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

Wendy S. Vitek, Omar Galárraga, Peter C. Klatsky, Jared C. Robins, Sandra A. Carson, Andrew S. Blazar

Research output: Contribution to journalArticle

20 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)1381-1388.e1
JournalFertility and Sterility
Volume100
Issue number5
DOIs
StatePublished - Nov 2013

Keywords

  • Cost-effectiveness
  • split IVF-ICSI
  • unexplained infertility

ASJC Scopus subject areas

  • Reproductive Medicine
  • Obstetrics and Gynecology

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