scholarly journals Single Embryo Transfer Versus Double Embryo Transfer: A Cost-Effectiveness Analysis in a Non-IVF Insurance Mandated System

2020 ◽  
Vol 185 (9-10) ◽  
pp. e1700-e1705
Author(s):  
Collin Sitler ◽  
Michael Lustik ◽  
Gary Levy ◽  
Bruce Pier
Keyword(s):  
Cost Effectiveness ◽  
Embryo Transfer ◽  
Single Embryo Transfer ◽  
Vitro Fertilization ◽  
Total Cost ◽  
Live Births ◽  
Personal Costs ◽  
Military Facilities ◽  
Double Embryo Transfer

ABSTRACT Introduction Because of increased morbidity seen in multiple gestations, the American Society of Reproductive Medicine recommends transfer of blastocysts one at a time for most patients. While cost-effectiveness models have compared single embryo transfer (SET) versus double embryo transfer (DET), few incorporate maternal and neonatal morbidity, and none have been performed in U.S. Military facilities. The purpose of this study was to determine the cost effectiveness of sequential SET versus DET in a U.S. Military treatment facility. Materials and Methods A cost-effectiveness model was created based on 250 patients between the ages of 20–44 who previously underwent in vitro fertilization (IVF) at our facility. The model consisted of patients pursuing either SET or DET with two total embryos. Cycle outcomes were determined using the published SARTCORS success calculator. Neonatal and obstetrical outcomes were simulated based on singleton and twin IVF pregnancies. Neonatal and obstetrical cost estimates were based on internal data as well. Results If 250 model patients pursue SET, 140 live births would occur, with total cost of $5.7 million, and cost per delivery of $40,500. If the model patients pursued DET, 117 live births would occur, with total cost of $9.2 million and a cost per delivery of $77.700. DET would lead to more total infants (207 vs. 143 in SET cohort). Personal costs are higher in SET versus DET cohorts ($23,036 vs. $20,535). Conclusions SET in a system with no infertility coverage saves approximately $3.5 million per 250 patients. Higher personal costs as seen with SET may incentivize patients to seek DET. The total savings should encourage alteration to practice patterns with the U.S Military Healthcare System.

Elective Single-Embryo Transfer versus Double-Embryo Transfer in In Vitro Fertilization

2005 ◽  
Vol 60 (6) ◽  
pp. 376-377
Author(s):  
Ann Thurin ◽  
Jon Hausken ◽  
Torbj??rn Hillensjo?? ◽  
Barbara Jablonowska ◽  
Anja Pinborg ◽  
...  
Keyword(s):  
In Vitro Fertilization ◽  
Embryo Transfer ◽  
Single Embryo Transfer ◽  
Vitro Fertilization ◽  
Elective Single Embryo Transfer ◽  
Double Embryo Transfer

Elective Single-Embryo Transfer versus Double-Embryo Transfer in in Vitro Fertilization

2004 ◽  
Vol 351 (23) ◽  
pp. 2392-2402 ◽  
Author(s):  
Ann Thurin ◽  
Jon Hausken ◽  
Torbjörn Hillensjö ◽  
Barbara Jablonowska ◽  
Anja Pinborg ◽  
...  
Keyword(s):  
In Vitro Fertilization ◽  
Embryo Transfer ◽  
Single Embryo Transfer ◽  
Vitro Fertilization ◽  
Elective Single Embryo Transfer ◽  
Double Embryo Transfer

scholarly journals Time associations between U.S. birth rates and add-Ons to IVF practice between 2005–2016

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Norbert Gleicher ◽  
Lyka Mochizuki ◽  
David H. Barad
Keyword(s):  
Live Birth ◽  
Outcome Data ◽  
Single Embryo Transfer ◽  
Additional Treatment ◽  
Birth Rates ◽  
Preimplantation Genetic Testing ◽  
Vitro Fertilization ◽  
Live Births ◽  
Live Birth Rates

AbstractUntil 2010, the National Assisted Reproductive Technology Surveillance System (NASS) report, published annually by the Center for Disease Control and Prevention (CDC), demonstrated almost constantly improving live birth rates following fresh non-donor (fnd) in vitro fertilization (IVF) cycles. Almost unnoticed by profession and public, by 2016 they, however, reached lows not seen since 1996–1997. We here attempted to understand underlying causes for this decline. This study used publicly available IVF outcome data, reported by the CDC annually under Congressional mandate, involving over 90% of U.S. IVF centers and over 95% of U.S. IVF cycles. Years 2005, 2010, 2015 and 2016 served as index years, representing respectively, 27,047, 30,425, 21,771 and 19,137 live births in fnd IVF cycles. Concomitantly, the study associated timelines for introduction of new add-ons to IVF practice with changes in outcomes of fnd IVF cycles. Median female age remained at 36.0 years during the study period and center participation was surprisingly stable, thereby confirming reasonable phenotype stability. Main outcome measures were associations of specific IVF practice changes with declines in live IVF birth rates. Time associations were observed with increased utilization of “all-freeze” cycles (embryo banking), mild ovarian stimulation protocols, preimplantation genetic testing for aneuploidy (PGT-A) and increasing utilization of elective single embryo transfer (eSET). Among all add-ons, PGT-A, likely, affected fndIVF most profoundly. Though associations cannot denote causation, they can be hypothesis-generating. Here presented time-associations are compelling, though some of observed pregnancy and live birth loss may have been compensated by increases in frozen-thawed cycles and consequential pregnancies and live births not shown here. Pregnancies in frozen-thawed cycles, however, represent additional treatment cycles, time delays and additional costs. IVF live birth rates not seen since 1996–1997, and a likely continuous downward trend in U.S. IVF outcomes, therefore, mandate a reversal of current outcome trends, whatever ultimately the causes.

Embryo Glue: The Use of Hyaluronan in Embryo Transfer Media

2021 ◽  
Author(s):  
Beth Atkinson ◽  
Emma Woodland
Keyword(s):  
Embryo Transfer ◽  
Large Scale ◽  
Multiple Pregnancy ◽  
Single Embryo Transfer ◽  
Transfer Policy ◽  
Vitro Fertilization ◽  
Meta Analyses ◽  
Detrimental Impact ◽  
Robust Evidence

AbstractEmbryoGlue is available to patients at many in vitro fertilization clinics, usually at an additional cost. The efficacy of hyaluronan-enriched transfer medium (HETM) is supported by moderate quality evidence that indicates a significant improvement in clinical outcomes such as live birth rates for patients, including poorer prognosis women (i.e., maternal age factor [>35 years] and recurrent implantation failure). An increased multiple pregnancy rate has been reported with the use of HETM; therefore, a single embryo transfer policy should be considered in conjunction with the use of EmbryoGlue. There is no evidence to suggest that HETM has any detrimental impact, and therefore the use of HETM in clinics may be justified for a specific demographic of patients. Further robust evidence, in the form of meta-analyses or large-scale randomized controlled trials, is needed to build a sufficient consensus regarding the benefit of hyaluronan supplementation in embryo transfer media.

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