Economic implications of the Society for Assisted Reproductive Technology embryo transfer guidelines: healthcare dollars saved by reducing iatrogenic triplets

Following the initial publication in 1998 of the Society for Assisted Reproductive Technology guidelines limiting number of embryos to transfer, more than 16,000 higher-order multiple live births have been avoided, corresponding to $6.0 billion healthcare dollars saved.


Malinda S. Lee, M.D., M.B.A., Brady T. Evans, M.D., M.B.A., Ariel D. Stern, Ph.D., Mark D. Hornstein, M.D.



To estimate the national cost savings resulting from reductions in higher-order multiple (HOM) live births (defined as three or more fetuses), following the initial publication of the Society for Assisted Reproductive Technology (SART) guidelines on ET in 1998.


Descriptive use and cost analysis.


Not applicable.


Not applicable.


Not applicable.

Main Outcome Measure(s)

Estimates of the total number of HOM deliveries prevented (from 1998–2012) following the publication of SART guidelines; the associated healthcare savings (2014 US dollars).


A singleton live birth was estimated to cost $17,100–$24,200. A twin live birth was estimated at $66,000–$117,500. A triplet live birth was estimated at $190,800–$456,300. The percentage of HOM gestations among all ART pregnancies decreased from 11.4% in 1997 to 2.0% in 2012, with the sharpest year-over-year decline of 20.3% occurring in the year following the publication of the guidelines. The number of prevented HOM deliveries from 1998 through 2012 was estimated to be between 13,500 and 16,300, corresponding to cost savings of $6.02B (billion) (range, $2.35B–$7.03B, 2014 US dollars).


Iatrogenic HOM gestations represent a substantial economic burden to our healthcare system. The introduction of guidelines for ET in 1998 coincided with a dramatic decrease in the HOM rate in subsequent years and an associated cumulative cost savings of more than $6B. Further reductions in HOM gestations could save up to an additional $2B annually.

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