title: The impact of consumer affordability on access to assisted reproductive technologies and embryo transfer practices: an international analysis.
abstract: OBJECTIVE
  To systematically quantify the impact of consumer cost on assisted reproduction technology (ART) utilization and numbers of embryos transferred.
  
  
  METHODS
  Ordinary least squared (OLS) regression models were constructed to measure the independent impact of ART affordability-measured as consumer cost relative to average disposable income-on ART utilization and embryo transfer practices.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Women undergoing ART treatment.
  
  
  METHODS
  None.
  
  
  METHODS
  OLS regression coefficient for ART affordability, which estimates the independent effect of consumer cost relative to income on utilization and number of embryos transferred.
  
  
  RESULTS
  ART affordability was independently and positively associated with ART utilization with a mean OLS coefficient of 0.032. This indicates that, on average, a decrease in the cost of a cycle of 1 percentage point of disposable income predicts a 3.2% increase in utilization. ART affordability was independently and negatively associated with the number of embryos transferred, indicating that a decrease in the cost of a cycle of 10 percentage points of disposable income predicts a 5.1% increase in single-embryo transfer cycles.
  
  
  CONCLUSIONS
  The relative cost that consumers pay for ART treatment predicts the level of access and number of embryos transferred. Policies that affect ART funding should be informed by these findings to ensure equitable access to treatment and clinically responsible embryo transfer practices.
authors.affiliation: National Perinatal Epidemiology and Statistics Unit, School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia. Electronic address: g.chambers@unsw.edu.au.
authors.forename: Georgina M
authors.initials: GM
authors.lastname: Chambers
authors.affiliation: National Perinatal Epidemiology and Statistics Unit, School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Van Phuong
authors.initials: VP
authors.lastname: Hoang
authors.affiliation: National Perinatal Epidemiology and Statistics Unit, School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Sullivan
authors.affiliation: School of Women's and Children's Health, Royal Hospital for Women, Sydney, New South Wales, Australia; IVF Australia, Sydney, New South Wales, Australia.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Chapman
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, Saitama Medical University, Moroyama, Saitama, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Ishihara
authors.affiliation: Clinica las Condes and Program of Ethics and Public Policies, University Diego Portales, Santiago, Chile.
authors.forename: Fernando
authors.initials: F
authors.lastname: Zegers-Hochschild
authors.affiliation: Institute of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Karl G
authors.initials: KG
authors.lastname: Nygren
authors.affiliation: Palo Alto Medical Foundation Fertility Physicians of Northern California, Palo Alto, California; Department of Gynecology and Obstetrics, Stanford University School of Medicine, Stanford, California; Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California.
authors.forename: G David
authors.initials: GD
authors.lastname: Adamson
mesh_terms: D000293:Adolescent; D000328:Adult; D004624:Embryo Transfer / Q000191:economics* / Q000639:trends; D036262:Empirical Research; D005260:Female; D006297:Health Services Accessibility / Q000191:economics* / Q000639:trends; D006801:Humans; D038622:Internationality; D008875:Middle Aged; D011247:Pregnancy; D012042:Registries; D027724:Reproductive Techniques, Assisted / Q000191:economics* / Q000639:trends; D012959:Socioeconomic Factors; D055815:Young Adult
keywords: Assisted reproductive technology; cost analysis; insurance mandates; single-embryo transfer