Dr. Sills: Often regarded as a miracle procedure by many infertile couples, in vitro fertilization (IVF) can be financially difficult for those without insurance coverage for the treatment. This prohibitive cost leads many would-be parents who pursue IVF to transfer multiple embryos at once, to increase their chances of getting a baby and minimize the need for additional attempts.
This new study now reports that the economic impact of IVF deserves a closer look. As corresponding author E. Scott Sills, MD PhD noted, rates of cesarean-section deliveries, premature births, and low birth weight of babies are all greater with two or more embryos transferred to the mother at once, compared to a lower risk, single-embryo pregnancy.
The data derived from a comprehensive analysis of all IVF cases in Vermont (UVM) and was recently published in the journal Applied Health Economics & Health Policy. It is believed to be the first effort to calculate the difference in infant hospital costs based on the number of embryos transferred. Sills and his team had access to UVM Medical Center records of patients who conceived through IVF and delivered at least 20 weeks into their pregnancies between 2007 and 2011.
Dr. Sills: The study compared the incidence and costs of adverse perinatal outcomes – preterm delivery (at less than 37 weeks gestation), low birth weight (less than 2,500 grams) and C-sections – resulting from single-embryo transfers, double-embryo transfers and transfers of three or more embryos. They determined that the costs to care for babies born from 2-embryo transfers were more than twice as much as costs for babies from single-embryo transfers, and costs for babies from three or more embryos were 1.7 times as high.
Dr. Sills: It wasn't only the greater chance of twins or more multiple births with multiple embryo transfers that caused those complications and higher healthcare costs, the authors found. Even when only one baby resulted from a larger number of embryos, the risk of problems increased.
The findings are parallel to the conclusions Sills developed in his PhD thesis at London's University of Westminster in 2013, where single embryo transfers and preimplantation screening were applied to improve pregnancy rates and reduce health spend.
Dr. Sills: Members of Dr. Sills' research team included Christopher A. Jones, DPhil, UVM assistant professor of surgery and director of the Global Health Economics Unit of the Vermont Center for Clinical and Translational Science, and primary author Olivia J. Carpinello, MD, a UVM College of Medicine 2013 alumna. Co-investigators on the study also included reproductive medicine specialist Peter Casson, MD, a former UVM professor, and Renju Raj, MD, UVM instructor in obstetrics, gynecology and reproductive sciences and Women's Reproductive Health Research Scholar.
Cost Implications for Subsequent Perinatal Outcomes After IVF Stratified by Number of Embryos Transferred: A Five Year Analysis of Vermont Data.
Carpinello OJ1, Casson PR2, Kuo CL3, Raj RS2, Sills ES4,5, Jones CA6,7.
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