Department of Obstetrics and Gynecology, Catharina Medical Center, Michelangelolaan 2, 5623EJ Eindhoven, The Netherlands; Centre for Reproductive Medicine, Academic Medical Centre, Amsterdam, The Netherlands.
Centre for Reproductive Medicine, Academic Medical Centre, Amsterdam, The Netherlands.
Reprod Biomed Online. 2014 Mar;28(3):336-42. doi: 10.1016/j.rbmo.2013.10.021. Epub 2013 Dec 1.
Couples with unexplained subfertility are often treated with intrauterine insemination (IUI) with ovarian stimulation, which carries the risk of multiple pregnancies. An explorative randomized controlled trial was performed comparing one cycle of IVF with elective single-embryo transfer (eSET) versus three cycles of IUI-ovarian stimulation in couples with unexplained subfertility and a poor prognosis for natural conception, to assess the economic burden of the treatment modalities. The main outcome measures were ongoing pregnancy rates and costs. This study randomly assigned 58 couples to IVF-eSET and 58 couples to IUI-ovarian stimulation. The ongoing pregnancy rates were 24% in with IVF-eSET versus 21% with IUI-ovarian stimulation, with two and three multiple pregnancies, respectively. The mean cost per included couple was significantly different: €2781 with IVF-eSET and €1876 with IUI-ovarian stimulation (P<0.01). The additional costs per ongoing pregnancy were €2456 for IVF-eSET. In couples with unexplained subfertility, one cycle of IVF-eSET cost an additional €900 per couple compared with three cycles of IUI-ovarian stimulation, for no increase in ongoing pregnancy rates or decrease in multiple pregnancies. When IVF-eSET results in higher ongoing pregnancy rates, IVF would be the preferred treatment. Couples that have been trying to conceive unsuccessfully are often treated with intrauterine insemination (IUI) and medication to improve egg production (ovarian stimulation). This treatment carries the risk of multiple pregnancies like twins. We performed an explorative study among those couples that had a poor prognosis for natural conception. One cycle of IVF with transfer of one selected embryo (elective single-embryo transfer, eSET) was compared with three cycles of IUI-ovarian stimulation. The aim of this study was to assess the economic burden of both treatments. The Main outcome measures were number of good pregnancies above 12weeks and costs. We randomly assigned 58 couples to IVF-eSET and 58 couples to IUI-ovarian stimulation. The ongoing pregnancy rates were comparable: 24% with IVF-eSET versus 21% with IUI-ovarian stimulation. There were two multiple pregnancies with IVF-eSET and three multiple pregnancies with IUI-ovarian stimulation. The mean cost per included couple was significantly different, €2781 with IVF-eSET and €1876 with IUI-ovarian stimulation. The additional costs per ongoing pregnancy were €2456 for IVF-eSET. In couples with unexplained subfertility, one cycle of IVF-eSET costed an additional €900 per couple compared to three cycles of IUI-ovarian stimulation, for no increase in ongoing pregnancy rates or decrease in multiple pregnancies. We conclude that IUI-ovarian stimulation is the preferred treatment to start with. When IVF-eSET results in a higher ongoing pregnancy rate (>38%), IVF would be the preferred treatment.
对于不明原因不孕的夫妇，常采用宫腔内人工授精（IUI）联合卵巢刺激治疗，但存在多胎妊娠的风险。本探索性随机对照试验比较了不明原因不孕且自然受孕预后不良的夫妇进行一次体外受精（IVF）联合选择性单胚胎移植（eSET）与三次 IUI-卵巢刺激治疗的经济性负担，以评估这两种治疗方法的经济负担。主要结局指标为持续妊娠率和成本。本研究将 58 对夫妇随机分配至 IVF-eSET 组和 IUI-卵巢刺激组。IVF-eSET 组的持续妊娠率为 24%，IUI-卵巢刺激组为 21%，分别有两例和三例多胎妊娠。纳入夫妇的平均成本差异具有统计学意义：IVF-eSET 组为 2781 欧元，IUI-卵巢刺激组为 1876 欧元（P<0.01）。IVF-eSET 的每个持续妊娠的额外成本为 2456 欧元。对于不明原因不孕的夫妇，与三次 IUI-卵巢刺激相比，一次 IVF-eSET 治疗的额外费用为每对夫妇 900 欧元，但持续妊娠率或多胎妊娠率并无增加。当 IVF-eSET 导致更高的持续妊娠率时，IVF 将成为首选治疗方法。那些尝试怀孕但不成功的夫妇通常会接受宫腔内人工授精（IUI）和药物治疗以提高卵子产量（卵巢刺激）。这种治疗方法有双胞胎等多胎妊娠的风险。我们在自然受孕预后不良的夫妇中进行了一项探索性研究。一次体外受精（IVF）联合转移一个选择的胚胎（选择性单胚胎移植，eSET）与三次 IUI-卵巢刺激进行比较。本研究的目的是评估这两种治疗方法的经济负担。主要结局指标为 12 周以上的良好妊娠数和成本。我们将 58 对夫妇随机分配至 IVF-eSET 组和 IUI-卵巢刺激组。IVF-eSET 组的持续妊娠率为 24%，IUI-卵巢刺激组为 21%。IVF-eSET 组有两例多胎妊娠，IUI-卵巢刺激组有三例多胎妊娠。纳入夫妇的平均成本差异具有统计学意义，IVF-eSET 组为 2781 欧元，IUI-卵巢刺激组为 1876 欧元。IVF-eSET 的每个持续妊娠的额外成本为 2456 欧元。对于不明原因不孕的夫妇，与三次 IUI-卵巢刺激相比，一次 IVF-eSET 治疗的额外费用为每对夫妇 900 欧元，但持续妊娠率或多胎妊娠率并无增加。我们的结论是，IUI-卵巢刺激是首选的起始治疗方法。当 IVF-eSET 导致更高的持续妊娠率（>38%）时，IVF 将成为首选治疗方法。
