A real-life prospective health economic study of elective single embryo transfer versus two-embryo transfer in first IVF/ICSI cycles.
BACKGROUND
We analysed the difference in maternal, neonatal and total costs after single (SET) versus double day 3 embryo transfer (DET).


METHODS
We performed a two-centre prospective study of women in their first IVF/ICSI cycle choosing between SET or DET. Infertility treatment data were gathered from a database; maternal and neonatal outcome data from a case report form (CRF); health economic data from medical acts registered in the CRF for the outpatient part and from hospital bills. SET was performed in 206/367 (56.1%) and DET in 161/367 (43.9%) women.


RESULTS
In all, 367 transfers yielded 186 positive pregnancy tests, 148 ongoing pregnancies and 136 live deliveries (50.7, 40.3 and 37.1% per embryo transfer) of which 15 (11.0%) were twins. Live birth rate was 37.4% for SET, 36.6% for DET. Intention-to-treat analysis showed differences for: duration of pregnancy (SET: 39.0 +/- 1.4 versus DET: 38.3 +/- 2.2 weeks; P = 0.055), percentage prematurity (8.5 versus 23.8%; P = 0.033), percentage of neonates hospitalized (5.7 versus 17.9%; P = 0.121) and duration of neonatal hospitalization (6.3 +/- 2.2 versus 10.3 +/- 10.1 days; P = 0.01). Total cost after DET was higher (SET: 4700 +/- 3239 versus DET: 8613 +/- 10 105; P = 0.105), due to significantly higher neonatal costs (451 +/- 957 versus 3453 +/- 8154; P < 0.001) and not to differences in maternal costs (4250 +/- 2882 versus 5160 +/- 4106; P = 0.152).


CONCLUSIONS
This prospective health economic study shows that transfer of a single top quality embryo is equally effective as, but substantially cheaper than, double embryo transfer in women <38 years of age in their first IVF/ICSI cycle.
Centre for Reproductive Medicine, Middelheim Hospital, Lindendreef 1, 2020 Antwerp, Belgium. jan.gerris@ocmw.antwerpen.be
J
J
Gerris
P
P
De Sutter
D
D
De Neubourg
E
E
Van Royen
J
J
Vander Elst
K
K
Mangelschots
M
M
Vercruyssen
P
P
Kok
M
M
Elseviers
L
L
Annemans
P
P
Pauwels
M
M
Dhont
D001723:Birth Rate; D036861:Delivery, Obstetric / Q000706:statistics & numerical data; D004624:Embryo Transfer / Q000191:economics* / Q000706:statistics & numerical data; D005260:Female; D005307:Fertilization in Vitro; D017048:Health Care Costs; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D011181:Postnatal Care / Q000191:economics; D011247:Pregnancy; D018873:Pregnancy Rate; D011272:Pregnancy, Multiple / Q000706:statistics & numerical data; D011446:Prospective Studies; D020554:Sperm Injections, Intracytoplasmic; D014427:Twins / Q000706:statistics & numerical data