Agonist versus antagonist in ICSI cycles: a randomized trial and cost effectiveness analysis

Objective: GnRH antagonists have been introduced into clinical practice as an attractive alternative to GnRH long protocol under the concept of a patient friendly medication. We wished to evaluate the cost effectiveness of a human menopausal gonadotropin (hMG) / GnRH antagonist flexible protocol versus a long GnRH agonist / hMG protocol.Design: single center randomized controlled trial using sealed envelopes as a method for randomization.Materials and methods: One hundred women undergoing ICSI were randomized to receive either hMG/Gn RH agonist long protocol (group I) or hMG/GnRH antagonist when follicle reaches 15 mm (group II).Results: Two cases had premature LH surge in group II. Fifteen cases (30%) got pregnant in the first group as compared to 12 cases (24%) in the second group. The difference was statistically non-significant. The mean cost of medications per cycle was estimated to be $608 (3740 Egyptian Pounds) in the hMG/antagonist group, while it was $680 (4180 E.P) in the long GnRH agonist protocol treated group. This difference was statistically. However, thetotal cost per pregnancy was $6531 (40166 EP) in the hMG/antagonist protocol and $5008 (30800 EP) in the GnRH-a/hMG protocol which is statistically significant.Conclusion: the use of the hMG/antagonist protocol is not a cost effective strategy although it provides short and simple stimulation protocol.