The Cost-effectiveness of Clomiphene Citrate Against Gonadotropin Therapy in Women with Unexplained Infertility

Abstract

Aim: Clomiphene citrate (CC) is the most frequently used agent for ovarian stimulation (OS). Gonadotropin (GND) treatment can be encouraged as a next step in women who are not able to become pregnant with CC. We aimed to determine the efficacy and costeffectiveness of CC and GND in patients with unexplained infertility undergoing OS and intrauterine insemination. Material and Method: The cost-effectiveness and success of CC and GND were retrospectively evaluated in 358 infertile women, of whom 247 received CC and 11 received GND treatment. The total CC/GND dose, endometrial thickness, semen parameters, duration of OS, follicle size, and pregnancy outcome were recorded. The medical costs of both strategies were analyzed, including the costs of medication and cycle monitoring. The cost of insemination was not evaluated since it was applied in both groups. The Shapiro-Wilk test, Student’s t-test and Mann-Whitney U test were used for statistical analyses. Results: There were no statistically significant differences between the groups in terms of cycle characteristics, semen analysis, total drug dose used, duration of OS, and dominant follicle size (p>0.05 for all). The pregnancy rate was 23.5% among the 264 (73.7%) patients with primary infertility and 17% among the 94 (26.3%) patients with secondary infertility. No significant difference was observed between the CC and GND groups with regard to the achieved pregnancy rate (21.1% vs. 23.4%, p=0.615). No side effect was observed. The cost of treatment for a couple with unexplained infertility was 1,716.42 TL for GND and 30.67 TL for CC. Conclusion: The treatment success of OS with CC and GND seems to be similar in patients with unexplained infertility. Therefore, considering the cost-effectiveness and side effects of GND medication, the first choice should be CC in these patients.

Keywords

• clinical pregnancy
• clomiphene citrate
• gonadotropin
• ovulation induction; unexplained infertility

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