Prospective randomized trial comparing the outcome and cost of in vitro fertilization with that of a traditional treatment algorithm as first-line therapy for couples with infertility

Objective: To determine whether IVF or a standard infertility treatment algorithm results in better outcome and/or lower cost when used as first-line therapy for couples with infertility. Design: Prospective, randomized clinical study. Setting: University-affiliated infertility clinic. Patient(s): Couples with newly diagnosed infertility and no prior treatment. Intervention(s): Couples were randomized to undergo either IVF(group 1, n = 46) or a standard infertility treatment algorithm (group 2, n = 50) as initial therapy for infertility. Main Outcome Measure(s): Pregnancy rates and costs per couple, per month of treatment, and per pregnancy. Result(s): Pregnancy rates were higher in group 2 than in group 1. Costs per couple were not statistically different, although a trend toward higher costs was apparent in group 1, reflected by a higher median cost per clinical pregnancy established and a higher cost per month of treatment. Whereas cost differences between the groups diminished over time, pregnancy rates remained the same. Conclusion(s): In vitro fertilization currently does not represent an appropriate first-line treatment option for couples with infertility. The use of a standard infertility treatment algorithm results in a higher pregnancy rate and lower cost and therefore should he the preferred treatment approach. (Fertil Steril(R) 1999:71:468-75. (C)1999 by American Society for Reproductive Medicine.).