title: Cost Implications for Subsequent Perinatal Outcomes After IVF Stratified by Number of Embryos Transferred: A Five Year Analysis of Vermont Data.
abstract: BACKGROUND
  In states in the USA without in vitro fertilzation coverage (IVF) insurance coverage, more embryos are transferred per cycle leading to higher risks of multi-fetal pregnancies and adverse pregnancy outcomes.
  
  
  OBJECTIVE
  To determine frequency and cost of selected adverse perinatal complications based on number of embryos transferred during IVF, and calculate incremental cost per IVF live birth.
  
  
  METHODS
  Medical records of patients who conceived with IVF (n = 116) and delivered at >20 weeks gestational age between 2007 and 2011 were evaluated. Gestational age at delivery, low birth weight (LBW) term births, and delivery mode were tabulated. Healthcare costs per cohort, extrapolated costs assuming 100 patients per cohort, and incremental costs per infant delivered were calculated.
  
  
  RESULTS
  The highest prematurity and cesarean section rates were recorded after double embryo transfers (DET), while the lowest rates were found in single embryo transfers (SET). Premature singleton deliveries increased directly with number of transferred embryos [6.3 % (SET), 9.1 % (DET) and 10.0 % for ≥3 embryos transferred]. This trend was also noted for rate of cesarean delivery [26.7 % (SET), 36.6 % (DET), and 47.1 % for ≥3 embryos transferred]. The proportion of LBW infants among deliveries after DET and for ≥3 embryos transferred was 3.9 and 9.1 %, respectively. Extrapolated costs per cohort were US$718,616, US$1,713,470 and US$1,227,396 for SET, DET, and ≥3 embryos transferred, respectively.
  
  
  CONCLUSIONS
  Attempting to improve IVF pregnancy rates by permitting multiple embryo transfers results in sharply increased rates of multiple gestation and preterm delivery. This practice yields a greater frequency of adverse perinatal outcomes and substantially increased healthcare spending. Better efforts to encourage SET are necessary to normalize healthcare expenditures considering the frequency of very high cost sequela associated with IVF where multiple embryo transfers occur.
authors.affiliation: University of Vermont College of Medicine, Burlington, VT, USA.
authors.forename: Olivia J
authors.initials: OJ
authors.lastname: Carpinello
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, University of Vermont College of Medicine, Burlington, VT, USA.
authors.forename: Peter R
authors.initials: PR
authors.lastname: Casson
authors.affiliation: Department of Community Medicine and Health Care, University of Connecticut Health Center, Farmington, CT, USA.
authors.forename: Chia-Ling
authors.initials: CL
authors.lastname: Kuo
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, University of Vermont College of Medicine, Burlington, VT, USA.
authors.forename: Renju S
authors.initials: RS
authors.lastname: Raj
authors.affiliation: Reproductive Research Section, Center for Advanced Genetics, 3144 El Camino Real, Suite 106, Carlsbad, CA, 92008, USA. drsills@CAGivf.com.|Department of Molecular and Applied Biosciences, University of Westminster, London, UK. drsills@CAGivf.com.
authors.forename: E Scott
authors.identifier: http://orcid.org/0000-0001-7334-1031
authors.initials: ES
authors.lastname: Sills
authors.affiliation: Global Health Economics Unit of the Vermont Center for Clinical and Translational Science and Department of Surgery, University of Vermont College of Medicine, Burlington, VT, USA.|Center for Study of Multiple Births, Chicago, IL, USA.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Jones
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis; D002658:Developmental Disabilities / Q000191:economics* / Q000453:epidemiology / Q000209:etiology; D004624:Embryo Transfer / Q000009:adverse effects / Q000191:economics* / Q000706:statistics & numerical data; D005260:Female; D005307:Fertilization in Vitro / Q000009:adverse effects / Q000191:economics* / Q000379:methods; D005865:Gestational Age; D017048:Health Care Costs; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D008423:Maternal Age; D009010:Monte Carlo Method; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000191:economics* / Q000453:epidemiology; D011272:Pregnancy, Multiple; D014707:Vermont / Q000453:epidemiology