Management of the first in vitro fertilization cycle for unexplained infertility cost effectiveness analysis of split in vitro fertilization intracytoplasmic sperm injection

Conventional IVF may be the preferred insemination method in the initial treatment of couples with unexplained infertility, but split IVF-ICSI becomes preferable if more than one IVF cycle is necessary.

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Authors

Wendy Vitek, M.D., Omar Galarraga, Ph.D., Peter C. Klatsky, M.D., M.P.H., Jared C. Robins, M.D., Sandra A. Carson, M.D., Andrew S. Blazar, M.D.

Volume 100, Issue 5, Pages 1381-1388.e1, November 2013

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.

Read the full text at: http://www.fertstert.org/article/S0015-0282(13)00735-8/fulltext


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Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. The journal publishes juried original scientific articles in clinical and laboratory research relevant to reproductive endocrinology, urology, andrology, physiology, immunology, genetics, contraception, and menopause. Fertility and Sterility® encourages and supports meaningful basic and clinical research, and facilitates and promotes excellence in professional education, in the field of reproductive medicine.

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