The direct health services costs of providing assisted reproduction services in overweight or obese women: a retrospective cross-sectional analysis

Maheshwari, Abha; Scotland, Graham; Bell, Jacqueline; McTavish, Alison; Hamilton, Mark; Bhattacharya, Siladitya

doi:10.1093/humrep/den424

Cited by 44 publications

(42 citation statements)

References 18 publications

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“…Age-dependent probabilities of failing to reach embryo transfer were applied (Scottish clinical data set) in subsequent fresh cycles, with a proportion of these failures assumed to occur before egg recovery. 30 Women experiencing cancellation before egg recovery could proceed with another fresh cycle, without the cancelled cycle counting as one of their three fresh attempts. Cancellations following egg recovery were counted as one of the three fresh attempts and these women were only eligible to proceed with associated frozen cycles or a final fresh cycle.…”

Section: Linking Cyclesmentioning

confidence: 99%

Minimising twins in in vitro fertilisation: a modelling study assessing the costs, consequences and cost-utility of elective single versus double embryo transfer over a 20-year time horizon

Scotland

McLernon

Kurinczuk

et al. 2011

BJOG: An International Journal of Obstetrics &Amp; Gynaecology

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Objectives To assess the cumulative costs and consequences of double embryo transfer (DET) or elective single embryo transfer (eSET) in women commencing in vitro fertilisation (IVF) treatment aged 32, 36 and 39 years. Design Microsimulation model.Setting Three assisted reproduction centres in Scotland.Sample A total of 6153 women undergoing treatment at one of three Scottish IVF clinics, between January 1997 and June 2007.Methods A microsimulation model, populated using data inputs derived from a large clinical data set and published literature, was developed to compare the costs and consequences of using eSET or DET over multiple treatment cycles.Main outcome measures Disability-free live births; twin pregnancy rate; women's quality-adjusted life-years (QALYs); health service costs.Results Not only did DET produce a higher cumulative live birth rate compared with eSET for women of all three ages, but also a higher twin pregnancy rate. Compared with eSET, DET ranged from costing an additional £27 356 per extra live birth in women commencing treatment aged 32 years, to costing £15 539 per extra live birth in 39-year-old women. DET cost £28 300 and £20 300 per additional QALY in women commencing treatment aged 32 and 39 years, respectively.Conclusions Considering the high twin pregnancy rate associated with DET, coupled with uncertainty surrounding QALY gains, eSET is likely to be the preferred option for most women aged £36 years. The cost-effectiveness of DET improves with age, and may be considered cost-effective in some groups of older women. The decision may best be considered on a case-by-case basis for women aged 37-39 years.Keywords Cost-effectiveness, in vitro fertilisation, single embryo transfer.Please cite this paper as: Scotland G, McLernon D, Kurinczuk J, McNamee P, Harrild K, Lyall H, Rajkhowa M, Hamilton M, Bhattacharya S. Minimising twins in in vitro fertilisation: a modelling study assessing the costs, consequences and cost-utility of elective single versus double embryo transfer over a 20-year time horizon.

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Section: Linking Cyclesmentioning

confidence: 99%

Minimising twins in in vitro fertilisation: a modelling study assessing the costs, consequences and cost-utility of elective single versus double embryo transfer over a 20-year time horizon

Scotland

McLernon

Kurinczuk

et al. 2011

BJOG: An International Journal of Obstetrics &Amp; Gynaecology

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“…The authors held this view mainly for class I obese women compared with the normal BMI group and maintained that the small number of women included in higher BMI groups led to uncertainty regarding their conclusion. 53 Another study modelled the costs of achieving live birth in both ovulatory and anovulatory obese women using different modalities of infertility treatment as compared with women with normal BMIs. In their hypothetical model based on an extensive literature search of reported success rates of different treatments they included the direct costs of treatment and indirect costs of pregnancy complications.…”

Section: Bariatric Surgerymentioning

confidence: 99%

Effect of obesity on assisted reproductive treatment outcomes and its management: a literature review

Khairy

Rajkhowa

2017

The Obstetric & Gynaecologis

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Obesity is associated with infertility and poor obstetric outcomes. The current trends of advanced maternal age and rising obesity rates contribute indirectly to the growing demand for fertility treatment and assisted reproduction treatment (ART), posing clinical and ethical dilemmas for fertility service providers. The live-birth rate, after ART, is significantly lower in obese women than non-obese women, possibly due to impaired oocyte quality and/or defective endometrial receptivity. Poor ART outcomes correlate positively with the severity of obesity. Management of obesity-related infertility should include diet, exercise, cognitive behavioural interventions and possibly adjunctive pharmacotherapy. Bariatric surgery may benefit morbidly obese women who struggle to lose weight otherwise. Randomised controlled trials are required to clarify the effects of various therapeutic interventions for obesity on ART outcomes. Learning objectivesTo understand the association of obesity and infertility with ART outcomes. To learn the principles of obesity-related infertility management. Ethical issuesTo understand the ethical challenges in the provision of ART for obese women and to inform the stance of professional bodies, such as the British Fertility Society and the European Society of Human Reproduction and Embryology.Keywords: assisted reproduction treatment (ART) / bariatric surgery / infertility / pregnancy / obesity Linked resource: Single best answer questions are available for this article at https://stratog.rcog.org.uk/tutorial/tog-online-sba-resource Please cite this paper as: Khairy M, Rajkhowa M. Effect of obesity on assisted reproductive treatment outcomes and its management: A literature review.

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“…Although the cost of IVF treatment is variable among different countries, it is generally an expensive treatment in most parts of the world. The average cost of one fresh IVF cycle (excluding associated frozen embryo transfers) is as high as £3,123 in the United Kingdom;1,2 in the United States, it is even higher (Table 1). Public funding and the provision of health insurance for IVF treatment differ widely between countries; there is no uniformity in the provision of this treatment even in the developed world 3.…”

Section: High Treatment Cost: a Barrier To Accessing Ivf Treatmentmentioning

confidence: 99%

Low-cost in vitro fertilization: current insights

Teoh¹,

Maheshwari²

2014

IJWH

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Despite the development of in vitro fertilization (IVF) more than 30 years ago, the cost of treatment remains high. Furthermore, over the years, more sophisticated technologies and expensive medications have been introduced, making IVF increasingly inaccessible despite the increasing need. Globally, the option to undergo IVF is only available to a privileged few. In recent years, there has been growing interest in exploring strategies to reduce the cost of IVF treatment, which would allow the service to be provided in low-resource settings. In this review, we explore the various ways in which the cost of this treatment can be reduced.

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The direct health services costs of providing assisted reproduction services in overweight or obese women: a retrospective cross-sectional analysis

Cited by 44 publications

References 18 publications

Minimising twins in in vitro fertilisation: a modelling study assessing the costs, consequences and cost-utility of elective single versus double embryo transfer over a 20-year time horizon

Minimising twins in in vitro fertilisation: a modelling study assessing the costs, consequences and cost-utility of elective single versus double embryo transfer over a 20-year time horizon

Effect of obesity on assisted reproductive treatment outcomes and its management: a literature review

Low-cost in vitro fertilization: current insights

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