Real-world utilization of assisted reproductive technology (art) and controlled ovarian stimulation (cos) – a retrospective claims database study from 2016 to 2022

To evaluate real-world utilization of assisted reproductive technology (ART) and controlled ovarian stimulation (COS) among infertile women in the US. This was a retrospective study of the IQVIA PharMetrics® Plus database (January 2016-June 2022), a comprehensive real-world claims database on commercially insured patients in the US. Women aged 18-42 years who were newly diagnosed with infertility (i.e., no diagnosis of infertility for at least one year before the first diagnosis observed in the data; infertility was identified via the ICD-10 code N97) were included. ART utilization was determined by whether a patient received any COS treatment (menotropins, follitropin alfa and follitropin beta) or any ART procedure (oocyte retrieval, ART monitoring procedures and medications, ART laboratory procedures, cryopreservation, and embryo transfer) over a follow-up period up to three years. COS treatment patterns and insurance type were described at the initiation of COS treatment among women who had at least one diagnosis of infertility before treatment initiation. In this study, 127,866 newly diagnosed infertile women from 2017 to 2021 were included, of which, 22,523 (17.6%) patients used ART over a median follow-up of 20.9 months. The proportion of infertile patients using ART remained low over time, ranging from 18.5% of patients in 2017 over a median follow-up of 32.9 months to 15.7% of patients in 2021 over a median follow-up of 11.3 months. A total of 19,057 infertile patients were treated with COS, including 62.2% received menotropins (9.7% menotropins only, 28.7% menotropins with follitropin alfa and 23.8% menotropins with follitropin beta), 19.9% follitropin alfa only and 17.9% follitropin beta only. Menotropins use increased over time from 54.8% in 2016 to 71.2% in 2021 (menotropins only from 8.8% to 11.0%; menotropins with follitropin alfa/follitropin beta from 45.9% to 60.3%). Patient characteristics were similar between COS treatment groups with a mean (standard deviation [SD]) age of 34.7 (4.1) years and mean (SD) Charlson Comorbidity Index of 0.1 (0.5). Among COS-treated patients, 37.4% were self-insured vs. 62.6% private/commercial payers, and 76.1% had preferred provider organization (PPO) vs.23.9% health maintenance organization (HMO)/other insurance types. Around 83.0% patients treated with menotropins only were enrolled in PPO, 77.8% for menotropins with follitropin alfa /follitropin beta treated, 70.6% follitropin alfa only and 73.5% follitropin beta only. ART utilization remained low (17.6%) among newly diagnosed infertile patients from 2017 to 2021. Menotropins were the most used gonadotropins, with increased use over time both as a monotherapy and mixed protocols with follitropin alfa or follitropin beta. Insurance type was associated with COS treatment choices. Future studies assessing patient outcomes associated with infertile treatments in the real world are warranted.