title: Randomized single versus double embryo transfer: obstetric and paediatric outcome and a cost-effectiveness analysis.
abstract: BACKGROUND
  Transfer of several embryos after IVF results in a high multiple birth rate associated with increased morbidity and high costs for the neonatal care. In a previous randomized trial we demonstrated that a single embryo transfer (SET) strategy, including one fresh single embryo transfer and, if no live birth, one additional frozen-thawed SET, resulted in a live-birth rate that was not substantially lower than after double embryo transfer (DET) but markedly reduced the multiple birth rate.
  
  
  METHODS
  We compared costs for maternal health care and productivity losses and paediatric costs for the SET and DET strategies. In addition, maternal and paediatric outcomes between the two groups were compared.
  
  
  RESULTS
  The SET strategy resulted in lower average total costs from treatment until 6 months after delivery. There were a few more deliveries with at least one live-born child in the DET group. The incremental cost per extra delivery in the DET alternative was high, 71 940. The rates of prematurely born and low birthweight children were significantly lower with the SET strategy. There were also markedly fewer maternal and paediatric complications in the SET group.
  
  
  CONCLUSIONS
  The SET strategy is superior to the DET strategy, when number of deliveries with at least one live-born child, incremental cost-effectiveness ratio and maternal and paediatric complications are taken into consideration. The findings do not support continuing transfers of two embryos in this group of patients.
authors.affiliation: Reproductive Medicine, Department of Obstetrics and Gynaecology, Institute for Health of Women and Children, Sahlgrenska Academy, SU/S SE-413 45 Göteborg, Sweden.
authors.forename: Ann Thurin
authors.initials: AT
authors.lastname: Kjellberg
authors.forename: Per
authors.initials: P
authors.lastname: Carlsson
authors.forename: Christina
authors.initials: C
authors.lastname: Bergh
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis; D004624:Embryo Transfer / Q000191:economics*; D005260:Female; D005307:Fertilization in Vitro / Q000191:economics*; D006801:Humans; D050498:Live Birth / Q000191:economics*; D008427:Maternal Health Services / Q000191:economics*; D011247:Pregnancy; D018873:Pregnancy Rate; D011272:Pregnancy, Multiple; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic