Abstract
Study question
Our objective was to compare the results and costs between conjugal intrauterine insemination (IAC) and in vitro fertilization (IVF) in a third-level public health hospital.
Summary answer
The direct estimated cost for achieving a clinical pregnancy was € 3808.24 for IAC and € 14,195.88 for IVF.
What is known already
There is a belief among patients, professionals, and media in favor of the results offered by IVF. Studies on the results, risks, complications and costs are difficult to understand, thus making IVF the most widespread and in demand reproduction technique among fertility clinics. In 2013 the National Institute of Health and Care Excellence conducted a study comparing artificial insemination using 25 mg of clomiphene citrate vs. expectant management of sterility, without finding significant differences. After this, in their guide they recommended the elimination of insemination from the couples’ treatment protocols, proposing to replace it with three cycles of IVF.
Study design, size, duration
This is a retrospective observational study of a total of 1384 conjugal insemination cycles carried out in our center between 2007–2019 and 646 cycles of in vitro fertilization, intracytoplasmic injection (ICSI) or mixed.
Participants/materials, setting, methods
All IAC were included. IVF cycles analyzed were those made under the diagnose of tubal factor, to homogenize the samples. The calculation of the direct costs of each technique has been carried out by the collection of the costs of these procedures from the registry of public costs of the Andalusian public health system. The pharmacy spending in an average cycle has been obtained from the public prices of prescriptions made in our service.
Main results and the role of chance
The direct estimated cost for achieving a clinical pregnancy with the cumulative clinical pregnancy rate found in our sample was € 3808.24 for IAC and € 14,195.88 for IVF. The additional cost of a pregnancy achieved by IVF compared to one achieved by IAC was € 10,387.64. The mean age of the patients was higher in the group undergoing in vitro fertilization treatment (34.41 years) compared to those undergoing artificial insemination treatment (32.18 years), the differences between both being statistically significant ( p < 0.005). We also found statistically significant differences between the clinical pregnancy rate (12.2% in the group that underwent an AI and the 25.8% in which an IVF was performed) and the live newborn rate between both groups (8.7% in the group that underwent AI and 16% in which IVF was performed), both being higher for the group subjected to in vitro fertilization. In the twin pregnancy rate, we also found significant differences (p 0.005) between both groups, being 6.8% in the patients undergoing IVF compared to 0.8% in the inseminations.
Limitations, reasons for caution
Regarding the costs per cycle, indirect costs of these have not been taken into account, such as values in the cost of pregnancy and delivery of single or multiple pregnancies, or costs of complications derived from the techniques (ovarian hyperstimulation syndrome, fetal reductions, terminations for other reasons, etc.)
Wider implications of the findings: The recommendations made by the NICE promote IVF treatment to couples with infertility of unknown origin. In our opinion, this recommendation should be subjected to a more extensive cost-effectiveness analysis of both techniques, given that IVF requires a considerably higher investment of resources, finding results not so different as expected.
Trial registration number
Not applicable
Male adiposity impairs clinical pregnancy rate by in vitro fertilization without affecting day 3 embryo quality
