title: Management of the first in vitro fertilization cycle for unexplained infertility: a cost-effectiveness analysis of split in vitro fertilization-intracytoplasmic sperm injection.
abstract: OBJECTIVE
  To determine the cost-effectiveness of split IVF-intracytoplasmic sperm injection (ICSI) for the treatment of couples with unexplained infertility.
  
  
  METHODS
  Adaptive decision model.
  
  
  METHODS
  Academic infertility clinic.
  
  
  METHODS
  A total of 154 couples undergoing a split IVF-ICSI cycle and a computer-simulated cohort of women <35 years old with unexplained infertility undergoing IVF.
  
  
  METHODS
  Modeling insemination method in the first IVF cycle as all IVF, split IVF-ICSI, or all ICSI, and adapting treatment based on fertilization outcomes.
  
  
  METHODS
  Live birth rate, incremental cost-effectiveness ratio (ICER).
  
  
  RESULTS
  In a single cycle, all IVF is preferred as the ICER of split IVF-ICSI or all ICSI ($58,766) does not justify the increased live birth rate (3%). If two cycles are needed, split IVF/ICSI is preferred as the increased cumulative live birth rate (3.3%) is gained at an ICER of $29,666.
  
  
  CONCLUSIONS
  In a single cycle, all IVF was preferred as the increased live birth rate with split IVF-ICSI and all ICSI was not justified by the increased cost per live birth. If two IVF cycles are needed, however, split IVF/ICSI becomes the preferred approach, as a result of the higher cumulative live birth rate compared with all IVF and the lesser cost per live birth compared with all ICSI.
authors.affiliation: Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of Rochester School of Medicine & Dentistry, Rochester, New York. Electronic address: Wendy_vitek@urmc.rochester.edu.
authors.forename: Wendy S
authors.initials: WS
authors.lastname: Vitek
authors.forename: Omar
authors.initials: O
authors.lastname: Galárraga
authors.forename: Peter C
authors.initials: PC
authors.lastname: Klatsky
authors.forename: Jared C
authors.initials: JC
authors.lastname: Robins
authors.forename: Sandra A
authors.initials: SA
authors.lastname: Carson
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Blazar
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D003663:Decision Trees; D005260:Female; D005298:Fertility; D005307:Fertilization in Vitro / Q000191:economics*; D017048:Health Care Costs; D006801:Humans; D007246:Infertility / Q000191:economics* / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D050498:Live Birth / Q000191:economics; D008297:Male; D018803:Models, Economic; D018579:Patient Selection; D011247:Pregnancy; D018873:Pregnancy Rate; D020554:Sperm Injections, Intracytoplasmic / Q000191:economics*; D016896:Treatment Outcome
keywords: Cost-effectiveness; split IVF-ICSI; unexplained infertility