In a nutshell
This study evaluated the clinical and cost-effectiveness of a luteinizing hormone (LH)-based modified gonadotrophin-releasing hormone (GnRH) antagonist protocol in patients with normal ovarian response undergoing in vitro fertilization (IVF) treatment. The data showed that the LH-based modified GnRH antagonist protocol was more cost-effective and had similar clinical effectiveness compared to the conventional flexible GnRH antagonist protocol.
Many couples with infertility opt to use assisted reproductive techniques (ART). In vitro fertilization (IVF) is an ART in which eggs are collected and fertilized embryos are implanted in the uterus. IVF is a complex process that requires medical control over the ovulation (egg release) cycle. The most commonly used protocol for IVF involves first suppressing the woman’s natural hormones. This allows better control of the timing of ovulation.
Two methods are commonly used. These are GnRH agonist and GnRH antagonist protocols. GnRH is a chemical produced by the brain to stimulate the pituitary to release other hormones such as follicle-stimulating hormone (FSH). The GnRH agonist protocol takes a longer period of time but may improve the body’s own level of FSH. FSH promotes ovarian follicle development. GnRH antagonist is the other commonly used option to reduce LH levels. This protocol takes a shorter period of time and may be gentler for women with poor ovarian response.
Previous studies have shown that an ultra-high or low LH level would cause harm to pregnancy outcomes. Therefore, a modified GnRH antagonist protocol based on LH level was suggested. However, the clinical and cost-effectiveness of a modified GnRH antagonist protocol based on LH levels in patients with a normal ovarian response undergoing IVF treatment is still unknown.
Methods & findings
This study involved 367 women with a normal ovarian response undergoing IVF. Patients were randomly assigned into two groups. Group 1 included 181 patients who were treated with LH-based modified GnRH antagonist protocol. Group 2 included 186 patients who were treated with a conventional flexible GnRH antagonist protocol.
The cumulative ongoing pregnancy rate was 65.1% in group 1 and 70.1% in group 2. The number of retrieved oocytes was associated with a higher cumulative ongoing pregnancy rate.
The average medicine cost per patient was 1,031.51 USD for group 1 versus 1,209.94 USD for group 2. The cost per cumulative ongoing pregnancy was 1,584.50 USD for group 1 versus 1,726.02 USD for group 2. It was estimated that the LH-based GnRH antagonist protocol saved approximately 3568.6 USD for each additional ongoing pregnancy compared to the conventional flexible GnRH antagonist protocol.
The bottom line
This study concluded that LH-based modified GnRH antagonist protocol was more cost-effective and had similar clinical effectiveness compared to the conventional flexible GnRH antagonist protocol in women with a normal ovarian response undergoing IVF treatment.
The fine print
This study only included patients treated at medical institutions in China. The studies only included patients with a normal ovarian response.
Published By :
Frontiers in Endocrinology
Aug 30, 2022