Effectiveness and Cost-effectiveness of Minimal Ovarian Stimulation in-vitro Fertilization versus Conventional Ovarian Stimulation in Poor Responders: Economic Evaluation Alongside a Propensity Score Adjusted Prospective Observational Study

Abstract

Objective: Information on the pregnancy rate after successive in-vitro fertilization (IVF) cycles and their associated costs is relevant for couples undergoing assisted reproduction treatments (ARTs). This study, therefore, sought to investigate the effectiveness and the costeffectiveness of two ARTs, the minimal ovarian stimulation IVF (MS-IVF) compared to the conventional ovarian stimulation IVF (C-IVF) from the payer's perspective.Methods: A 10-months follow-up prospective observational study was conducted in a sample of couples who sought ARTs in a private clinic in Southern Brazil. Women had to satisfy the Bologna Criteria and be older than 35 years. The effect outcome was pregnancy rate per initiated cycle. Medication costs were based on medical records. Costs and effect differences were estimated using seemingly unrelated regressions adjusted for the propensity score estimated based on women's characteristics.Results: All 84 eligible women who agreed to participate received a total of 92 IVF cycles (MS-IVF, n=27[35 cycles]; C-IVF n=57[57 cycles]. The effect difference between MS-IVF and C-IVF was -5.1% (95%CI, -13.2 to 5.2). Medication costs of MS-IVF were significantly lower than C-IVF by €-1260 (95%CI, -1401 to -1118). The probabilities of MS-IVF being cost-effective compared to C-IVF ranged from 1 to 0.76 for willingness-to-pay of €0 to €15,000 per established pregnancy, respectively.Conclusions: Even though there were no positive effect differences between groups, MS-IVF might be costeffective compared to C-IVF from the payer's perspective due to its relatively large cost savings compared to C-IVF. However, further investigation is needed to confirm these findings in a larger sample.

Donor side effects experienced under minimal controlled ovarian stimulation (COS) with in vitro maturation (IVM) versus conventional COS forin vitrofertilization (IVF) treatment

“…Minimal COS combined with IVM and IVF compared to conventional COS and IVF treatment is considered a less invasive, faster, and potentially less expensive treatment (40,41), making reproductive treatments more accessible for women. A recent study assessed costs in assisted reproduction, concluding that minimal COS was more cost-effective than conventional procedures due to significant savings from reduced hormone doses (14). Additionally, a reduction to 0 – 4 days of stimulation from 9–14 days in conventional COS means that women undergo significantly less monitoring in the form of ultrasound and bloodwork, often needing only one appointment with minimal COS and IVM compared to 3-6 appointments in conventional COS.…”

“…The treatment may induce emotional and physical stress with frequent injections, monitoring appointments, and uncertainty in IVF success (11)(12)(13). Moreover, the high doses of hormones used in infertility treatments result in expensive costs for women who wish to preserve their fertility or achieve their desired motherhood, which often requires the need for multiple cycles (14). The health and financial consequences of conventional COS contribute highly to limiting overall access to IVF treatment and continue to reinforce inequality in care worldwide, which is a major concern globally for health equity in fertility treatment.…”

Ovarian support cell in vitro maturation (OSC-IVM) results in healthy murine live births with no evidence of reprotoxicology in a multigenerational study

“…Consequently, this innovative technique not only shortens the duration of treatment, but also substantially reduces medication costs, thereby rendering IVF more affordable. Additionally, IVM may offer a more cost-effective and accessible option compared to conventional IVF ( Souza et al, 2023), particularly for patients with conditions such as polycystic ovary syndrome (PCOS) or those susceptible to ovarian complications (Cela et al, 2018; De Vos et al, 2021; Gilchrist and Smitz, 2023; Mahajan, 2015; Schirmer et al, 2020).…”