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Objective: To determine the cost of achieving a live birth after first transfer using highly purified human menotropin (HP-hMG) or recombinant follicle-stimulating hormone (FSH) for controlled ovarian stimulation in predicted high-responder patients in the Menopur in Gonadotropin-releasing hormone Antagonist Single Embryo Transfer-High Responder (MEGASET-HR) trial. Design: Cost minimization analysis of trial results. Setting: Thirty-one fertility centers. Patient(s): Six hundred and nineteen women with serum antim€ ullerian hormone R5 ng/mL. Intervention(s): Controlled ovarian stimulation with HP-hMG or recombinant FSH in a gonadotropin-releasing hormone (GnRH) antagonist assisted reproduction cycle where fresh transfer of a single blastocyst was performed unless ovarian response was excessive whereupon all embryos were cryopreserved and patients could undergo subsequent frozen blastocyst transfer within 6 months of randomization. Main Outcome Measure(s): Mean cost of achieving live birth after first transfer (fresh or frozen). Result(s): First-transfer efficacy, defined as live birth after first fresh or frozen transfer, was 54.5% for HP-hMG and 48.0% for recombinant FSH (difference 6.5%). Average cost to achieve a live birth after first transfer (fresh or frozen) was lower with HP-hMG compared with recombinant FSH. For fresh transfers, the cost was lower with HP-hMG compared with recombinant FSH. The average cost to achieve a live birth after first frozen transfer was also lower in patients treated with HP-hMG compared with recombinant FSH.

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OBJECTIVE: Financial constraints limit many patients from being able to access infertility care, especially assisted reproductive technologies (ART) such as in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI). We sought to determine the impact of state insurance mandates for infertility coverage on the utilization of IVF within each state.DESIGN: Retrospective analysis of publicly available data. MATERIALS AND METHODS: All IVF centers in the United States in 2017, their zip code, and number of cycles performed were extracted from CDC data. Using US census data, the median salaries for zip code and state were extracted. The number of IVF centers and number of IVF cycles between states with and without infertility coverage insurance mandates were compared. The association between geographic region, income and the number of IVF cycles was evaluated. IVF centers in mandate and non-mandate states were sequentially sorted by the median household income of the zip code they are located in and grouped into successive increments of $10,000 of median household income. Total number of cycles per successive $10,000 income bracket were compared in mandate and non-mandate states. Paired and unpaired Student's T-tests were performed for continuous variables.RESULTS: Fifteen states mandate some degree of infertility coverage. States with insurance mandates for infertility coverage had a greater number of yearly IVF cycles per 100,000 residents compared to states without infertility coverage mandates (104 cycles vs 57 cycles per 100,000 p¼0.029). However, there was no difference between the number of IVF centers per person between states with and without infertility coverage mandates (0.16 vs 0.13 per 100,000 residents, p¼0.058). On average, IVF centers were located in zip codes with greater median incomes than their respective states

miR-200c, let-7d-3p and miR-150-5p) were selected for a subsequent validation set. The results showed that the serum levels of miR-181d-5p was significantly increased in the HR group when compared with LR group (p¼ 0.0002) and NR group (p¼ 0.0091). No differences were observed between NR and PR groups (p¼0.2772). Serum levels of miR-181d-5p was also positively correlated with the number of aspirated follicles (p<0.0001), number of retrieved oocytes (p<0,0001), and number of mature oocytes (p¼0.0002).CONCLUSIONS: The quantification of miR-181d-5p prior to the COS may discriminate patients who will respond in an exacerbated manner to those who will respond insufficiently to the COS. The use of this tool associated with other previously described parameters may allow the individualization of the treatment, increasing treatment success while decreasing patients' risks and physical, emotional and economic burden.