A real-life prospective health economic study of elective single embryo transfer versus two-embryo transfer in first IVF/ICSI cycles

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Abstract
BACKGROUND: We analysed the difference in maternal, neonatal and total costs after single (SET) versus double day 3 embryo transfer (DET). METHODS: We performed a two‐centre prospective study of women in their first IVF/ICSI cycle choosing between SET or DET. Infertility treatment data were gathered from a database; maternal and neonatal outcome data from a case report form (CRF); health economic data from medical acts registered in the CRF for the outpatient part and from hospital bills. SET was performed in 206/367 (56.1%) and DET in 161/367 (43.9%) women. RESULTS: In all, 367 transfers yielded 186 positive pregnancy tests, 148 ongoing pregnancies and 136 live deliveries (50.7, 40.3 and 37.1% per embryo transfer) of which 15 (11.0%) were twins. Live birth rate was 37.4% for SET, 36.6% for DET. Intention‐to‐treat analysis showed differences for: duration of pregnancy (SET: 39.0 ± 1.4 versus DET: 38.3 ± 2.2 weeks; P = 0.055), percentage prematurity (8.5 versus 23.8%; P = 0.033), percentage of neonates hospitalized (5.7 versus 17.9%; P = 0.121) and duration of neonatal hospitalization (6.3 ± 2.2 versus 10.3 ± 10.1 days; P = 0.01). Total cost after DET was higher (SET: €4700 ± 3239 versus DET: €8613 ± 10 105; P = 0.105), due to significantly higher neonatal costs (€451 ± 957 versus €3453 ± 8154; P < 0.001) and not to differences in maternal costs (€4250 ± 2882 versus €5160 ± 4106; P = 0.152). CONCLUSIONS: This prospective health economic study shows that transfer of a single top quality embryo is equally effective as, but substantially cheaper than, double embryo transfer in women <38 years of age in their first IVF/ICSI cycle.

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