Cost-effective analysis of infertility treatment in women with anovulatory polycystic ovarian syndrome

Abstract

Introduction: Polycystic ovarian syndrome (PCOS) is a common cause of female infertility. Clomiphene citrate (CC) is a first line treatment for infertility secondary to PCOS, in addition to Letrozole. After unsuccessful cycles using CC and timed intercourse, pregnancy may be achieved using in-vitro fertilization (IVF), bypassing gonadotropins. We explore the most efficient and cost-effective way to obtain at least 70% live-birth rate in PCOS patients who fail first-line treatment. Materials and methods: A review of relevant trials using PUBMED was performed to obtain pregnancy rates of women with PCOS undergoing various treatments. Six randomized trials were included in this study. We used 761 cycles from these trials. Four different protocols were structured: protocol 1 consisted of 3 cycles of CC/intrauterine insemination (IUI) followed by 3 cycles of human menopausal gonadotropin stimulation with IUI followed by 2 cycles of IVF/intracytoplasmic sperm injection (ICSI). Protocol 2 involved 3 cycles of CC/IUI followed by 2 cycles of IVF/ICSI. Protocol 3 was comprised of 3 cycles of human menopausal gonadotropin/IUI followed by 2 cycles of IVF/ICSI, and protocol 4 was composed of 2 cycles of IVF/ICSI and 1 cycle of frozen embryo transfer. Each protocol was analyzed for cost per live birth and time to live birth. Results: Protocol 1 yielded a live-birth rate of 75%, costing $34,923 per live-birth achieved over a 10-month period. Protocol 2 yielded a pregnancy rate of 71%, costing $32,172 over 7 months. Protocol 3 yielded a pregnancy rate of 73%, costing $39,812 over 7 months. Lastly, protocol 4 yielded a pregnancy rate of 70%, costing $37,884 per pregnancy over a 5-month period. Conclusion: Protocol 4 was the most efficient, reaching a 70% live birth rate in a 5-month period. Protocol 2 was the most cost-effective, with a total cost of $32,172 per live birth. These results will assist physicians in counseling PCOS patients with subfertility to determine the optimal treatment method.