Please use this identifier to cite or link to this item: https://hdl.handle.net/2440/88135
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Type: Journal article
Title: Long-term outcome in couples with unexplained subfertility and an intermediate prognosis initially randomized between expectant management and immediate treatment
Author: Custers, I.
van Rumste, M.
van der Steeg, J.
van Wely, M.
Hompes, P.
Bossuyt, P.
Broekmans, F.
Renckens, C.
Eijkemans, M.
Van Dessel, T.
van der Veen, F.
Mol, B.
Steures, P.
CECERM
Citation: Human Reproduction, 2012; 27(2):444-450
Publisher: Oxford University Press
Issue Date: 2012
ISSN: 0268-1161
1460-2350
Statement of
Responsibility: 
Inge M. Custers, Minouche M.E. van Rumste, Jan Willem van der Steeg, Madelon van Wely, Peter G.A. Hompes, Patrick Bossuyt, Frank J. Broekmans, Cees N.M. Renckens, Marinus J.C. Eijkemans, Thierry J.H.M. van Dessel, Fulco van der Veen, Ben W.J. Mol, Pieternel Steures, and CECERM
Abstract: BACKGROUND We recently reported that treatment with intrauterine insemination and controlled ovarian stimulation (IUI-COS) did not increase ongoing pregnancy rates compared with expectant management (EM) in couples with unexplained subfertility and intermediate prognosis of natural conception. Long-term cost-effectiveness of a policy of initial EM is unknown. We investigated whether the recommendation not to treat during the first 6 months is valid, regarding the long-term effectiveness and cumulative costs. METHODS Couples with unexplained subfertility and intermediate prognosis of natural conception (n=253, at 26 public clinics, the Netherlands) were randomly allocated to 6 months EM or immediate start with IUI-COS. The couples were then treated according to local protocol, usually IUI-COS followed by IVF. We followed couples until 3 years after randomization and registered pregnancies and resources used. Primary outcome was time to ongoing pregnancy. Secondary outcome was treatment costs. Analysis was by intention-to-treat. Economic evaluation was performed from the perspective of the health care institution. RESULTS Time to ongoing pregnancy did not differ between groups (log-rank test P=0.98). Cumulative ongoing pregnancy rates were 72–73% for EM and IUI-COS groups, respectively [relative risk 0.99 (95% confidence interval (CI) 0.85–1.1)]. Estimated mean costs per couple were €3424 (95% CI €880–€5968) in the EM group and €6040 (95% CI €4055–€8125) in the IUI-COS group resulting in an estimated saving of €2616 per couple (95% CI €385–€4847) in favour of EM. CONCLUSIONS In couples with unexplained subfertility and an intermediate prognosis of natural conception, initial EM for 6 months results in a considerable cost-saving with no delay in achieving pregnancy or jeopardizing the chance of pregnancy. Further comparisons between aggressive and milder forms of ovarian stimulation should be performed.
Keywords: unexplained subfertility
intrauterine insemination and controlled ovarian stimulation
expectant management
long-term outcome
economic analysis
Rights: © The Author 2011.
DOI: 10.1093/humrep/der389
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Paediatrics publications

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