How to save money on Gonadotropin injections?

One of the major expenses of an IVF cycle is the cost of the Gonadotropin injections (HMG/ FSH/ menotropins) which are used for superovulation. You can save money by getting your doctor to prescribe generic medicines, and not the heavily advertised products that sell at a much higher price.

What changed?

Since gonadotropins are natural hormones, they were formerly manufactured by extracting and purifying them from the menopausal women (urinary-gonadotropins), a relatively inexpensive process. These urinary gonadotropins were manufactured by 2 large multinational companies, Serono and Organon, and these were marketed as Pergonal and Humegon. Hundreds of thousands of babies were born with the use of these medicines which were safe, effective and inexpensive.

However, given the ever-increasing demand for these products, these companies then decided to use modern recombinant DNA technology to manufacture gonadotropin injections (rec-gonadotropins). The products they market are Gonal-F and Follistim.

Read more- Superovulation in IVF

For the sake of profits

While the good news was that this technology allowed them to manufacture large quantities of pure HMG, the bad news is that they became greedy. First, they withdrew their inexpensive urinary gonadotropins from the market. They did not do this to help infertile patients, but to preserve their profits.

They were worried that doctors would continue to prescribe the older less expensive effective products, as a result of which the market share of their newer recombinant products (which were much more profitable for them) would be much less!

Expensive products

To add insult to injury, they doubled the price of the new gonadotropins. Even though the newer recombinant products are no better than the older, tried and tested, urinary products (as proven by many research studies sponsored by the pharmaceutical companies themselves), since this was an oligopoly, they could get away with this.

Instead of looking after the interests of infertile patients, they then spent millions of dollars marketing the "new and improved" versions to doctors, most of whom have now been brainwashed by clever advertising.

But aren't the recombinant products better than the urinary products?

Better for whom ? Not for the patient, definitely! I would be the first to agree that the recombinant products are as good in clinical practice as the older products. However, there is absolutely no evidence to show that they are any better.

In fact, if you stop to think about it, it would be very surprising if they were better. They were developed as alternatives to the older products, and have been shown to be as effective as them, which is what one would expect. They are definitely better for the pharmaceutical companies manufacturing them, because they are far more profitable , since they have been over-priced.

What about the clinical studies?

All the studies have simply shown that they are as effective as the older urinary products. In fact, this is what the studies were designed to do, so that they could get permission from the FDA to market the rec products.

Unfortunately, some marketing whiz seems to have got the brainwave that the newer products should be presented as being better - not just as being as good! They then massaged all the data to try to show this - but have failed to do so.

How cost-effective are the recombinant products?

If you calculate the dollar cost per baby born, since the products are much more expensive as the older products, they are much less cost-effective. They just represent an unnecessary additional cost burden to infertile patients - a burden most can ill afford to incur.

But the new products are pure FSH! Doesn't this make them better?

The recombinant products contain only pure FSH, while the urinary gonadotropins contain equal amounts of the two gonadotropins, FSH and LH. However, there is no evidence that using only pure FSH ( as compared to using a mixture of FSH and LH) affects pregnancy rates. The combination products have stood the test of time.

What about the studies which show a higher pregnancy rate with the rec products?

It is true that pregnancy rates with IVF are now better than they were in the past, and the manufacturers of these products are happy to take the credit for this improvement in pregnancy rates. However, this improvement has been because of the improved lab conditions we now provide in the IVF lab, not the medicines. Controlled prospective studies which have compared the urinary products with the rec products do not show any difference in pregnancy rates.

What do you have against the recombinant products?

Nothing! My only criticism is that the manufacturers have become greedy, and are charging exorbitantly for their products. This is a very unfair burden on infertile couples. If they priced their rec products at the same level at which they price their urinary products, I would be very happy to prescribe them.

Read more-Making sense of your IVF medications

What can patients do?

Given the fact that the urinary products are as effective as the recombinant products, request your doctor to prescribe these for you. Even though Organon and Serono have stopped manufacturing urinary gonadotropins, the good news is that they are still being manufactured by other multinational companies, such as Ferring. Ferring manufactures Repronex , which sells for only US $ 30 in India ( versus US $ 55 in the USA). The brand name is Menogon.

You can save a lot of money by buying this from us !

If you have any questions, please contact us.

Authored by : Dr Aniruddha Malpani, MD and reviewed by Dr Anjali Malpani.