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Menopur scores more births according to new analysis


The in vitro fertilisation (IVF) treatment Menopur (highly-purified human menopausal gonatropin or HP-hMG, Ferring) offers considerable cost-savings over recombinant follicle stimulating hormone (rFSH), according to health economics data presented at this week’s meeting of the European Society of Human reproduction and Embryology (ESHRE), held in Amsterdam (29th June-July 1st 2009).

The results could translate into more live births for a given treatment budget and help widen access to IVF, according to speakers at a press conference held at ESHRE.

HP-hMG and rFSH are two gonadotropin drugs commonly used to enhance egg production in patients receiving IVF treatment. HP-hMG, contains both FSH and hCG-driven (human chorionic gonadotropin) LH-activity (luteinizing hormone). In contrast, rFSH is a recombinant product and contains only rFSH.

“Until recently, discussions regarding funding for infertility treatment services have been hindered by a relative paucity of economic studies of the specific treatments,” said investigator Dr Jaro Wex from PharmArchitecture, UK.

Dr Wex’s analysis determined the cost-effectiveness of different gonadotropins in IVF cycles involving frozen embryo transfers using a simulation model.  The economic evaluation compared HP-hMG and rFSH using individual patient data (n=986) pooled from two recent large, randomised trials (EISG and MERiT).

The model used both live-birth data for the compared products and published UK costs of IVF related medical resources. The main objectives were to determine for each patient starting treatment consisting of one fresh and up to two cryo or fresh cycles: The number of live-births; the average cost of treatment; the average cost per live-birth; the incremental cost-effectiveness; and the impact of inclusion of maternal and neonatal costs arising from successful pregnancies.

After a sequence of one fresh and up to two frozen or fresh cycles, the cumulative live-birth rate was 53.7% for HP-hMG and 44.6% for rFSH (p<0.005). The use of HP-hMG resulted in a saving of £875 per patient cycle, a saving that could finance an additional treatment for every seven treatments delivered, said Dr Wex.  The cost per IVF baby delivered with HP-hMG was £11,157, compared with £14,227 for rFSH(p<0.001).

“When using HP-hMG instead of rFSH higher cumulative success rates also mean one additional live-birth for every 11-24 patients, and one additional baby born for every 10-25 patients,” said Dr wex.

“Our economic evaluation suggested that HP-hMG compared to rFSH produces more live-births and babies in combination of fresh and frozen IVF cycles.  HP-hMG offers considerable cost savings vs rFSH, which could translate into increased availability of IVF – these results should be considered when choosing a gonadotrophin for ovarian stimulation,” he added.

Blood test may predict IVF success
A blood test to predict the potential success or failure of IVF treatment is the promise of research presented at ESHRE by Dr Cathy Allen, from the Rotunda Hospital, Dublin, Ireland.

She told the conference that her research would help understand why IVF works for some patients but not for others – an important question given the high cost of IVF treatment cycles.   One of the most difficult decisions for patients who have had unsuccessful IVF treatments is whether they should try further attempts.

Dr Allen’s test us based on  gene expression patterns in RNA extracted from blood samples taken at eight different stages during the period around conception and the early stages of the IVF cycle.

“We found that the gene expression profiles in blood of patients at the time of pituitary down-regulation showed interesting patterns of gene clustering. Over 200 genes were differentially expressed in patients who went on to achieve an IVF pregnancy compared with those who did not,” she said.   The peripheral blood gene expression ‘signature’ (also known as the transcriptome) before IVF was predictive of IVF outcome.

“IVF technology has advanced tremendously over the past three decades, yet success after IVF remains an unpredictable outcome,” said Dr. Allen. “We hope that our work will lead to the development of a clinically useful tool to help doctors counsel their patients in the difficult decision-making involved in IVF.”

Story by Ian Mason

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