Minimal-Stimulation IVF Plus SET Reduces Costs and Improves Access to Effective IVF Care

Article

The combined approach of minimal-stimulation in vitro fertilization (IVF) with single-embryo transfer (SET) decreases the treatment costs associated with traditional IVF in women with favorable prognostic features without adversely affecting pregnancy results, according to findings from a new study.

Susan C. Carr, MSN, CRNP, of Reproductive Associates of Delaware in Newark, DE, presented results from the study at the Scientific Congress & Expo of the American Society for Reproductive Medicine, held October 15 to 19, 2016, in Salt Lake City, UT.

Medication costs, clinical services, and laboratory operations contribute to the high cost of traditional IVF, which is often not covered by health insurance. With cost as a major barrier to care, some patients may opt for less expensive but less successful treatment, may delay treatment, or may forgo fertility treatment altogether.

Relative to traditional IVF, minimal-stimulation IVF involves lower doses of costly gonadotropins and reduces the clinical and laboratory expenses associated with follicle retrieval. In addition, SET lowers the risk of multiple pregnancies and reduces associated downstream medical costs. In the present retrospective analysis, Carr and her colleagues examined whether the combined approach of minimal-stimulation IVF and SET could provide high numbers of live births, ongoing pregnancy rates at lower costs, or both.

The research team evaluated the medical records of 137 women with good prognostic features for IVF, defined as age younger than 35 years, anti-mullerian hormone (AMH) level higher than 2.4 ng/mL, antral follicle count above 10, body mass index below 35 kg/m², and a diagnosis of polycystic ovarian syndrome, stage 1/2 endometriosis, tubal-factor infertility, and/or mild to moderate male-factor infertility. All patients had undergone traditional IVF or minimal-stimulation IVF according to personal and physician preferences.

Baseline characteristics were similar in both treatment groups. Patients had a mean age of approximately 29 years, mean body mass index of 25.6 to 25.9 kg/m², mean basal follicle-stimulating hormone (FSH) level of 5.8 to 6.1 mIU/mL, and mean AMH level of 5.5 to 7.6 ng/mL.

Traditional IVF protocols were individualized for each patient, resulting in a mean FSH dose of 240 IU/day for 11 days. In the minimal-stimulation IVF group, patients received a mean dose of clomiphene citrate 100 mg/day for 5 days, followed by FSH 150 IU/day for 8 days. Patients in both groups received a standard low-dose human chorionic gonadotropin trigger when the majority of the dominant follicles reached more than 18 mm in size. Egg retrieval was performed 36 hours after the trigger and mature oocytes were fertilized. Embryos were grown to blastocyst stage and transferred on day 5 or cryopreserved.

The minimal-stimulation IVF plus SET protocol utilized lower doses of FSH and led to fewer oocytes retrieved, fewer blastocytes created, and a higher rate of fresh blastocyst transfers relative to traditional IVF (Table 1). Despite these differences, the overall success rate was comparable, with 78% of oocyte retrievals in the minimal-stimulation IVF/SET group resulting in ongoing pregnancies compared with 85% in the traditional IVF group.

Table 1. Procedural Outcomes From Minimal-Stimulation IVF and Traditional IVF

Outcome Minimal-Stimulation IVF
Traditional IVF
P Value
Stimulation cycles, n 83 54 NR
Mean total FSH dose, IU 1209 2169 < .01
Retrievals, n (%) 78/83 (94) 54/54 (100) NS
Mean total oocytes, n 15.7 24.1 < .01
Mean blastocysts, n 7.5 11.7 < .01
Fresh transfer/retrieval, n (%) 53/78 (68) 25/54 (45) < .04
Ongoing pregnancies/fresh transfer, n (%) 33/53 (62) 17/25 (68) NS
Frozen transfers, n 45 44 NR
Ongoing pregnancies/frozen transfer, n (%) 28/45 (62) 29/44 (66) NS
Cumulative ongoing pregnancies/retrieval, n (%) 61/78 (78) 46/54 (85) NS
Mean transfers to ongoing pregnancy, n 1.2 1.3 NS

IVF = in vitro fertilization, NR = not reported, NS = nonsignificant.

Costs were significantly lower in the minimal-stimulation IVF/SET group, resulting in a total savings of more than $5,000 relative to traditional IVF (Table 2). In the cost analysis, medication costs were calculated using standard specialty pharmacy pricing. Cycle maintenance fees were based on actual billing reimbursement data from the patient records.

Table 2. Procedural Costs From Minimal-Stimulation IVF and Traditional IVF

Mean Cost
Minimal-Stimulation IVF, $
Traditional IVF, $
Absolute Difference, $
Percent Difference
Medications 3844.65 5681.67 1837.02 32
Treatment cycle 9716.55 13,107.10 3390.55 26
Total cost (medication + treatment) 13,561.20 18,788.77 5227.57 28
Total cost per live birth 17,340.55 22,056.38 4715.83 21

IVF = in vitro fertilization.

In women with good prognostic features, minimal-stimulation IVF using clomiphene and low-dose FSH followed by SET reduced the total cost of treatment by 28% without compromising pregnancy results relative to traditional IVF. By lowering cost-related barriers, minimal-stimulation IVF with SET may improve access to effective IVF treatment for many patients.

Source: Carr SC, Ramos EE, Modelski M, et al. Can affordability and access to care be enhanced by minimal stimulation IVF (MS-IVF) and single embryo transfer (SET)? Presented at: American Society for Reproductive Medicine 2016 Scientific Congress & Expo; October 15-19, 2016; Salt Lake City, UT. Abstract O-11.