Replacing hMG/FSH by low dose hCG to complete corifollitropin alfa stimulation substantially reduces the cost per clinical pregnancy of IVF: a randomised pragmatic trial

Abstract Research question The cost of in vitro fertilization (IVF) treatment remains high, among other factors because of the medication needed for controlled ovarian stimulation (COS). This study investigated the effect of using low dose human chorionic gonadotropin (hCG) for the second phase of follicular maturation after corifollitropin alfa induction to replace the more expensive follicle stimulating hormone (FSH), either recombinant or human menopausal gonadotropin (hMG), on the cost of COS. Design One hundred and seven patients were randomly divided into 2 groups: patients of Group A (n = 50) received low dose hCG from day 7 until the diameter of at least 3 follicles reached 17 mm or more, patients of group B (n = 55) received the conventional COS with menotropin (Menopur®) injections. Results The pregnancy rate in group A was 30% higher than in group B (Number Need to Treat; NNT=13). The cost per pregnancy needed for COS was reduced from 4902 € in group B to 2684 € in group A. Hence, the amount of money needed for COS medication to obtain 10 pregnancies using the conventional FSH-protocol is sufficient to attain 17 pregnancies when applying the low dose hCG protocol. Conclusion This study provides evidence that using hCG instead of hMG/FSH for COS results in a significant reduction of the in cost of IVF with, at least, an equivalent pregnancy outcome.