Management of the first in vitro fertilization cycle for unexplained infertility: a cost- effectiveness analysis of split in vitro fertilization-intracytoplasmic.

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Presentation transcript:

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, M.D., Omar Galárraga, Ph.D., Peter C. Klatsky, M.D., M.P.H., Jared C. Robins, M.D., Sandra A. Carson, M.D., Andrew S. Blazar, M.D. Fertility and Sterility Volume 100, Issue 5, Pages 1381-1388.e1 (November 2013) DOI: 10.1016/j.fertnstert.2013.06.035 Copyright © 2013 American Society for Reproductive Medicine Terms and Conditions

Figure 1 Simplified decision tree for fertilization (fert) method (all conventional IVF, split IVF-intracytoplasmic sperm injection [ICSI], all ICSI) for couples with unexplained infertility. Fertilization outcomes included adequate fertilization (fertilization rate, ≥20%), poor fertilization (fertilization rate, >0 and <20%), or failed fertilization. Split IVF-ICSI = oocytes randomly allocated to IVF or ICSI; FET = frozen ET. Fertility and Sterility 2013 100, 1381-1388.e1DOI: (10.1016/j.fertnstert.2013.06.035) Copyright © 2013 American Society for Reproductive Medicine Terms and Conditions

Figure 2 Simplified adaptive decision tree for fertilization (fert) method (all conventional IVF, split IVF-intracytoplasmic sperm injection [ICSI], all ICSI) for couples with unexplained infertility. Fertilization outcomes included adequate fertilization (fertilization rate, ≥20%), poor fertilization (fertilization rate, >0 and <20%), or failed fertilization. In the event of poor or failed fertilization with conventional IVF, all ICSI would be performed on all oocytes in the second cycle. If adequate fertilization with conventional IVF was observed, all conventional IVF would be performed in the second cycle. If failed fertilization occurred with conventional IVF and ICSI, donor insemination would be recommended in the second cycle. The symbol [x] designates a collapsed node. The outcomes for the second treatment cycles for the collapsed nodes are illustrated in the all IVF arm. Split IVF-ICSI = oocytes randomly allocated to IVF or ICSI; FET = frozen ET. Fertility and Sterility 2013 100, 1381-1388.e1DOI: (10.1016/j.fertnstert.2013.06.035) Copyright © 2013 American Society for Reproductive Medicine Terms and Conditions

Supplemental Figure 1 Sensitivity analysis. The figure shows the varied cost of IVF-intracytoplasmic sperm injection (ICSI) for two cycles in the x-axis and the net monetary benefit in the y-axis. The base cost of an IVF cycle is held constant, whereas the additional cost of ICSI is varied. The threshold point ($14,125.67) is shown. Fertility and Sterility 2013 100, 1381-1388.e1DOI: (10.1016/j.fertnstert.2013.06.035) Copyright © 2013 American Society for Reproductive Medicine Terms and Conditions