Diagnosis of subtle ovulation disorders in subfertile women with regular menstrual cycles: cost-effective clinical practice?

Serial monitoring by plasma progesterone measurement is advised in the lite rature for fertility work-up, to detect ovulation disturbances in women pre senting with regular menstrual cycles. Three strategies to diagnose such 's ubtle ovulation disorders' (SOD, defined as anovulation, inadequately limed ovulation or ovulation of a follicle of reduced size in regularly cycling women) were evaluated, in order to investigate rests of such a diagnosis. O n the basis of a 'maximal', an 'ultrasound-only', and a 'preselection' stra tegy, total medical costs and costs including non-medical costs were calcul ated for each SOD diagnosis. A 'maximal' diagnostic strategy resulted in a total medical cost of ECU 9057 per diagnosis (including non-medical costs E CU 12 787); an 'ultrasound-only' strategy in ECU 4520 (ECU 6791) per diagno sis. By use of a 'preselection' strategy, 4.25% of the women were found to have an SOD, at a cost of ECU 3036 (ECU 6868)for each diagnosis. Ar the rea l significance of SOD diagnosis Sor the prognosis of the patient to become pregnant without treatment remains unclear, and as no randomized trials on treatment effectiveness have as yet been undertaken, it is questionable whe ther this approach is worthwhile.