Authors' objectives:

The Ontario Health Technology Advisory Committee asked the Medical Advisory Secretariat to determine the clinical effectiveness and cost-effectiveness of IVF for infertility treatment as well as the role of IVF in reducing the rate of multiple pregnancies.

Authors' results and conclusions: Overall, there is a lack of good RCTs in this area, and considerable diversity in definition and measurement of outcomes between existing trials. Many studies used fertility or pregnancy rates instead of live birth rates. Moreover, the denominator for rate calculation varied from study to study (e.g. rates were calculated per cycle started, per cycle completed, per couple, etc.). Nevertheless, few studies of sufficient quality were identified and categorized by the cause of infertility and existing alternatives to IVF. Following are the key findings: : A 2005 meta-analysis demonstrated that in patients with idiopathic infertility, IVF was clearly superior to expectant management, but there were no statistically significant differences in live birth rates between IVF and IUI, nor between IVF and gamete-intra-Fallopian transfer. : A subset of data from a 2000 study showed no significant differences in pregnancy rates between IVF and IUI for moderate male factor infertility. : In patients with moderate male factor infertility, standard IVF was also compared with ICSI in a 2002 meta-analysis. All studies included in the meta-analysis showed superior fertilization rates with ICSI, and the pooled risk ratio for oocyte fertilization was 1.9 (95% Confidence Interval 1.4-2.5) in favor of ICSI. Two other RCTs in this area published after the 2002 meta-analysis had similar results and further confirmed these findings. There were no RCTs comparing IVF with ICSI in patients with severe male factor infertility, mainly because based on the expert opinion, ICSI might be only effective treatment for severe male factor infertility.

Authors' recommendations: A review of published studies has demonstrated that IVF-SET is an effective treatment for infertility that avoids multiple pregnancies.However, results of an Ontario-based economic analysis shows that cost savings associated with a reduction in multiple pregnancies after IVF-SET does not justify the cost of universal IVF-SET coverage by the province. Moreover, the province currently funds IUI, which has been shown to be as effective as IVF for certain types of infertility and is significantly less expensive.In patients with severe male factor infertility, IVF in conjunction with ICSI may be the only effective treatment.Thus, 2 indications where additional IVF access should be considered include:IVF/ICSI for patients with severe male factor infertilityIVF-SET in infertile women with serious medical contraindications to multiple pregnancy

Authors' methods: Review

Project Status: Completed

Year Published: 2006

URL for published report: http://www.health.gov.on.ca/english/providers/program/mas/tech/reviews/pdf/rev_ivf_101906.pdf

URL for additional information: http://www.hqontario.ca/en/mas/mas_ohtas_tech_ivf_101906.html

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Canada

Organisation Name: Medical Advisory Secretariat

Contact Address: Medical Advisory Secretariat, 20 Dundas Street West, 10th Floor, Toronto, ON M5G 2N6 CANADA. Tel: 416-314-1092l; Fax: 416-325-2364;

Contact Name: MASinfo.moh@ontario.ca

Contact Email: MASinfo.moh@ontario.ca

Copyright: Medical Advisory Secretariat, Ontario Ministry of Health and Long-Term Care