Human reproduction
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Randomized Controlled Trial Comparative Study
Cost-effectiveness of a mild compared with a standard strategy for IVF: a randomized comparison using cumulative term live birth as the primary endpoint.
BACKGROUND Conventional ovarian stimulation and the transfer of two embryos in IVF exhibits an inherent high probability of multiple pregnancies, resulting in high costs. We evaluated the cost-effectiveness of a mild compared with a conventional strategy for IVF. METHODS Four hundred and four patients were randomly assigned to undergo either mild ovarian stimulation/GnRH antagonist co-treatment combined with single embryo transfer, or standard stimulation/GnRH agonist long protocol and the transfer of two embryos. ⋯ The incremental cost-effectiveness ratio of the standard strategy compared with the mild strategy was euro185 000 per extra pregnancy leading to term live birth. CONCLUSIONS Despite an increased mean number of IVF cycles within 1 year, from an economic perspective, the mild treatment strategy is more advantageous per term live birth. It is unlikely, over a wide range of society's willingness-to-pay, that the standard treatment strategy is cost-effective, compared with the mild strategy.
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Clinical manifestations of androgen excess-hirsutism, acne and alopecia-are very common and distressing symptoms in women of reproductive age. These symptoms are frequently associated with polycystic ovary syndrome, in which condition menstrual disturbances are also common. The combination of the anti-androgen cyproterone acetate (2 mg) and ethinyl estradiol (35 microg) (co-cypridiol) is of proven efficacy in management of symptoms of both hyperandrogenism and menstrual abnormalities but its long-term use has been discouraged because of concern about increased risk of venous thromboembolism. In this article, we review the evidence for efficacy and adverse effects and conclude that its benefits are clear and that the risks of venous thromboembolism are no more common that with the use of third generation combined oral contraceptives.