Prospective randomized trial comparing the outcome and cost of in vitro fertilization with that of a traditional treatment algorithm as first-line therapy for couples with infertility

Vishvanath C. Karande; Alan Korn; Randy Morris; Ramaa Rao; Martin Balin; John Rinehart; Karen Dohn; Norbert Gleicher

doi:10.1016/s0015-0282(98)00490-7

Assisted Reproduction Outcomes and Effectiveness

Prospective randomized trial comparing the outcome and cost of in vitro fertilization with that of a traditional treatment algorithm as first-line therapy for couples with infertility

Karande VC, Korn A, Morris R, Rao R, Balin M, Rinehart J, Dohn K, Gleicher N

Published March 5, 1999 Fertility and Sterility, 71(3), 468-475

DOI 10.1016/s0015-0282(98)00490-7 PMID 10065784

RRM Academy Synopsis

IVF first gave fewer pregnancies than an algorithm in 96 couples

In a randomized trial of 96 couples at one Chicago clinic, IVF first led to fewer pregnancies than a standard algorithm: about 35 versus 56 in 100. Costs per couple did not differ significantly.

Key Findings

By June 30, 1997, clinical pregnancy rates were 34.8% (16 of 46) with IVF first and 56% (28 of 50) with the standard infertility treatment algorithm (P = .037).
Earlier analyses showed a similar gap. On December 31, 1996, rates were 19.6% versus 38% (P = .047). On March 31, 1997, they were 23.9% versus 42% (P = .06).
By June 30, 1997, mean cost per couple in charges was $13,225 with IVF and $9,557 with the algorithm, reported as not statistically different. Median cost per pregnancy was $38,021 and $16,725.
Pregnancies outside treatment: 3 of 46 (6.5%) with IVF, 9 of 50 (18%) with the algorithm, 16 of 88 (18.2%) among couples who declined randomization. The three groups did not differ significantly.

Interpretation

This single-clinic randomized trial enrolled 96 couples. The woman was 38 or younger. Couples with absent fallopian tubes or severe male factor infertility were excluded. By June 30, 1997, 23 of the 46 couples in the IVF group had undergone IVF, and follow-up was short. Costs are one clinic's charges and leave out the cost of the pregnancy itself. The authors conclude IVF should not be recommended as a universal first-line approach.

RRM Context

The IVF group had a minimal workup first. Restorative reproductive medicine evaluates both partners for the cause. IVF bypasses infertility without finding why conception fails. Couples in all three groups, including those who declined randomization, conceived outside treatment. The authors called these high spontaneous rates unexpected. The comparison arm was a traditional algorithm.

Our editorial summary of this paper, not the article's abstract.

Abstract

Objective

To determine whether IVF or a standard infertility treatment algorithm results in better outcome and/or lower cost when used as first-line therapy for couples with infertility.

Design

Prospective, randomized clinical study.

Setting

University-affiliated infertility clinic.

Patients

Couples with newly diagnosed infertility and no prior treatment.

Interventions

Couples were randomized to undergo either IVF (group 1, n = 46) or a standard infertility treatment algorithm (group 2, n = 50) as initial therapy for infertility.

Main Outcome Measures

Pregnancy rates and costs per couple, per month of treatment, and per pregnancy.

Results

Pregnancy rates were higher in group 2 than in group 1. Costs per couple were not statistically different, although a trend toward higher costs was apparent in group 1, reflected by a higher median cost per clinical pregnancy established and a higher cost per month of treatment. Whereas cost differences between the groups diminished over time, pregnancy rates remained the same.

Conclusions

In vitro fertilization currently does not represent an appropriate first-line treatment option for couples with infertility. The use of a standard infertility treatment algorithm results in a higher pregnancy rate and lower cost and therefore should be the preferred treatment approach.

Topics

Assisted Reproduction › Outcomes and Effectiveness › Live Birth Rates · Cost and Access › Cost of Care › Cost Effectiveness

Vishvanath C. Karande, Alan Korn, Randy Morris, Ramaa Rao, Martin Balin, John Rinehart, Karen Dohn, Norbert Gleicher

V Karande, A Korn, R Morris, R Rao, M Balin, Jack Rinehart, J Rinehart, K Dohn, N Gleicher

PMID 10065784 10065784 DOI 10.1016/s0015-0282(98)00490-7 10.1016/s0015-0282(98)00490-7 Karande et al. 1999, Karande 1999

Keywords

Adult, Algorithms, Cost-Benefit Analysis, Female, Fertilization in Vitro/economics, Humans, Infertility/economics/therapy, Male, Ovulation Induction, Pregnancy, Pregnancy Rate, Prospective Studies, Treatment Outcome

Prospective randomized trial comparing the outcome and cost of in vitro fertilization with that of a traditional treatment algorithm as first-line therapy for couples with infertility

IVF first gave fewer pregnancies than an algorithm in 96 couples

Key Findings

Interpretation

RRM Context

Abstract

Topics

By this author

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Keywords