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Varying the cost of P support, the sensitivity analysis demonstrated that P support was cost-effective as long as P costs < $569.31/week ($3415.86 for six weeks). Varying the cost of GND-IUI, the sensitivity analysis demonstrated that P luteal support was cost-effective as long as the cost of the GND-IUI cycle is R $1215. P support was costeffective across the published 95% CI for live birth increase, ranging from $220 to $6664 cost savings per live birth. CONCLUSIONS: Daily vaginal P supplementation after GND-IUI improves live birth rates and effectively reduces the overall treatment cost per live birth. These findings persisted in the analyses of vaginal P inserts and P gel as well as in all sensitivity analyses of live birth rates and the costs of GND-IUI and P support. Given the significantly higher birth rates with P supplementation and the present findings demonstrating cost-effectiveness, P luteal support should be recommended for all GND-IUI cycles.

Western blot data were consistent with the hypothesis that the extracellular segment of TGF-alpha is cleaved from the transmembrane precursor in vivo, as has been demonstrated in other tissues. Immunohistochemistry demonstrated that the TGF-alpha antigens are concentrated in the luminal surface epithelium and decline and disappear in the early to midsecretory phase. These findings suggest that the most active period of membrane-bound TGF-alpha cleavage corresponds with the interval during which preimplantation embryos are in the uterine cavity.