Economic perspective of evaluating fertility treatment in obese and overweight infertile women

Munazzah Rafique; Ahmad Al-Badr; Ahmed Saleh; Dania H. Al-Jaroudi

doi:10.15537/smj.2021.42.6.20200733

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Table 1

- Descriptive analysis of variables (N=826).

Parameters	n (%)
BMI classifications	12 (1.5)
<18.5 (underweight)	176 (21.3)
18.5-24.9 (normal)	338 (40.9)
25 - 29.9 (overweight)	300 (36.3)
≥ 30 (obese)
Parity	786 (95.2)
0	35 (4.2)
1	5 (0.6)
2
Causes of infertility
Anovulatory infertility	680 (82.3)
Ovulatory	146 (17.7)
Anovulatory
Polycystic ovarian syndrome	129 (15.6)
Yes	697 (84.4)
No
Tubal factor infertility	37 (4.5)
Yes	789 (95.5)
No
Unexplained infertility	123 (14.9)
Yes	703 (85.1)
No
Endometriosis	35 (4.2)
Yes	791 (95.8)
No
Number of embryos transferred	807 (97.7)
Yes	19 (2.3)
No
Number of frozen embryos	203 (24.6)
Yes	623 (75.4)
No
Treatment protocol	576 (69.7)
Antagonist	250 (30.3)
Long
Assisted reproduction technique	811 (98.2)
IVF-ICSI	15 (1.8)
IVF
Gonadotropins	413 (50.0)
HMG (merional)	413 (50.0)
r-FSH (gonal-F)
Clinical pregnancy rate	347 (42.0)
Yes	479 (58.0)
No
Miscarriage rate	110 (13.3)
Yes	716 (86.7)
No
Live birth rate	120 (14.5)
Yes	706 (85.5)
No

HMG: human menopausal gonadotropins, r-FSH: recombinant follicle stimulating hormone

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Table 2

- Impact and association of body mass index (BMI) with respect to clinical characteristics of the study.

Parameters	Description	<18.5 (Underweight)	18.5-24.9 (Normal)	25-29.9 (Overweight)	>30 (Obese)	P-value
Age	Median (IQR)	27.5 (31.75 - 25.5)	31 (35 - 28)	33 (37 - 29)	33 (38 - 29.25)	<0.001*
BMI	Median (IQR)	17.2 (18 - 16.25)	22.8 (23.88 - 21.2)	27.4 (28.7 - 26.3)	32.2 (33.9 - 31)	<0.001*
Duration of infertility	Median (IQR)	5.5 (8.75 - 4)	5 (8 - 4)	6 (8 - 4)	7 (10 - 5)	0.022*
FSH (IU/L)	Median (IQR)	7.2 (8.76 - 5.21)	6.5 (7.6 - 4.7)	5.9 (6.92 - 4.33)	6.3 (7.4 - 4.71)	0.112
LH (IU/L)	Median (IQR)	7.65 (8.43 - 5.59)	5.6 (8.3 - 3.75)	5.1 (7.98 - 3.75)	6.2 (8.95 - 4.15)	0.030*
E2 (pmol/L)	Median (IQR)	119 (259.5 - 87.25)	146.5 (250.5 - 86.78)	145.5 (213 - 56.69)	143 (220 - 49)	0.891
Prolactin (mIU/L)	Median (IQR)	203 (306 - 19.8)	234 (409.75 - 16.2)	204 (378 - 14.25)	208 (370 - 16)	0.945
TSH (mIU/L)	Median (IQR)	1.2 (4.65 - 0.84)	2.6 (4.7 - 1.89)	2.52 (4.78 - 1.6)	2.54 (4.13 - 1.49)	0.329
Number of eggs fertilized	Median (IQR)	3.5 (6.5 - 1.0)	2 (4 - 1.75)	3 (4 - 2)	3 (4 - 2)	0.113
Number of aspirated follicles	Median (IQR)	8.5 (15 - 5.25)	6 (10.75 - 4)	7 (11 - 4)	7 (11 - 4)	0.873
Dose of r-FSH (Gonal-F) (IU)	Median (IQR)	150 (150 - 112)	150 (206 - 112)	150 (225 - 150)	150 (225 - 150)	0.486
Dose of HMG (Merional)(IU)	Median (IQR)	150 (375 - 150)	225 (300 - 150)	225 (300 - 150)	225 (300 - 150)	0.685
Treatment days	Median (IQR)	10 (11 - 9)	10 (11 - 9)	11 (13 - 9)	11 (13 - 9)	0.562
Patients with embryo transfer (%)	Yes	11 (91.7)	173 (98.3)	333 (98.5)	290 (96.7)	0.198
Patients with embryo transfer (%)	No	1 (8.3)	3 (1.7)	5 (1.5)	10 (3.3)	0.198
Patients with frozen embryos (%)	Yes	4 (33.3)	36 (20.5)	86 (25.4)	77 (25.7)	0.486
Patients with frozen embryos (%)	No	8 (66.7)	140 (79.5)	252 (74.6)	223 (74.3)	0.486
Miscarriages (%)	Yes	0 (0.0)	18 (10.2)	45 (13.3)	47 (15.7)	0.192
Miscarriages (%)	No	12 (100.0)	158 (89.8)	293 (86.7)	253 (84.3)	0.192
Assisted reproduction technique	IVF-ICSI	12 (100.0)	173 (98.3)	332 (98.2)	294 (98.0)	0.961
Assisted reproduction technique	IVF	0 (0.0)	3 (1.7)	6 (1.8)	6 (2.0)	0.961
Gonadotropins	HMG (Merional)	5 (41.7)	95 (54.0)	161 (47.6)	152 (50.7)	0.521
Gonadotropins	r-FSH (Gonal-F)	7 (58.3)	81 (46.0)	177 (52.4)	148 (49.3)	0.521
Clinical pregnancy	Yes	6 (50.0)	63 (35.8)	144 (42.6)	134 (44.7)	0.259
Clinical pregnancy	No	6 (50.0)	113 (64.2)	194 (57.4)	166 (55.3)	0.259
Live birth rate	Yes	1 (8.3)	23 (13.1)	48 (14.2)	48 (16.0)	0.747
Live birth rate	No	11 (91.7)	153 (86.9)	290 (85.8)	252 (84.0)	0.747

FSH: follicle-stimulating hormone, LH: luteinizing hormone, TSH: thyroid stimulating hormone, HMG: human menopausal gonadotropins, IQR: interquartile range IVF-ICSI: in-vitro fertilization/intracytoplasmic sperm injection, r-FSH: recombinant follicle stimulating hormone

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Table 3

- Comparative analysis of IVF cost and patient’s body mass index.

Parameters	Description	<18.5	18.5 - 24.9	25 - 29.9	>30	P-value
Parameters	Description	(Underweight)	(Normal)	(Overweight)	(Obese)	P-value
Total cost HMG (Merional)	Median (IQR)	10280 (11680 - 9760)	10560 (11160 - 10120)	10440 (10920 - 10040)	10560 (10920 - 10140)	0.712
Total cost r-FSH (Gonal-F)	Median (IQR)	10200(10320 - 10080)	10200(10590 - 10080)	10440 (10800 - 10080)	10320 (10605 - 10080)	0.254
Total cost of injections	Median (IQR)	1240 (1410 - 1080)	1380 (2055 - 1080)	1440 (1920 - 1080)	1440 (1800 - 1080)	0.598
Total cost of IVF/IVF-ICSI (SR)	Median (IQR)	10240 (10410 -10080)	10380 (11055 -10080)	10440 (10920 -10080)	10440 (10800 -10080)	0.598

HMG: human menopausal gonadotropins, r-FSH: recombinant follicle stimulating hormone, IQR: interquartile range, IVF-ICSI: in-vitro fertilization/intracytoplasmic sperm injection