NEW YORK (Reuters Health) – Compared with standard infertility treatment, a “fast track approach” to in vitro fertilization (IVF) that eliminates gonadotropin/intrauterine insemination results in a shorter time to pregnancy and lower costs, according to a study in the June 15th online issue of Fertility and Sterility.

“Over the last two decades as IVF stimulation protocols, laboratory procedures, and transfer catheters and techniques have improved, IVF success rates for couples in which the woman is younger than 40 years have nearly doubled,” Dr. Richard H. Reindollar, from the Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire, and co-authors note.

During the same period, neither success rates of gonadotropin/intrauterine insemination therapy nor the risk of associated high-order multiple births have changed.

Dr. Reindollar’s group conducted a trial among candidates for ovulation induction with intrauterine insemination as their initial treatment. All women were 21 to 39 years of age.

The couples were randomized to conventional treatment (3 cycles of clomiphene/intrauterine insemination, 3 cycles of follicle stimulating hormone/intrauterine insemination, and up to 6 cycles of IVF) or an accelerated treatment that omitted the 3 cycles of follicle stimulating hormone/intrauterine insemination. A total of 247 couples received conventional treatment and 256 received accelerated treatment.

The cumulative percentage of pregnancies for accelerated vs standard treatment was 65.4% and 55.4%, respectively, the authors report. The time to pregnancy was also shorter with accelerated treatment (8 months vs 11 months, hazard ratio 1.25, p = 0.045).

The average of all health insurance charges per delivery were $9,846 lower in the accelerated arm.

“Follicle stimulating hormone/intrauterine insemination treatment was of no added value,” the research team concludes.

“For couples with unexplained infertility who reside in states…that require comprehensive insurance coverage, the majority will succeed,” Dr. Reindollar and associates maintain. “The overall success of treatment and low dropout rates observed for couples, largely because of comprehensive coverage, make a case for similar coverage nationwide.”

References:
Fertil Steril 2009.