Evidence mapPaperPMID 42332165Full record

ArticleJournal of assisted reproduction and genetics2026

Cost-effectiveness of infertility treatment pathways in PCOS: where does oocyte in-vitro maturation fit?

Linde Mostinckx, Neli Hofer, Max Lelie, Shari Mackens, Ingrid Segers, Katrien Beeckman, Michel De Vos

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Article in Journal of assisted reproduction and genetics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

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Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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3 · Its place in the literature

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4 · The record

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5 · Who and what money

Authors and funding

7 authors.

Linde MostinckxBrussels IVF, Universitair Ziekenhuis Brussel, Brussels, Belgium.
Neli HoferBrussels IVF, Universitair Ziekenhuis Brussel, Brussels, Belgium.
Max LelieVrije Universiteit Brussel, Brussels, Belgium.
Shari MackensBrussels IVF, Universitair Ziekenhuis Brussel, Brussels, Belgium.
Ingrid SegersBrussels IVF, Universitair Ziekenhuis Brussel, Brussels, Belgium.
Katrien BeeckmanBrussels IVF, Universitair Ziekenhuis Brussel, Brussels, Belgium.
Michel De VosBrussels IVF, Universitair Ziekenhuis Brussel, Brussels, Belgium. michel.devos@uzbrussel.be.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeWhich infertility treatment pathway is most cost-effective for women with polycystic ovary syndrome (PCOS)-related infertility in centres with expertise in oocyte in vitro maturation (IVM)?

methodsCost-effectiveness analysis of treatment pathways for PCOS-related infertility using a Markov decision-analytic model. Real-life data from 517 anovulatory PCOS patients treated between January 2018 and January 2023 at a Belgian tertiary infertility clinic informed model parameters and defined the treatment-as-usual (TAU) strategy. Five pathways including incremental cycles of letrozole, low-dose gonadotropins, assisted reproductive technology (ART) after conventional ovarian stimulation (COS) or IVM were modelled and compared to TAU. Patients transitioned between treatment cycles, resulting in ongoing pregnancy or drop-out over a 24-month horizon. Costs were assessed from healthcare and societal perspectives, including direct and indirect costs. Incremental cost-effectiveness ratios (ICERs) were calculated, with sensitivity analyses performed.

resultsOngoing pregnancy rates (OPR) after the first, fourth, and sixth letrozole cycles were 16.1%, 41.6%, and 45.7%, with minimal gain beyond 4 cycles. Deterministic analysis identified two cost-effective pathways: (a) 4 cycles of letrozole followed by 2 cycles of low-dose gonadotropins and COS, and (b) 4 cycles of letrozole followed by 2 cycles of low-dose gonadotropins, 1 cycle of IVM, and COS, with ICERs of -€8174 and -€10,805 from the healthcare perspective, and -€11,494 and -€14,083 from the societal perspective, respectively. Incorporating IVM as second-line would require a 25.7% relative OPR increase from IVM, to become the most cost-effective pathway. Probabilistic sensitivity analyses confirmed robustness.

conclusionThis model highlights the role of IVM as a valuable component of PCOS infertility treatment in centres of expertise, with potential for greater impact as culture systems advance.

Indexed as

Cost-effectiveness analysisDecision-analytic modelInfertility treatmentIVMMarkovPCOS

Identifiers

PMID42332165

What Socratic holds

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.