Long term costs and effects of reducing the number of twin pregnancies in IVF by single embryo transfer: the TwinSing study

Abstract

BackgroundPregnancies induced by in vitro fertilisation (IVF) often result in twin gestations, which are associated with both maternal and perinatal complications. An effective way to reduce the number of IVF twin pregnancies is to decrease the number of embryos transferred from two to one. The interpretation of current studies is limited because they used live birth as outcome measure and because they applied limited time horizons. So far, research on long-term outcomes of IVF twins and singletons is scarce and inconclusive. The objective of this study is to investigate the short (1-year) and long-term (5 and 18-year) costs and health outcomes of IVF singleton and twin children and to consider these in estimating the cost-effectiveness of single embryo transfer compared with double embryo transfer, from a societal and a healthcare perspective.Methods/DesignA multi-centre cohort study will be performed, in which IVF singletons and IVF twin children born between 2003 and 2005 of whom parents received IVF treatment in one of the five participating Dutch IVF centres, will be compared. Data collection will focus on children at risk of health problems and children in whom health problems actually occurred. First year of life data will be collected in approximately 1,278 children (619 singletons and 659 twin children). Data up to the fifth year of life will be collected in approximately 488 children (200 singletons and 288 twin children). Outcome measures are health status, health-related quality of life and costs. Data will be obtained from hospital information systems, a parent questionnaire and existing registries. Furthermore, a prognostic model will be developed that reflects the short and long-term costs and health outcomes of IVF singleton and twin children. This model will be linked to a Markov model of the short-term cost-effectiveness of single embryo transfer strategies versus double embryo transfer strategies to enable the calculation of the long-term cost-effectiveness.DiscussionThis is, to our knowledge, the first study that investigates the long-term costs and health outcomes of IVF singleton and twin children and the long-term cost-effectiveness of single embryo transfer strategies versus double embryo transfer strategies.

Elective single-embryo transfer

“…Not surprisingly, these studies report increased costs for eSET over DET for this end point (14,(54)(55)(56)(57). For example, two independent studies from The Netherlands, conducted at around the same time, calculated costs per birth among patients randomized to either single-or double-embryo transfer (14,54).…”

A comparison of perinatal outcomes in singletons and multiples born after in vitro fertilization or intracytoplasmic sperm injection stratified for neonatal risk criteria

“…The other children were assigned to the “low‐risk” category. A detailed description of the risk stratification procedure can be found elsewhere .…”

Predicting personalized multiple birth risks after in vitro fertilization–double embryo transfer

“…Historically, the transfer of multiple embryos led to a greater chance of pregnancy but also an increased risk of multiple birth and its associated costs, including higher risks of neonatal and obstetric complications. Elective single embryo transfer (eSET) eliminates all risk of multiple pregnancy except spontaneous identical twinning but may compromise a patient's chance of having a live birth altogether (1)(2)(3)(4).…”