Outcomes and cost analysis of single-embryo transfer versus double-embryo transfer

Area of Science:

• Reproductive Medicine
• In Vitro Fertilization (IVF)
• Health Economics

Background:

• Previous studies indicated single-embryo transfer (SET) had lower live birth rates than double-embryo transfer (DET) with cleavage stage embryos.
• Single blastocyst transfer demonstrated improved live birth rates compared to SET at the cleavage stage.

Purpose of the Study:

• To compare live birth rates and costs of elective single-embryo transfer (eSET) versus double-embryo transfer (DET).
• To determine the incremental cost-effectiveness ratio of eSET versus DET in an unselected patient population.

Main Methods:

• Retrospective analysis of 4232 women undergoing their first fresh IVF/intracytoplasmic sperm injection cycles (2010-2017).
• Comparison of outcomes between 564 women undergoing eSET and 3668 women undergoing DET.
• Inclusion of data from sequential thaw single-embryo transfer cycles for women who did not achieve live birth in their initial eSET cycle.

Main Results:

• eSET demonstrated a significantly higher live birth rate (41.3%) compared to DET (32.6%).
• Cumulative live birth rate for sequential eSET (fresh + thaw) was 47.9%.
• eSET resulted in cost savings of S$20,172 per live birth compared to DET, reducing to S$1476 with sequential transfers.

Conclusions:

• Elective single-embryo transfer is a dominant and cost-effective strategy in unselected populations undergoing assisted reproductive treatments.
• Adopting eSET can lead to significant cost savings without negatively impacting live birth rates.