Bruk av GnRH-antagonist ved in vitro-fertilisering

Ekerhovd, Erling

doi:10.4045/tidsskr.10.0489

Cited by 3 publications

(4 citation statements)

References 47 publications

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“…This substantially lowers the number of injections required during IVF, and may improve drug compliance and/or prevent errors during drug administration [12]. The use of GnRH-a and GnRH-antagonists in assisted fertility treatments has been the focus of considerable comparative research [1,13-16]. Reproductive outcomes, as well as safety and efficacy, between these two treatment approaches are thought to be similar [8,17-20] and GnRH-antagonists have joined alongside GnRH-a as mainstream therapeutic agents used widely at infertility units worldwide.…”

Section: Discussionmentioning

confidence: 99%

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Balancing selected medication costs with total number of daily injections: a preference analysis of GnRH-agonist and antagonist protocols by IVF patients

Sills

Collins

Salem

et al. 2012

Reprod Biol Endocrinol

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BackgroundDuring in vitro fertilization (IVF), fertility patients are expected to self-administer many injections as part of this treatment. While newer medications have been developed to substantially reduce the number of these injections, such agents are typically much more expensive. Considering these differences in both cost and number of injections, this study compared patient preferences between GnRH-agonist and GnRH-antagonist based protocols in IVF.MethodsData were collected by voluntary, anonymous questionnaire at first consultation appointment. Patient opinion concerning total number of s.c. injections as a function of non-reimbursed patient cost associated with GnRH-agonist [A] and GnRH-antagonist [B] protocols in IVF was studied.ResultsCompleted questionnaires (n = 71) revealed a mean +/− SD patient age of 34 +/− 4.1 yrs. Most (83.1%) had no prior IVF experience; 2.8% reported another medical condition requiring self-administration of subcutaneous medication(s). When out-of-pocket cost for [A] and [B] were identical, preference for [B] was registered by 50.7% patients. The tendency to favor protocol [B] was weaker among patients with a health occupation. Estimated patient costs for [A] and [B] were $259.82 +/− 11.75 and $654.55 +/− 106.34, respectively (p < 0.005). Measured patient preference for [B] diminished as the cost difference increased.ConclusionsThis investigation found consistently higher non-reimbursed direct medication costs for GnRH-antagonist IVF vs. GnRH-agonist IVF protocols. A conditional preference to minimize downregulation (using GnRH-antagonist) was noted among some, but not all, IVF patient sub-groups. Compared to IVF patients with a health occupation, the preference for GnRH-antagonist was weaker than for other patients. While reducing total number of injections by using GnRH-antagonist is a desirable goal, it appears this advantage is not perceived equally by all IVF patients and its utility is likely discounted heavily by patients when nonreimbursed medication costs reach a critical level.

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Section: Discussionmentioning

confidence: 99%

“…GnRH-antagonists can serve an important role in advanced reproductive treatments, because this pharmacological approach enables the IVF sequence to be reduced from 4-5wks to <2wks, and lower overall gonadotropin consumption [1]. The attenuated stimulation associated with GnRH-antagonists also has been shown to minimize OHSS risk [2-4].…”

Section: Introductionmentioning

confidence: 99%

Balancing selected medication costs with total number of daily injections: a preference analysis of GnRH-agonist and antagonist protocols by IVF patients

Sills

Collins

Salem

et al. 2012

Reprod Biol Endocrinol

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“…Second, the attribute (safety) ‘risks of developing OHSS' was selected and described by the levels 2.6% (resembling a GnRH antagonist) and 4.2% (resembling a GnRH agonist). The 3 latter aspects were selected in order to reflect treatment burden and included the following: (1) ‘side effects' (such as headaches, hot flushes, insomnia) described by ‘present' (GnRH agonist) or ‘not present' (GnRH antagonist) [7,8], (2) ‘importance of compliance' described by the levels ‘very important' (GnRH antagonist) or ‘important' (GnRH agonist) [9,15,16] and (3) ‘treatment duration' described by the 2 levels ‘short' (GnRH antagonist) and ‘long' (GnRH agonist) [9,17]. …”

Section: Methodsmentioning

confidence: 99%

“…less headaches, hot flushes and insomnia, shorter treatment duration [7,8] and more safety (lesser chance of ovarian hyperstimulation syndrome, OHSS [7,9]). GnRH antagonists have limited treatment effectiveness (lower ongoing pregnancy rates [7,9]).…”

Section: Introductionmentioning

confidence: 99%

Patients' Preferences for Gonadotrophin-Releasing Hormone Analogs in in vitro Fertilization

Wijngaard

Wely

Dancet

et al. 2014

Gynecol Obstet Invest

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Background: Gonadotrophin-releasing hormone (GnRH) antagonists reduce ovarian hyperstimulation syndrome (OHSS) at the price of a small reduction in effectiveness compared to GnRH agonists. The aim of this study was to investigate patients' preferences on effectiveness, safety and burden of GnRH analogs. Methods: A discrete choice experiment (DCE) and a trade-off question were designed. Patients embarking on assisted reproductive technique treatment were asked to choose between two hypothetical medications which differed in effectiveness, safety and burden. Results: A total of 172 questionnaires were analyzed. All attributes of the DCE had a statistically significant impact on the preference of the respondents. Respondents were willing to trade off 0.87 and 0.81% effectiveness for a decrease in OHSS risk and for fewer side effects, respectively. Respondents were not willing to trade off effectiveness for ‘importance of compliance' (trade-off 0.40%) or a shorter ‘duration of treatment' (trade-off 0.26%). The trade-off questions showed that already at a 2.0% increase in pregnancy rate in favor of the agonists, the majority of the respondents changed their preference from antagonists to agonists (2.0%, 95% CI 1.7-2.1). Conclusion: Safety and burden are important to patients, but are not important enough to make up for a small decrease in pregnancy rate.

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GnRH antagonist for pituitary desensitization in IVF: Is it a time for a change of practice?

Youssef

Elashmawi

2011

Middle East Fertility Society Journal

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Bruk av GnRH-antagonist ved in vitro-fertilisering

Abstract: Stimulation with a GnRH-antagonist instead of a GnRH-agonist in IVF, is less physically and psychologically demanding for the patients and maintains the same birth rate.

Cited by 3 publications

References 47 publications

Balancing selected medication costs with total number of daily injections: a preference analysis of GnRH-agonist and antagonist protocols by IVF patients

Balancing selected medication costs with total number of daily injections: a preference analysis of GnRH-agonist and antagonist protocols by IVF patients

Patients' Preferences for Gonadotrophin-Releasing Hormone Analogs in in vitro Fertilization

GnRH antagonist for pituitary desensitization in IVF: Is it a time for a change of practice?

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