Can affordability and access to care be enhanced by minimal stimulation IVF (MS-IVF) and single embryo transfer (SET)?

Abstract

To analyze cumulative live birth/ongoing pregnancy rates and potential cost savings associated with MS-IVF and single embryo transfer (SET) in good prognosis patients. A retrospective analysis comparing outcomes and costs of MS-IVF and traditional IVF in good prognosis patients. 137 good prognosis patients (defined as age <35, AMH>2.4, AFC>10, BMI <35, with diagnoses of PCOS, stage I-II endometriosis, tubal factor, and/or mild to moderate male factor) underwent MS-IVF or traditional IVF based on patient/physician preferences. FSH/low dose hcg/antagonist protocols were utilized. MS-IVF included 5 days of clomiphene 100mg prior to initiation of 150u FSH. Traditional IVF cycles had a mean starting FSH of 244u FSH. Cycle outcomes and cost analyses of the two groups included all fresh and frozen transfers. The two groups were comparable in age, basal FSH, BMI, and mean embryos transferred, with SET in all but one fresh transfer and all but one frozen transfer. The MS-IVF group was more likely to have a fresh transfer, contributing to cost reduction. 5 MS-IVF cycles were canceled due to low response; this was not statistically significant. There were significant differences in mean total gonadotropins, oocytes retrieved, blastocysts formed, and fresh transfers. SET was utilized to decrease multiple pregnancies while resulting in delivered, ongoing, and cumulative pregnancies higher than U.S. averages (SART 2014). Ongoing fresh, FET, and cumulative pregnancy rates achieved from one stimulation cycle were not statistically different between the two groups. Overall costs were 27% less in the MS-IVF group, while a 24% cost reduction was found on a per live birth/ongoing pregnancy basis. Greater affordability should result in enhanced access to IVF care by offering lower cost MS-IVF to good prognosis patients without sacrificing success. SET can dramatically reduce downstream costs associated with multiple gestation. We propose that MS-IVF combined with SET could be an appealing aspect of fertility benefits for employers and insurers who desire greater subscriber access to affordable IVF care.Tabled 1MS-IVF and Traditional IVF Outcome and Cost ComparisonMS-IVFTraditional IVFp ValueNumber of Stimulation Cycles8354Mean Total FSH Dose (IU's)12092168p<0.01Mean Total Oocytes15.724.1p<0.01Mean Blastocysts7.511.7p<0.01Fresh Transfers/Retrieval53/78 (68%)25/54 (45%)p<0.04Ongoing Pregnancies/Fresh transfer - N (%)33/53 (62%)17/25 (68%)NSOngoing Pregnancies/Frozen Transfer - N (%)28/45 (62%)29/44 (66%)NSOngoing Cumulative Pregnancies/Stimulation Cycle - N (%)61/83 (73%)46/54 (85%)NSMean Number of Transfers to Ongoing Pregnancy1.21.3NSMean Cycle Cost/Stimulation Cycle$14,088.80$19,345.54p<0.01Mean Cost/Live Birth or Ongoing Pregnancy$15,265.91$20,131.72p<0.01 Open table in a new tab