost of a treatment cycle (at times this is hard to figure out). This assessment also does not factor in the emotional or financial costs undergoing fertility treatments for a longer period of time to get pregnant with lower level therapies. 

Note that if a given therapy has a particular success rate per cycle and that therapy is repeated, then the probability of pregnancy is NOT additive.   For example, if the probability of pregnancy for a given therapy is 50%, then the chance of getting pregnant in two tries is NOT 100% (50% + 50%).   Rather, the probability of pregnancy in two tries is 75% (50% + (50% x 50)).

Our estimates for IVM are based on our “good prognosis patients”, namely women under 35 with a high antral follicle count.  They may or may not have male factor.  Male factor does not affect prognosis with IVM but it does for all other therapies.  Cost estimates for all therapies are based on our program and experience.  There can be a wide difference in costs if injectible gonadotropins are used.

The analysis looks at the number of cycles and cost of these cycles to have a 40% chance of achieving pregnancy with different therapies.  Of course if you are “lucky”, you might achieve pregnancy in your first try of the lowest cost therapy (someone will; someone also always wins the lottery). The number 40% was chosen because it is the expected pregnancy rate for one cycle of IVM and makes the calculations easier.  The analysis can be adapted using the above idea to any desired probability of pregnancy.

Clomiphene citrate and IUI cycle.  This cycle type is classically used for PCO/anovulation or mild male factor.  Best estimates for pregnancy rate per cycle range from 8% (male factor) to 12% (responsive anovulation/PCO).  For more severe male factor, the pregnancy rates may be much lower.  We estimate a cost of $1.3K per cycle.

8% success rate;  requires 7 cycles to get pregnancy rate > 40%;  costs $9.1K

12% success rate;  requires 5 cycles to get pregnancy rate > 40%; costs $6.5K

 

Gonadotropin cycle with IUI.  This type of cycle is used for many indications as a pregnancy acceleration technique.  It works best with PCO, but must be used cautiously with PCO to avoid multiple gestations.  Our series using it in patients with failed clomiphene/IUI donor insemination cycles had a pregnancy rate of 17%.   Male factor is likely to be lower.   We estimate a pregnancy rate of 17-25% and a cost per cycle of $3K to $4K, depending on the amount of gonadotropins used.

17% success rate;  requires 3 cycles to get pregnancy rate > 40%;  costs $9-12K

25% success rate;  requires 2 cycles to get pregnancy rate > 40%;  costs $6-8K

IVM.  Discussed in detail on this web site.  No impact of male factor.  Programmed IVM cycle cost plus anesthesia and monitoring is $6K.

40% success rate;  requires 1 cycle to get pregnancy rate > 40%;  costs $6K

Bottom line.  Looking at this situation mathematically, the case can be made that any IVF variant cycle that cost less than $9000 (and has a take home baby rate of 35%) is a better financial deal than IUI if male factor is present.  It is likely that the best estimates of success if male factor is present for IUI with clomiphene citrate or gonadotropins are a bit lower than the estimates used above.  For example, the European Infertility group (ESHRE) reviewed the medical literature for randomized controlled trials involving IUI and male factor.  Randomized controlled trials are the gold standard for estimating  effectiveness of medical treatments.  Putting data from these randomized trials together, they found a pregnancy rate of 7% per cycle for clomiphene and IUI. For gonadotropins with IUI, they found a pregnancy rate of only 12% per cycle. (Human Reproduction Update 2009 15(3):265-277)