Abstract
Objective: To assess the cost-effectiveness of two ovarian stimulation procedures comparing the use of FSH antagonists with the use of FSH progestin primed controlled ovarian stimulation in an oocyte donor program.
Design: To calculate cost-effectiveness ratios (costs per outcome achieved) from clinical practices using a retrospective cohort single university center study carried out from 2012 to 2021.
Main outcome measure(s): Cost-effectiveness ratios as cost per mature oocyte and cost per treatment.
Results: According to the economic analysis, ovarian stimulation with FSH antagonist protocol increased statistically significantly the overall cost of the treatment as well as the cost per retrieved and effective oocyte. The cost of gonadotrophins per mature oocyte retrieved was 49.27 ± 17.94 € and the cost of medication per mature retrieved oocyte was 59.26 ± 28.01 €. In the FSH primed progesterone group, the cost of gonadotrophins per mature retrieved oocyte was 44.67 ± 16.65 € and the cost of medication per mature retrieved oocyte retrieved 44.91 ± 20.86 €.
Conclusion: Cost-effectiveness is a compelling reason for an egg donation program. Progestins can present an effective and less expensive option for egg donation programs in terms of cost.
References
Lutjen P, Trounson A, Leeton J, Findlay J, Wood C, Renou P. The establishment and maintenance of pregnancy using in vitro fertilization and embryo donation in a patient with primary ovarian failure. Nature. 1984;307(5947):174–175.
Pennings G, De Mouzon J, Shenfield F, et al. Socio-demographic and fertility-related characteristics and motivations of oocyte donors in eleven European countries. Human Reprod. 2014;29(5):1076–1089.
Nyboe Andersen A, Goossens V, Bhattacharya S, et al.; European IVF-monitoring (EIM) Consortium, for the European Society of Human Reproduction and Embryology (ESHRE). Assisted reproductive technology and intrauterine inseminations in Europe, 2005: results generated from European registers by ESHRE: ESHRE. The European IVF Monitoring Programme (EIM), for the European Society of Human Reproduction and Embryology (ESHRE). Hum Reprod. 2009;24(6):1267-1287.
Ferraretti AP, Goossens V, Kupka M, et al. Assisted reproductive technology in Europe, 2009: Results generated from European registers by ESHRE. Human Reprod. 2013;28(9):2318–2331.
de Geyter C, Calhaz-Jorge C, Kupka MS, et al. ART in Europe, 2014: Results generated from European registries by ESHRE. Human Reprod. 2018;33(9):1586–1601.
Monitoring Consortium (EIM), for the European Society of Human Reproduction and Embryology (ESHRE); Wyns C, De Geyter C, Calhaz-Jorge C, et al. ART in Europe, 2018: results generated from European registries by ESHRE. Hum Reprod Open. 2022;2022(3):hoac022.
Gonzalo J, Perul M, Corral M, et al. A follow-up study of the long-term satisfaction, reproductive experiences, and self-reported health status of oocyte donors in Spain. European J Contracept Reprod Health Care. 2019;24(3):227–232.
Martinez F, Racca A, Rodríguez I, Polyzos NP. Ovarian stimulation for oocyte donation: a systematic review and meta-analysis. Human Reprod Update.; 2021;27(4):673–696.
Bodri D, Guillén JJ, Polo A, Trullenque M, Esteve C, Coll O. Complications related to ovarian stimulation and oocyte retrieval in 4052 oocyte donor cycles. Reprod Biomed Online. 2008;17(2):237–243.
Massin N. New stimulation regimens: Endogenous and exogenous progesterone use to block the LH surge during ovarian stimulation for IVF. Hum Reprod Update. 2017;23(2):211–220.
Kuang Y, Chen Q, Fu Y, et al. Medroxyprogesterone acetate is an effective oral alternative for preventing premature luteinizing hormone surges in women undergoing controlled ovarian hyperstimulation for in vitro fertilization. Fertil Steril. 2015;104(1):62-70.e3.
Zhu X, Ye H, Fu Y. Use of Utrogestan during controlled ovarian hyperstimulation in normally ovulating women undergoing in vitro fertilization or intracytoplasmic sperm injection treatments in combination with a “freeze all” strategy: a randomized controlled dose-finding study of 100 mg versus 200 mg. Fertil Steril. 2017;107(2):379-386.e4.
Yu S, Long H, Ya-Ning Chang H, et al. New application of dydrogesterone as a part of a progestin-primed ovarian stimulation protocol for IVF: A randomized controlled trial including 516 first IVF/ICSI cycles. Human Reprod. 2018;33(2):229–237.
Yildiz S, Turkgeldi E, Angun B, Eraslan A, Urman B, Ata B. Comparison of a novel flexible progestin primed ovarian stimulation protocol and the flexible gonadotropin-releasing hormone antagonist protocol for assisted reproductive technology. Fertil Steril. 2019;112(4):677–683.
Begueria R, Garcia D, Vassena R, Rodriguez A. Medroxyprogesterone acetate versus ganirelix in oocyte donation: a randomized controlled trial. Human Reprod. 2019;34(5):872–880.
Giles J, Alama P, Gamiz P, et al. Medroxyprogesterone acetate is a useful alternative to a gonadotropin-releasing hormone antagonist in oocyte donation: a randomized, controlled trial. Fertil Steril. 2021;116(2):404–412.
Martínez F, Clúa E, García S, Coroleu B, Polyzos NP, Barri PN. Does LH suppression by progesterone-primed ovarian stimulation compared with GnRH antagonist affect live birth rate among oocyte recipients? Reprod Biomed Online. 2020;40(5):661–667.
Evans MB, Parikh T, DeCherney AH, Csokmay JM, Healy MW, Hill MJ. Evaluation of the cost-effectiveness of ovulation suppression with progestins compared with GnRH analogs in assisted reproduction cycles. Reprod Biomed Online. 2019;38(5):691–698.
Ata B, Capuzzo M, Turkgeldi E, Yildiz S, La Marca A. Progestins for pituitary suppression during ovarian stimulation for ART: A comprehensive and systematic review including meta-analyses. Human Reprod Update. 2021;27(1):48–66.
Castillo JC, Guerrero J, Delgado R, et al. Natural micronized progesterone versus GnRH antagonist in egg-donation cycles. An extended experience (O-124). Human Reprod. 2020;35(Suppl i1-i513:i54.
Khurana RK, Rao V, Nayak C, Pranesh GT, Rao KA. Comparing progesterone primed ovarian stimulation (PPOS) to GnRH antagonist protocol in oocyte donation cycles. J Hum Reprod Sci. 2022;15(3):278–283.
Zhao W, Sun P, Li T, Li Y, Liang X, Li J. Outcomes and cost-effectiveness comparisons of progestin-primed ovarian stimulation, GnRH antagonist protocol, and luteal phase stimulation for fertility preservation. Int J Gynaecol Obstet. 2023;163(2):645–650.
Letterie G, MacDonald A, Shi Z. An artificial intelligence platform to optimize workflow during ovarian stimulation and IVF: process improvement and outcome-based predictions. Reprod Biomed Online. 2022;44(2):254–260.
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright (c) 2024 Josep Gonzalo, Camil Castelo-Branco, Sandra Garcia, Marta Devesa, Nikolaos P. Polyzos