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Which treatment method can potentially save the most time and money and have the greatest success?

R.H. Reindollar, M.M. Regan, P.J. Neumann, B.S. Levine, K.L. Thornton, M.M. Alper, M.B. Goldman

July 5, 2017
Emma Holt

Comparing Accelerated vs. Conventional Infertility Treatments

Treatments for infertility can be time-consuming, expensive, and have unforeseen outcomes.  A team of researchers dared to compare two treatments for unexplained fertility and found some fascinating results.

The Research

In 2010, a team of doctors published a study entitled “A randomized clinical trial to evaluate optimal treatment for unexplained infertility: the fast track and standard treatment [FASTT] trial” comparing two methods of fertility treatment.  Let’s start our discussion of this study by unpacking that lengthy title.  Essentially, the authors of the study wanted to compare two methods of fertility treatment and determine which treatment was the better treatment based upon several factors (discussed below).  Are you still with me?  The authors of the study called one method of fertility treatment the conventional method.  This method involved the following steps: three cycles of clomiphene/intrauterine insemination (CC/IUI), three cycles of gonadotropin/intrauterine insemination, and up to six cycles of in vitro fertilization (IVF).  The other method of fertility treatment was called the accelerated method.  This method involved only three cycles of CC/IUI and up to six cycles of IVF.  You’ve probably already noticed that the three cycles of gonadotropin/IUI treatment were not used in the accelerated method.  Thus, this treatment cycle could be completed faster than the conventional method.

What factors did the researchers compare to attempt to understand which treatment was optimal?  The researchers, well aware of the cost and current success rates of conventional infertility treatments, asked the following questions to compare the two treatments:

Which treatment is the most effective regarding time to pregnancy and resulting in live birth?

How much did each treatment cost for the individuals undergoing the various required medical visits?

What were the negative consequences of each treatment?

Who did the researchers study?

The researchers focused specifically on women within the age range of 21 to 39 years old who had attempted contraception for a 12-month period; possessed at least one ovary and ipsilateral patent fallopian tube; and lacked any evidence of pelvic pathology, ectopic pregnancy, or previous infertility treatment.  The women involved in the study were randomly split into two groups.  247 women and their partners received the conventional treatment (three cycles of CC/IUI, three cycles of gonadotropin/IUI, and up to six cycles of IVF); 256 women and their partners received the accelerated treatment (three cycles of CC/IUI and up to six cycles of IVF). 

What did the researchers find?

Effectiveness of treatment resulting in live birth

It was found that couples who received the accelerated treatment became pregnant faster after fewer treatments. The FSH/IUI treatment was stated to provide no added value to the treatment regime.  Furthermore, a greater proportion of couples receiving the accelerated treatment delivered a live-born baby than their counterparts who were treated using the conventional method.  It is important to note, however, that a large proportion of couples who received the conventional treatment regime also delivered a live-born baby.

Cost-effectiveness of the treatments

Based upon insurance charge data, it was determined by the authors of the study that the accelerated treatment method was a cheaper alternative to the conventional treatment method.  Even though the observed difference in charges is not statistically significant, any amount of money that can be saved is significant in my book (and hopefully yours too).

Possible negative consequences of the treatments

Gonadotropin/IUI treatment is costly, and its tendency to result in multiple births is described as unavoidable by the authors. There is also a risk of hyperstimulation of the ovaries associated with this treatment method. You may recall, this was included in the conventional treatment method but not the accelerated treatment method.   


The study we are discussing here has its own limitations and/or reasons why it may not apply specifically to you.  First, the women investigated in this study had to meet very specific criteria.  If those criteria do not apply to you, it is possible the results cannot be extrapolated to your own personal fertility treatment journey.  Second, the study was conducted in Massachusetts, a state where insurers are required to cover the cost of treatment.  This in addition to the fact that researchers only calculated cost based on insurance charge data (not the actual amount of money couples paid for treatments covered by insurance, but what the insurance charged those couples) and cost diaries that couples recorded minimizes the ability to estimate how much similar treatments will cost for you. 

Although the authors of the study advocate that treatments regimes beginning with CC/IUI can result in pregnancy for about ¼ of couples with a minimal risk of multiple pregnancies and at a low cost, it is important to discuss any medical decisions you make regarding your healthcare and your treatment plan with your personal healthcare providers.  Perhaps even mention this research to your doctor at your next visit and get their opinion.  Scientific research is a continuous endeavor that shifts and changes as new knowledge is obtained, and the fact that this research was published in 2010 likely means many advances have been made in the field of fertility science by now.  The authors of this study in 2010 stated that they anticipated other treatment changes that would influence the cost and amount of time required for IVF treatments.  Single embryo transfer methods had only recently been developed around the time of publication of this study, and, thus, researchers neglected to compare this treatment method to either the conventional treatment method or the accelerated treatment method. 

You may choose to use this information to discuss your treatment plan with your doctor, for the researchers have argued throughout their paper that an accelerated approach to IVF starting with CC/IUI and eliminating gonadotropin/IUI results in shorter time to pregnancy, fewer treatment cycles, and possible cost savings.  Please bear in mind, however, that the information provided here is meant to empower you and inform you about the research done regarding fertility so you can have discussions with your doctor and advocate for yourself, it is not meant to serve as a medical recommendation.  Please always consult your doctor prior to deciding on a treatment plan that is the best for you. 

Stay informed, stay empowered, and good luck on your journey.


A randomized clinical trial to evaluate optimal treatment for unexplained infertility: the fast track and standard treatment (FASTT) trial

Fertility and Sterility - August 2010, Volume 94, Issue 3, Pages 888–899


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