title: Costs of achieving live birth from assisted reproductive technology: a comparison of sequential single and double embryo transfer approaches.
abstract: OBJECTIVE
  To assess treatment and pregnancy/infant-associated medical costs and birth outcomes for assisted reproductive technology (ART) cycles in a subset of patients using elective double embryo (ET) and to project the difference in costs and outcomes had the cycles instead been sequential single ETs (fresh followed by frozen if the fresh ET did not result in live birth).
  
  
  METHODS
  Retrospective cohort study using 2012 and 2013 data from the National ART Surveillance System.
  
  
  METHODS
  Infertility treatment centers.
  
  
  METHODS
  Fresh, autologous double ETs performed in 2012 among ART patients younger than 35 years of age with no prior ART use who cryopreserved at least one embryo.
  
  
  METHODS
  Sequential single and double ETs.
  
  
  METHODS
  Actual live birth rates and estimated ART treatment and pregnancy/infant-associated medical costs for double ET cycles started in 2012 and projected ART treatment and pregnancy/infant-associated medical costs if the double ET cycles had been performed as sequential single ETs.
  
  
  RESULTS
  The estimated total ART treatment and pregnancy/infant-associated medical costs were $580.9 million for 10,001 double ETs started in 2012. If performed as sequential single ETs, estimated costs would have decreased by $195.0 million to $386.0 million, and live birth rates would have increased from 57.7%-68.0%.
  
  
  CONCLUSIONS
  Sequential single ETs, when clinically appropriate, can reduce total ART treatment and pregnancy/infant-associated medical costs by reducing multiple births without lowering live birth rates.
authors.affiliation: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia. Electronic address: sgv0@cdc.gov.
authors.forename: Sara
authors.initials: S
authors.lastname: Crawford
authors.affiliation: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Sheree L
authors.initials: SL
authors.lastname: Boulet
authors.affiliation: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Allison S
authors.initials: AS
authors.lastname: Mneimneh
authors.affiliation: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Kiran M
authors.initials: KM
authors.lastname: Perkins
authors.affiliation: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Denise J
authors.initials: DJ
authors.lastname: Jamieson
authors.affiliation: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Yujia
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Dmitry M
authors.initials: DM
authors.lastname: Kissin
mesh_terms: D000328:Adult; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D004624:Embryo Transfer / Q000191:economics* / Q000379:methods; D005260:Female; D005298:Fertility; D017048:Health Care Costs; D006801:Humans; D007246:Infertility / Q000175:diagnosis / Q000191:economics* / Q000503:physiopathology / Q000628:therapy*; D050498:Live Birth; D011247:Pregnancy; D018873:Pregnancy Rate; D011272:Pregnancy, Multiple; D012189:Retrospective Studies; D056826:Single Embryo Transfer / Q000191:economics*; D016896:Treatment Outcome
keywords: Sequential single embryo transfer (SET); assisted reproductive technology (ART); double embryo transfer (DET); infertility; in vitro fertilization (IVF)