The OPTIMIST study: optimisation of cost effectiveness through individualised FSH stimulation dosages for IVF treatment. A randomised controlled trial

TC van Tilborg, Rene Eijkemans, Joop Laven, CAM Koks, Hans Bruin, GJ Scheffer, RJT van Golde, Kathrin Fleischer, A Hoek, AW Nap, WKH Kuchenbecker, PA Manger, EA Brinkhuis, AM Heusden, AV Sluijmer, A Verhoeff, MHA Hooff, J Friederich, JMJ Smeenk, J KweeHR Verhoeve, CB Lambalk, FM Helmerhorst, F van der Veen, BWJ (Ben) Mol, HL Torrance, FJM Broekmans

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Abstract

Background: Costs of in vitro fertilisation (IVF) are high, which is partly due to the use of follicle stimulating hormone (FSH). FSH is usually administered in a standard dose. However, due to differences in ovarian reserve between women, ovarian response also differs with potential negative consequences on pregnancy rates. A Markov decision-analytic model showed that FSH dose individualisation according to ovarian reserve is likely to be cost-effective in women who are eligible for IVF. However, this has never been confirmed in a large randomised controlled trial (RCT). The aim of the present study is to assess whether an individualised FSH dose regime based on an ovarian reserve test (ORT) is more cost-effective than a standard dose regime. Methods/Design: Multicentre RCT in subfertile women indicated for a first IVF or intracytoplasmic sperm injection cycle, who are aged < 44 years, have a regular menstrual cycle and no major abnormalities at transvaginal sonography. Women with polycystic ovary syndrome, endocrine or metabolic abnormalities and women undergoing IVF with oocyte donation, will not be included. Ovarian reserve will be assessed by measuring the antral follicle count. Women with a predicted poor response or hyperrespon Discussion: The results of this study will be integrated into a decision model that compares cost-effectiveness of the three dose-adjustment strategies to a standard dose strategy. The study outcomes will provide scientific foundation for national and international guidelines.
Original languageUndefined/Unknown
JournalBMC Womens Health
Volume12
DOIs
Publication statusPublished - 2012

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