OBJECTIVES: This study was conducted to evaluate the cost-effectiveness of recombinant FSH (rFSH) and LH (rLH) for treatment in vitro fertilization (IVF) patients from the payer's perspective. METHODS: A cost-effectiveness analysis from retrospective database of women waiting to be come pregnant (1100 IVF cycles). All patients received rFSH in combination with rLH or HP-hMG or non-purified hMG. Based on ovarian reserve, initial dose varied from 150 to 450 IU of r-hFSH associated with 75 to 225 IU of rLH or 1 to 4 vials of hMG. Statistical analysis was performed using the SPSS. In addition, a probabilistic sensitivity analysis was conducted by Boostrap simulation. RESULTS: Clinical and ongoing pregnancy rates (PR) per cycle were: rLH 47.16% and 44.95%; hMG 37.86% and 37.0%; HP-hMG 31.77% and 28.13%. PR with rFsh+rLH were significantly higher than with urinary products (P<0.05), however mean age was significantly lower (rLH 35.27±4.30; hMG 35.94±4.69; HP-hMG 36.25±4.64; P<0.05). Patient age group analysis showed than <35 years had higher PR in the rFSH+rLH group compared to rFSH+HP-hMG (clinical PR: 57.47% vs 32.76%, P<0.01; ongoing PR 54.71% vs 27.59%, P<0.01). The non purified hMG+rFSH group had lower PR than the rFSH+rLH group (clinical PR: 46.71% and 57.47%, P<0.05), but the difference in ongoing PR did not reach statistical significance (46.11% and 54.71%,). Costs of gonadotropins in patients <35 years were: non-purified hMG (6616.74±€1100.97) < rLH (6819.71±€1204.30 or 7064.91±€1246.28 using the unit costs of combo of rFSH 150 IU + rLH 75 IU and free combination respectively) < HP-hMG 7103.36±€1121.89. It was therefore showed rFSH 150UI +rLH 75UI combination is more effective than rFSH+HP-hMG. CONCLUSIONS: This study indicate that rFSH 150UI +rLH 75UI treatment is a dominant option, lower costs and higher effectiveness, with respect to HP-hMG and free combination. rFSH+rLH is the most cost-effectiveness option.