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Hum. Reprod. Advance Access published online on September 19, 2005
Human Reproduction, doi:10.1093/humrep/dei298
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© The Author 2005. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved.
Received May 28, 2005
Revised July 20, 2005
Accepted July 25, 2005

Article

Randomized single versus double embryo transfer: obstetric and paediatric outcome and a cost-effectiveness analysis

Ann Thurin Kjellberg 1, Per Carlsson 2, and Christina Bergh 1*

1 Reproductive Medicine, Department of Obstetrics and Gynaecology, Institute for Health of Women and Children, Sahlgrenska Academy, SU/S SE-413 45 Göteborg
2 Center for Medical Technology Assessment, Linköping University, SE-581 83 Linköping, Sweden

* To whom correspondence should be addressed.
Christina Bergh, E-mail: christina.bergh{at}vgregion.se


  Abstract

BACKGROUND: Transfer of several embryos after IVF results in a high multiple birth rate associated with increased morbidity and high costs for the neonatal care. In a previous randomized trial we demonstrated that a single embryo transfer (SET) strategy, including one fresh single embryo transfer and, if no live birth, one additional frozen-thawed SET, resulted in a live-birth rate that was not substantially lower than after double embryo transfer (DET) but markedly reduced the multiple birth rate. METHODS: We compared costs for maternal health care and productivity losses and paediatric costs for the SET and DET strategies. In addition, maternal and paediatric outcomes between the two groups were compared. RESULTS: The SET strategy resulted in lower average total costs from treatment until 6 months after delivery. There were a few more deliveries with at least one live-born child in the DET group. The incremental cost per extra delivery in the DET alternative was high, euro71 940. The rates of prematurely born and low birthweight children were significantly lower with the SET strategy. There were also markedly fewer maternal and paediatric complications in the SET group. CONCLUSIONS: The SET strategy is superior to the DET strategy, when number of deliveries with at least one live-born child, incremental cost-effectiveness ratio and maternal and paediatric complications are taken into consideration. The findings do not support continuing transfers of two embryos in this group of patients.

Keywords: cost-effectiveness/IVF/multiple births/randomized controlled trial/single embryo transfer.
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