Abstract
BackgroundPregnancies induced by in vitro fertilisation (IVF) often result in twin gestations, which are associated with both maternal and perinatal complications. An effective way to reduce the number of IVF twin pregnancies is to decrease the number of embryos transferred from two to one. The interpretation of current studies is limited because they used live birth as outcome measure and because they applied limited time horizons. So far, research on long-term outcomes of IVF twins and singletons is scarce and inconclusive. The objective of this study is to investigate the short (1-year) and long-term (5 and 18-year) costs and health outcomes of IVF singleton and twin children and to consider these in estimating the cost-effectiveness of single embryo transfer compared with double embryo transfer, from a societal and a healthcare perspective.Methods/DesignA multi-centre cohort study will be performed, in which IVF singletons and IVF twin children born between 2003 and 2005 of whom parents received IVF treatment in one of the five participating Dutch IVF centres, will be compared. Data collection will focus on children at risk of health problems and children in whom health problems actually occurred. First year of life data will be collected in approximately 1,278 children (619 singletons and 659 twin children). Data up to the fifth year of life will be collected in approximately 488 children (200 singletons and 288 twin children). Outcome measures are health status, health-related quality of life and costs. Data will be obtained from hospital information systems, a parent questionnaire and existing registries. Furthermore, a prognostic model will be developed that reflects the short and long-term costs and health outcomes of IVF singleton and twin children. This model will be linked to a Markov model of the short-term cost-effectiveness of single embryo transfer strategies versus double embryo transfer strategies to enable the calculation of the long-term cost-effectiveness.DiscussionThis is, to our knowledge, the first study that investigates the long-term costs and health outcomes of IVF singleton and twin children and the long-term cost-effectiveness of single embryo transfer strategies versus double embryo transfer strategies.
Highlights
Pregnancies induced by in vitro fertilisation (IVF) often result in twin gestations, which are associated with both maternal and perinatal complications
To support the general believe that twin pregnancies are a complication of IVF and to make an evidence-based decision on the preferred embryo transfer strategy in IVF, both long-term costs and health outcomes of twins and singletons need to be estimated
Objective and research questions The objective of the TwinSing study is to investigate the short (1-year) and long-term (5 and 18-year) costs, health outcomes and health-related quality of life (HRQoL) of twins and singletons born from IVF
Summary
In the Netherlands, about 16,000 IVF treatments are performed every year [1]. As a result, approximately 2.3% of all Dutch children are born from a pregnancy established by in vitro fertilization (IVF) [2]. To support the general believe that twin pregnancies are a complication of IVF and to make an evidence-based decision on the preferred embryo transfer strategy in IVF, both long-term costs and health outcomes of twins and singletons need to be estimated. Objective and research questions The objective of the TwinSing study is to investigate the short (1-year) and long-term (5 and 18-year) costs, health outcomes and HRQoL of twins and singletons born from IVF. These results will be linked to a Markov model in which seven embryo transfer strategies are compared [32], to enable estimation of the long-term cost-effectiveness of SET strategies versus DET strategies. What is the value of additional information through research to reduce decision uncertainty?
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