Cost-effectiveness of assisted conception for male subfertility

Moolenaar, Lobke M.; Cissen, M.; Bruin, Jan Peter de; Hompes, Peter G.A.; Repping, Sjoerd; Veen, Fulco van der; Mol, Ben Willem J.

doi:10.1016/j.rbmo.2015.02.006

Cited by 28 publications

(13 citation statements)

References 29 publications

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“…Carnitines also scavange free oxygen radicles and ROS, thus protecting against OS, as well as aiding cellular repair in mitochondria during β-oxidation of long-chain fatty acids (Steiber et al, 2004, Smits et al, 2019, Reuter and Evans, 2012, Fritz, 1963. However, whilst improved semen characterisitics have been reported, very few studies have recorded pregnancy outcomes after treatment of infertile men with carnitines, and none have considered live birth as a primary outcome (Hakonsen et al, 2011, Moolenaar et al, 2015, Poljsak, 2011, Shekarriz et al, 1995, Zini et al, 1993.…”

Section: Discussionmentioning

confidence: 99%

l-carnitine and l-acetylcarnitine supplementation for idiopathic male infertility

Khaw

Wong

Anderson

et al. 2020

Reproduction and Fertility

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15% of couples globally are estimated to be infertile, with up to half of these cases attributed to male infertility. Reactive oxidative species (ROS) are known to damage sperm leading to impaired quantity and quality. Although not routinely assessed, oxidative stress is a common underlying pathology in infertile men. Antioxidants have been shown to improve semen analysis parameters by reducing ROS and facilitating repair of damage caused by oxidative stress, but it remains unclear whether they improve fertility. Carnitines are naturally occurring antioxidants in mammals and are normally abundant in the epididymal luminal fluid of men. We conducted a systematic review and meta-analysis to evaluate the safety and efficacy of carnitine supplementation for idiopathic male infertility. We searched ClinicalKey, ClinicalTrials.gov, Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, MEDLINE, PubMed and ScienceDirect for relevant studies published from 1 January 2000 to 30 April 2020. Of the articles retrieved, only 8 randomised controlled trials were identified and included. Analysis showed that carnitines significantly improve total sperm motility, progressive sperm motility and sperm morphology, but without effect on sperm concentration. There was no demonstrable effect on clinical pregnancy rate in the 5 studies that included that outcome, although patient numbers were limited. Therefore, the use of carnitines in male infertility appears to improve some sperm parameters but without evidence of an increase in the chance of natural conception.

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Section: Discussionmentioning

confidence: 99%

l-carnitine and l-acetylcarnitine supplementation for idiopathic male infertility

Khaw

Wong

Anderson

et al. 2020

Reproduction and Fertility

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“…A cost-effective analysis shows that if only cost per live birth is considered for each treatment, above a pre-wash total motile sperm count (TMSC) of three million intrauterine insemination (IUI) is more costeffective than IVF. Below a pre-wash TMSC of three million, intracytoplasmic sperm injection (ICSI) is more cost-effective than IUI (Moolenaar et al, 2015). Therefore, it is important to secure sufficient total progressive sperm count (TPMS) numbers if first-line IUI treatment is to be efficiently managed (Bahadur et al, 2015;Hamilton et al, 2015).…”

Section: Introductionmentioning

confidence: 99%

Semen characteristics in consecutive ejaculates with short abstinence in subfertile males

Bahadur

Almossawi

Zaid

et al. 2016

Reproductive BioMedicine Online

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This study reports the favourable semen characteristics of 73 subfertile oligozoospermic men with short abstinence periods up to 40 min. Semen characteristics were compared between initial and consecutive ejaculate showing improved semen parameters: progressive grade A spermatozoa, morphology and sperm concentration. Median concentrations in initial and consecutive ejaculates were 10 million/ml and 17 million/ml, respectively. The second sample had a higher median normal morphology (7% versus 6%, P < 0.001). The median of non-progressive spermatozoa (Grade C) was significantly lower in the consecutive sample than the initial sample (0% versus 5%, P < 0.01). Medians for slow progression spermatozoa (B grade) and immotile spermatozoa (D grade) were lower in the consecutive samples (20% versus 13%, P < 0.01 and 60% versus 50%, P < 0.001, respectively). The median for rapid motility (Grade A) was significantly higher in the consecutive sample than the first (30% versus 5%, P < 0.001). Overall median progressive motility as benchmarked by the WHO 2010 criteria was significantly higher in the consecutive sample (43% versus 25%, P < 0.001). Semen analyses of consecutive semen samples collected 30 min (mean) apart in oligozoospemic men should be checked routinely for diagnostic purposes and for managing potential subfertility treatment.

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“…Bahadur, Ilahibuccus, Al-Habib, & Okolo, 2015;Peeraer et al, 2015). Furthermore, the low proportion of clinics that are adhering to the recommendation to reject IUI as a first-line treatment provides further evidence that this advice has not be well received (Kim et al, 2015).As a final consideration, recent economic analyses suggests that if only cost per live birth is considered then IUI continues to be better value that IVF (Moolenaar et al, 2015;Tjon-Kon-Fat et al, 2015), even without taking into account any of the aforementioned associated risks. Until more robust clinical and economic data becomes available, we suggest that provision of stimulated IUI, in centres where a satisfactory live birth rate is achieved, represents a significant cost-saving to those commissioning fertility services, with lower risks than IVF and an improvement on providing no treatment.…”

Section: Resultsmentioning

confidence: 99%

Replacing IUI with IVF for initial treatment of unexplained infertility: why this NICE recommendation is cause for concern

Woodward¹,

Tomlinson²,

Kirkman-Brown

2016

Human Fertility

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The latest guidelines from the National Institute for Health and Care Excellence (NICE) for assisted conception recommend that people experiencing unexplained infertility should no longer be offered stimulated intra-uterine insemination (IUI) as a first-line treatment, but rather be directed towards IVF or alternatively be left to expectant management. NICE has acknowledged that the cited evidence leading to this decision was not sufficiently robust. As such, we are concerned that accordance with these new NICE guidelines may result in people with no identifiable cause of their infertility being prematurely referred for IVF treatment. Since IVF constitutes a more invasive and expensive treatment process, which also represents an additional and unnecessary cost pressure to the National Health Service, there is a longstanding need for a robust clinical trial to resolve the uncertainty as to whether one treatment is more appropriate than another. Until such data is available, we suggest that provision of stimulated IUI, in centres achieving a satisfactory live birth rate, represents a significant cost-saving to those commissioning fertility services, with lower risks to people treated.

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Cost-effectiveness of assisted conception for male subfertility

Cited by 28 publications

References 29 publications

l-carnitine and l-acetylcarnitine supplementation for idiopathic male infertility

l-carnitine and l-acetylcarnitine supplementation for idiopathic male infertility

Semen characteristics in consecutive ejaculates with short abstinence in subfertile males

Replacing IUI with IVF for initial treatment of unexplained infertility: why this NICE recommendation is cause for concern

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