Early resort to ovarian stimulation improves the cost-effectiveness of a donor insemination programme

Women undergoing donor insemination (DI) are usually regularly ovulating, t herefore the role of ovulation induction in this modality of treatment has been controversial. Some recent studies reported higher pregnancy rates in stimulated cycles in comparison with natural cycles. We employed a sequenti al step-up protocol in which treatment was started in a natural cycle, cont inued with a clomiphene citrate-stimulated cycle, and finished with an ovul ation induction cycle. The patients were allowed three attempts at each ste p before moving to the next if conception did not occur. The aim of this pr otocol was to enhance the cost-effectiveness of the DI programme by increas ing the cycle fecundability, A total of 101 patients underwent 216 cycles o f DI, including 44 patients in 80 natural cycles, 38 patients in 89 CC-stim ulated cycles, and 19 patients in 47 ovulation induction cycles. The clinic al pregnancy rate per started cycle (CPR/C) and per patient during this per iod was 14% and 30% respectively, The pregnancy rates per started cycle and per patient in the natural, CC-stimulated and ovulation induction cycles w ere: 13 and 32%, 10 and 18%, and 21 and 53% respectively. There was no sign ificant difference in the CPR/C in the three groups; however, the CPR per p atient in the induced ovulation cycles was significantly higher than in the CC-stimulated cycles (P = 0.005), Only one patient during this period had a multiple pregnancy in the ovulation induction group, giving an overall mu ltiple pregnancy of 3%, By using this treatment strategy, we achieved a hig h clinical pregnancy rate, a low multiple pregnancy rate and a low cost of treatment per pregnancy.