Individualized cost-effective conventional ovulation induction treatment in normogonadotrophic anovulatory infertility (WHO group 2)

BACKGROUND: Conventional treatment in normogonadotrophic anovulatory infertility (WHO 2) consists of clomiphene citrate (CC), followed by exogenous gonadotrophins (FSH) and IVF. Response to these treatments may be predicted on the basis of individual patient characteristics. We aimed to devise a patient-tailored, cost-effective treatment algorithm involving the above-mentioned treatment modalities, based on individual patient characteristics. METHODS: Sixteen prognostic groups are defined, according to the presence or absence of: age > 30 years, amenorrhea, elevated androgen levels and obesity. The chances of response with each of the three treatments were calculated using prediction models. Treatment costs were based on the data of 240 patients visiting a specialist academic fertility unit. Outcome was an ongoing pregnancy within 12 months after initiation of treatment. The costs per pregnancy of three different strategies were compared, with a threshold for cost-effectiveness of EURO 10 000. RESULTS: The strategy CC + FSH + IVF compared with FSH + IVF generated more pregnancies against lower costs. Compared with CC + IVF, it also produced more pregnancies, but at higher costs. For < 30 years of age with normal androgen levels, costs per pregnancy were less than EURO 10 000. For women > 30 years old, costs per pregnancy were EURO 25 000 and over EURO 200 000, when presenting with normal or elevated androgen levels, respectively. CONCLUSIONS: The conventional treatment protocol is efficient for women aged < 30 years with normal androgen levels. For women > 30 years old with elevated androgen levels, FSH may be skipped.