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. Design Adaptive decision model. Setting Academic infertility clinic. Patient(s) 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. Intervention(s) Modeling insemination method in the first IVF cycle as all IVF, split IVF-ICSI, or all ICSI, and adapting treatment based on fertilization outcomes. Main Outcome Measure(s) Live birth rate, incremental cost-effectiveness ratio (ICER). Result(s) 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. Conclusion(s) 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.

Cost-effectiveness analysis of preimplantation genetic screening and in vitro fertilization versus expectant management in patients with unexplained recurrent pregnancy loss

“…Only direct medical costs were included. The average cost of preconception counseling and baseline RPL workup, including parental karyotyping, maternal antiphospholipid antibody testing, and uterine cavity evaluation, was $4,377 (range: $4,000-$5,000) (16). Because this was incurred by both groups before their entry into the decision tree, it was not included as a cost input in the study.…”

“…The average cost of IVF was $18,227 (range: $6,920-$27,685) (16) and includes cycle medications, oocyte retrieval, and one embryo transfer. The average cost of PGS was $4,268 (range $3,155-$12,626) (17), and the average cost of a frozen embryo transfer was $6,395 (range: $3,155-$12,626) (13,16). The average cost of managing a clinical miscarriage with dilation and curettage (D&C) was $1,304 (range: $517-$2,058) (18).…”

Role of In Vitro Fertilization in Unexplained Female Infertility

“…A recent study analyzed the cost-effectiveness of performing IVF and ICSI on sibling oocytes (split IVF-ICSI cycle) versus performing IVF only in couples with unexplained infertility [50]. The authors found that if a single cycle was needed to achieve the live birth, an all-IVF-cycle is preferred as the incremental cost-effectiveness ratio (ICER) of split IVF-ICSI or all ICSI (US$ 58,766) does not justify the increased live birth rate (3 %).…”

“…The authors found that if a single cycle was needed to achieve the live birth, an all-IVF-cycle is preferred as the incremental cost-effectiveness ratio (ICER) of split IVF-ICSI or all ICSI (US$ 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 US$ 29,666 [50].…”

The Great Recession, insurance mandates, and the use of in vitro fertilization services in the United States

“…The costs associated with fertility treatments involve expenses both immediate (e.g., costs of procedures and medications) and long term (e.g., costs of raising a child). The costs associated with one IVF cycle range from $6,920 to $27,685 (in 2012 U.S. dollars) (10). The costs of raising a child are not inconsequential and are estimated to be $241,080 for a middle-income couple (i.e., those with income in the middle tertile or with household income between $60,640 and $105,000) to raise a child born in 2012 for 18 years (11).…”