Article| Volume 42, ISSUE 1, P143-149, January 2021

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In-vitro maturation versus IVF: a cost-effectiveness analysis

Published:September 28, 2020DOI:


      Research question

      How do costs and effects of in-vitro maturation (IVM) compare to IVF in women with a high antral follicle count (AFC)?


      This cost-effectiveness analysis (CEA) was based on data of a previous retrospective cohort study at IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam. Between July 2015 and December 2017, 608 women underwent IVM and 311 women IVF. The effectiveness measure for the CEA was cumulative live birth rate (LBR) after one completed cycle including subsequent cryo-cycles within 12 months of inclusion. Data were collected on resource use related to treatment, medication and pregnancy from the case report forms. The mean costs and effects, average cost differences and incremental cost-effectiveness ratios (ICER) were calculated using non-parametric bootstrap resampling to assess the effect of uncertainty in the estimates.


      Cumulative LBR after one completed cycle were 239/608 (39.3%) in the IVM group versus 155/311 (49.8%) in the IVF group (adjusted odds ratio 0.52, 95% confidence interval [CI] 0.30–0.89). Ovarian hyperstimulation syndrome (OHSS) did not occur in the IVM group versus 11/311 (3.5%) in the IVF group. The mean costs per couple were €4300 (95% CI €1371–18,798) for IVM and €6493 (95% CI €2204–20,136) for IVF. The ICER per additional live birth with IVF was €20,144 (95% CI €9116–50,418). Results were robust over a wide range of assumptions.


      IVM is less expensive than IVF in women with a high AFC undergoing treatment with assisted reproductive technology, while leading to a slightly lower effectiveness in terms of cumulative LBR.


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        • Ellenbogen A.
        • Shavit T.
        • Shalom-Paz E.
        IVM results are comparable and may have advantages over standard IVF.
        Facts Views Vis. Obgyn. 2014; 6: 77-80
        • Gremeau A.S.
        • Andreadis N.
        • Fatum M.
        • Craig J.
        • Turner K.
        • McVeigh E.
        • Child T.
        In vitro maturation or in vitro fertilization for women with polycystic ovaries? A case-control study of 194 treatment cycles.
        Fertil. Steril. 2012; 98: 355-360
      1. Hakkaart-van Roijen L, Van der Linden N, Bouwmans CAM, Kanters TA, Tan SS. Costing manual: Methodology of costing research and reference prices for economic evaluations in healthcare [in Dutch: Kostenhandleiding: Methodologie van kostenonderzoek en referentieprijzen voor economische evaluaties in de gezondheidszorg]. 2015.), which is publicly available from the website of the National Health Care Institute (Zorginstituut Nederland;

        • Ho V.N.A.
        • Braam S.C.
        • Pham T.D.
        • Mol B.W.
        • Vuong L.N.
        The effectiveness and safety of in vitro maturation of oocytes versus in vitro fertilization in women with a high antral follicle count.
        Hum. Reprod. 2019; 34: 1055-1064
        • Ho V.N.A.
        • Pham T.D.
        • Le A.H.
        • Ho T.M.
        • Vuong L.N.
        Live birth rate after human chorionic gonadotropin priming in vitro maturation in women with polycystic ovary syndrome.
        J. Ovarian Res. 2018; 11: 70
        • Legro R.S.
        • Brzyski R.G.
        • Diamond M.P.
        • Coutifaris C.
        • Schlaff W.D.
        • Casson P.
        • Christman G.M.
        • Huang H.
        • Yan Q.
        • Alvero R.
        • Haisenleder D.J.
        • Barnhart K.T.
        • Bates G.W.
        • Usadi R.
        • Lucidi S.
        • Baker V.
        • Trussell J.C.
        • Krawetz S.A.
        • Snyder P.
        • Ohl D.
        • Santoro N.
        • Eisenberg E.
        • Zhang H.
        Letrozole versus clomiphene for infertility in the polycystic ovary syndrome.
        N. Engl. J. Med. 2014; 371: 119-129
        • Lukassen H.G.
        • Schonbeck Y.
        • Adang E.M.
        • Braat D.D.
        • Zielhuis G.A.
        • Kremer J.A.
        Cost analysis of singleton versus twin pregnancies after in vitro fertilization.
        Fertil. Steril. 2004; 81: 1240-1246
        • Mostinckx L.
        • Segers I.
        • Belva F.
        • Buyl R.
        • Santos-Ribeiro S.
        • Blockeel C.
        • Smitz J.
        • Anckaert E.
        • Tournaye H.
        • De Vos M.
        Obstetric and neonatal outcome of ART in patients with polycystic ovary syndrome: IVM of oocytes versus controlled ovarian stimulation.
        Hum. Reprod. 2019; 34: 1595-1607
        • Nahuis M.J.
        • Kose N.
        • Bayram N.
        • van Dessel H.J.
        • Braat D.D.
        • Hamilton C.J.
        • Hompes P.G.
        • Bossuyt P.M.
        • Mol B.W.
        • van der Veen F.
        • van Wely M.
        Long-term outcomes in women with polycystic ovary syndrome initially randomized to receive laparoscopic electrocautery of the ovaries or ovulation induction with gonadotrophins.
        Hum. Reprod. 2011; 26: 1899-1904
        • Paulson R.J.
        • Fauser B.
        • Vuong L.T.N.
        • Doody K.
        Can we modify assisted reproductive technology practice to broaden reproductive care access?.
        Fertil. Steril. 2016; 105: 1138-1143
        • Rose B.I.
        • Laky D.
        • Miller B.
        The case for in vitro maturation lower cost and more patient friendly.
        J. Reprod. Med. 2014; 59: 571-578
        • Saenz-de-Juano M.D.
        • Ivanova E.
        • Romero S.
        • Lolicato F.
        • Sanchez F.
        • Van Ranst H.
        • Krueger F.
        • Segonds-Pichon A.
        • De Vos M.
        • Andrews S.
        • Smitz J.
        • Kelsey G.
        • Anckaert E.
        DNA methylation and mRNA expression of imprinted genes in blastocysts derived from an improved in vitro maturation method for oocytes from small antral follicles in polycystic ovary syndrome patients.
        Hum. Reprod. 2019; 34: 1640-1649
        • Vuong L.N.
        • Ho T.M.
        • Gilchrist R.B.
        • Smitz J.
        The place of in vitro maturation in assisted reproductive technology.
        Fertility and Reproduction. 2019; 1: 1-5
        • Vuong L.N.
        • Le A.H.
        • Ho V.N.A.
        • Pham T.D.
        • Sanchez F.
        • Romero S.
        • De Vos M.
        • Ho T.M.
        • Gilchrist R.B.
        • Smitz J.
        Live births after oocyte in vitro maturation with a prematuration step in women with polycystic ovary syndrome.
        J. Assist. Reprod. Genet. 2020; 37: 347-357
        • Weiss N.S.
        • Nahuis M.J.
        • Bordewijk E.
        • Oosterhuis J.E.
        • Smeenk J.M.
        • Hoek A.
        • Broekmans F.J.
        • Fleischer K.
        • de Bruin J.P.
        • Kaaijk E.M.
        • Laven J.S.
        • Hendriks D.J.
        • Gerards M.H.
        • van Rooij I.A.
        • Bourdrez P.
        • Gianotten J.
        • Koks C.
        • Lambalk C.B.
        • Hompes P.G.
        • van der Veen F.
        • Mol B.W.J.
        • van Wely M.
        Gonadotrophins versus clomifene citrate with or without intrauterine insemination in women with normogonadotropic anovulation and clomifene failure (M-OVIN): a randomised, two-by-two factorial trial.
        Lancet. 2018; 391: 758-765


      Sanne Braam received her medical degree in 2008 at the University of Groningen, the Netherlands. She currently holds a position as a resident in obstetrics and gynaecology and is studying for her PhD in the field of reproductive medicine.
      Key message
      Both IVF and in-vitro maturation (IVM) are treatment options in women with a high antral follicle count (AFC). This cost-effectiveness analysis comparing both strategies showed that IVM is less expensive than IVF in women with high AFC undergoing ART, while leading to a slightly lower effectiveness in terms of cumulative live birth rate.