Costs of Other Infertility Treatments
There have been relatively few analyses of alternative treatments for infertile couples. The effectiveness of intrauterine inseminations (IUIs) with and without ovarian follicular stimulation with human menopausal gonadotropin injections (hMG-IUIs) has been demonstrated in multiple series for couples whose infertility is not associated with fallopian tube obstruction or severe male factor infertility.[25-28] IUI treatment is performed by isolating the motile sperm from an ejaculate using centrifugation procedures. The motile sperm are then placed into the uterus, bypassing the cervix, and thus allowing greater numbers of sperm to reach high in the female reproductive tract. This insemination is performed when the woman is ovulating during a natural cycle. Alternatively, the insemination can be performed after multiple egg development and ovulation have been stimulated by the oral medication clomiphene citrate or injectable gonadotropin treatment (hMG).
Although the effectiveness per cycle is inferior to that of IVF, the costs associated with these treatments are also lower; therefore, they are commonly used in treating infertile couples. In 1997, we published the first study designed to compare the cost-effectiveness of a wide variety of infertility treatments including IUI alone, clomiphene citrate administration plus IUI (CC-IUI), and hMG-IUI. Although the cost-effectiveness of these various treatments would ideally be determined after a prospective, randomized allocation of couples to treatments, such a study is not feasible and is not likely to be done. Therefore, we are left comparing cost-effectiveness of procedures as they are commonly performed in an infertility practice. We found that IUI, CC-IUI, and hMG-IUI are similar procedures in terms of cost per delivery (Table 3).
Despite the increased costs of hMG cycles due to medication and cycle monitoring, higher pregnancy rates reduced the cost per delivery of hMG-IUI cycles to the range seen in IUI and CC-IUI cycles. IUI, CC-IUI, and hMG-IUI are all more cost-effective procedures than IVF due to the higher costs associated with IVF cycles.
These results support the findings of an earlier study from Utah by Peterson and coworkers demonstrating that the cost per delivery for hMG-IUI cycles was roughly one third that of IVF cycles at their academic institution. The researchers suggested that a cost-effective approach to treating infertility would be to perform 3 to 4 cycles of hMG-IUI in most couples before resorting to IVF.