OBJECTIVES: To determine the cost-effectiveness of HP-HMG (menotropin, MENOPUR®) compared to rFSH (follitropin alpha, GONAL-F®), in producing live births in the ovulatory patient participating in an ART Program. METHODS: A previously validated and published European Markov model was adapted to the Canadian setting to estimate the incremental cost per additional live birth gained for HP-HMG compared to rFSH, projected over three treatment cycles.  These cycles included an initial fresh cycle then two additional cycles, as needed, of either fresh or cryoperserved embryos.  Live birth rates were derived from a published meta-analysis comparing HP-HMG menotropin to rFSH follitropin alpha. Factors such as discontinuation, ooctye fertilization and pregnancy rates were derived from the published literature. All clinical outcomes were validated against published Canadian ART registry data and through clinical expert review.  The analysis focused on direct medical costs only from the perspective of a provincial public health care system (Quebec). Cost data were obtained from a variety of sources including published references, provincial healthcare sources and expert opinion. All costs were reported as 2009 Canadian Dollars ($CAD). Given the short time-horizon discounting was not applied. Multiple sensitivity analyses were undertaken to test the robustness of the model to variations in key parameters including the cost and relative outcomes of comparators. RESULTS: The base case analysis indicates that HP-HMG results in a total cost per patient of $CAD 11,742 over 3 cycles compared to $CAD 13,202 for rFSH.  Further, treatment with HP-HMG results in more live births than rFSH with 0.485 versus 0.421, respectively. Thus, treatment with HP-HMG is dominant relative to rFSH (less costly and more effective). Results were robust over multiple sensitivity analyses. CONCLUSIONS: Treatment with HP-HMG (MENOPUR) is cost-effective compared to rFSH (GONAL-F), providing a greater number of live births at a lower cost to the public health care system.