Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore.
Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore.
Womens Health (Lond). 2023 Jan-Dec;19:17455057231206312. doi: 10.1177/17455057231206312.
Studies had compared single-embryo transfer to double-embryo transfer with cleavage stage embryos and found that while single-embryo transfer was less costly, it was also associated with a lower live birth rate than double-embryo transfer. A single blastocyst transfer has been shown to improve the live birth rate per cycle compared to single-embryo transfer at cleavage stage.
To compare live birth rates and real costs of elective single-embryo transfer to double-embryo transfer and to determine the incremental cost-effectiveness ratio of these two strategies in an unselected pool of women in a single center.
Retrospective study.
We analyzed data of 4232 women who underwent their first fresh in vitro fertilization/intra-cytoplasmic sperm injection cycles with at least two embryos available for transfer in KK Women's and Children's Hospital from 2010 to 2017.
Five hundred and sixty-four women underwent elective single-embryo transfer and 3668 women underwent double-embryo transfer. One hundred and fifty-six women who failed to achieve a live birth in their fresh elective single-embryo transfer cycle underwent a sequential thaw single-embryo transfer cycle. Live birth rate of fresh elective single-embryo transfer was significantly higher at 41.3% than that of double-embryo transfer at 32.6%. Cumulative live birth rate for sequential elective single-embryo transfer (fresh elective single-embryo transfer + thaw single-embryo transfer) was 47.9%. After accounting for variables which may affect live birth rates such as age and stage of embryo transfer, the odds of achieving a live birth from double-embryo transfer was 24% lower than that from sequential single-embryo transfer, although not statistically significant. For every live birth gained from an elective single-embryo transfer compared to double-embryo transfer, cost savings were S$20,172 per woman. If a woman had to have a sequential single-embryo transfer after a failed single-embryo transfer in her fresh cycle, cost savings were reduced to S$1476 per woman.
Single-embryo transfer is a dominant strategy in an unselected population and adopting it in assisted reproductive treatments (ART) can produce cost savings without compromising on live birth rates.
研究比较了卵裂期胚胎的单胚胎移植和双胚胎移植，发现单胚胎移植虽然成本较低，但活产率也低于双胚胎移植。与卵裂期的单胚胎移植相比，单个囊胚移植已被证明可以提高每个周期的活产率。
比较选择性单胚胎移植与双胚胎移植的活产率和实际成本，并确定在单中心未选择的女性人群中这两种策略的增量成本效益比。
回顾性研究。
我们分析了 2010 年至 2017 年在 KK 妇女儿童医院接受首次新鲜体外受精/胞浆内精子注射周期且至少有两个胚胎可供移植的 4232 名女性的数据。
564 名女性接受了选择性单胚胎移植，3668 名女性接受了双胚胎移植。156 名在新鲜选择性单胚胎移植周期未实现活产的女性接受了序贯解冻单胚胎移植周期。新鲜选择性单胚胎移植的活产率为 41.3%，明显高于双胚胎移植的 32.6%。序贯选择性单胚胎移植（新鲜选择性单胚胎移植+解冻单胚胎移植）的累积活产率为 47.9%。在考虑了可能影响活产率的变量（如年龄和胚胎移植阶段）后，双胚胎移植获得活产的几率比序贯单胚胎移植低 24%，尽管这没有统计学意义。与双胚胎移植相比，每获得一次单胚胎移植的活产，每位女性可节省 20172 新元。如果女性在新鲜周期的单胚胎移植失败后需要进行序贯单胚胎移植，每位女性的节省费用将减少至 1476 新元。
在未选择的人群中单胚胎移植是一种优势策略，在辅助生殖治疗（ART）中采用它可以在不影响活产率的情况下节省成本。
