Systematic review of worldwide trends in assisted reproductive technology 2004–2013

Kushnir, Vitaly A.; Barad, David H.; Albertini, David F.; Darmon, Sarah K.; Gleicher, Norbert

doi:10.1186/s12958-016-0225-2

Cited by 256 publications

(206 citation statements)

References 42 publications

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“…23 Since the onset of the ESTEEM study the consensus has shifted, especially in Europe, to elective single embryo transfer, whereas the ESTEEM protocol allowed transfer of up to two embryos. 24 Elective single embryo transfer would have nearly completely eliminated the incidence of twins in the ESTEEM study but would have necessitated a further excess of embryo transfers, though to a lesser degree in the PGT-A group. Another aspect not taken into account is the prevention of the birth of a disabled child and associated costs.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

An economic analysis of preimplantation genetic testing for aneuploidy by polar body biopsy in advanced maternal age

Neumann

Sermon

Bossuyt

et al. 2020

BJOG

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Objective What are the cost per live birth and the incremental cost of preventing a miscarriage with preimplantation genetic testing for aneuploidy (PGT‐A) by polar body biopsy and array‐based comprehensive genome hybridisation (aCGH) versus regular IVF/ICSI without PGT‐A for infertility treatment in women 36–40 years of age? Design Decision tree model. Population A randomised clinical trial on PGT‐A (ESTEEM study). Methods Two treatment strategies were compared: one cycle of IVF/ICSI with or without PGT‐A. Costs and effects were analysed with this model for four different cost scenarios: high‐, higher medium, lower medium and low‐cost. Base case, sensitivity, threshold, and probabilistic sensitivity analyses were used to examine the cost‐effectiveness implications of PGT‐A. Results PGT‐A increased the cost per live birth by approximately 15% in the high‐cost scenario to approximately 285% in the low‐cost scenario. Threshold analysis revealed that PGT‐A would need to be associated with an absolute increase in pregnancy rate by 6% to >39% or, alternatively, would need to be US$2,969 (high‐cost scenario) to US$4,888 (low‐cost scenario) cheaper. The incremental cost to prevent one miscarriage by PGT‐A using the base case assumptions was calculated to be US$34,427 (high‐cost scenario) to US$51,146 (low‐cost scenario). A probabilistic sensitivity analysis showed cost‐effectiveness for PGT‐A from 1.9% (high‐cost scenario) to 0.0% (low‐cost scenario) of calculated samples. Conclusions While avoiding unnecessary embryo transfers and miscarriages are important goals, patients and doctors need to be aware of the high‐cost implications of applying PGT‐A using aCGH on polar bodies. Tweetable abstract PGT‐A by polar body biopsy and comprehensive genome hybridisation increases cost per live birth and requires high financial spending per miscarriage averted.

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Section: Strengths and Limitationsmentioning

confidence: 99%

An economic analysis of preimplantation genetic testing for aneuploidy by polar body biopsy in advanced maternal age

Neumann

Sermon

Bossuyt

et al. 2020

BJOG

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“…Likely the most drastic negative effects of a broadly implemented eSET policy are, however, observed over the last 10 years in Japan, where national live birth rates over the decade dropped by two-thirds, while IVF cycle starts in the same time period tripled. Current live birth rates per cycle start are around 5.0% 35. In order to maintain the number of live births, the country, after 10 years, thus, ended up performing three times as many cycles as before, still only reaching a quite poor live birth rate of approximately 15.0%.…”

Section: No: To a Clinically Significant Degree Twins Do Not Constitumentioning

confidence: 99%

Is a Blanket Elective Single Embryo Transfer Policy Defensible?

Adashi¹,

Gleicher²

2017

Rambam Maimonides Med J

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For the purpose of reducing maternal and neonatal morbidity, elective single transfer (eSET) in in vitro fertilization (IVF) was first proposed in 1999. The purpose of this review is to summarize recent oral debate between a proponent and an opponent of expanded eSET utilization in an attempt to determine whether a blanket eSET policy, as is increasingly considered, is defensible. While eSET is preferable when possible, and agreed upon by provider and patient, selective double embryo transfer (DET) must be seriously entertained if deemed more appropriate or is desired by the patient. Patient autonomy, let alone prolonged infertility and advancing age, demand nothing less. Importantly, IVF-generated twins represent only 15.7% of the national twin birth rate in the United States. Non-IVF fertility treatments have been identified as the main cause of all multiple births for quite some time. However, educational and regulatory efforts over the last decade, paradoxically, have exclusively only been directed at the practice of IVF, although IVF patient populations are rapidly aging. It is difficult to understand why non-IVF fertility treatments, usually applied to younger women, have so far escaped attention. This debate on eSET utilization in association with IVF may contribute to a redirection of priorities.

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“…No Brasil, estimou-se uma taxa de infertilidade entre 8% e 15% em 2010, sendo o fator tubário o principal para a infertilidade associada a mulher (Pantoja & Fernandes, 2015) As técnicas de reprodução assistida (TRAs) foram introduzidas na década de 1970 e, desde então, o número de procedimentos vem aumentando no Brasil e em outras regiões do mundo (Correa & Loyola, 2015;Kushnir et al, 2017). Segundo o relatório do sistema nacional de produção de embriões (SisEmbrio), no Brasil,43.098 ciclos de fertilização in vitro foram realizados em 2018 (205,2 ciclos por milhão de habitantes) e 36.307 em 2017 (172,9 ciclos por milhão de habitantes) (Anvisa, 2019).…”

Section: Introductionunclassified

Modelo de impacto orçamentário da aplicação do single embryo transfer consecutivo comparado com o double embryo transfer em tratamentos de fertilização in vitro no Sistema de Saúde Suplementar

Lakryc¹

2019

JBES

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Systematic review of worldwide trends in assisted reproductive technology 2004–2013

Cited by 256 publications

References 42 publications

An economic analysis of preimplantation genetic testing for aneuploidy by polar body biopsy in advanced maternal age

An economic analysis of preimplantation genetic testing for aneuploidy by polar body biopsy in advanced maternal age

Is a Blanket Elective Single Embryo Transfer Policy Defensible?

Modelo de impacto orçamentário da aplicação do single embryo transfer consecutivo comparado com o double embryo transfer em tratamentos de fertilização in vitro no Sistema de Saúde Suplementar

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