The Case for Single-Embryo Transfers

The latest evidence supporting single-embryo transfer comes in with the unsurprising finding that hospital costs are significantly higher in multiple-birth infants than for singletons.

Reporting in JAMA Pediatrics, researchers from Australia described the stark economic and clinical burden of the unprecedented increase in multiple births that has occurred during the past 3 decades. Hospital costs skyrocket and complication rates are raised when multiple birth infants are compared with their singleton counterparts.

The evidence should support a change in how insurers cover IVF services, argues Pooja Mehta, MD, and Mark Pauly, PhD, of the University of Pennsylvania in an accompanying editorial.

"In light of studies that have shown that patients in settings with no mandated insurance coverage of IVF services make very different decisions regarding embryo transfer, we must recognize the dangerous and potentially discriminatory ways in which even educated reproductive decision making seems to be constrained by a restrictive coverage environment,” they wrote.

The Australian study, which involved 233,850 infants born during a 10-year period, documented greater morbidity and mortality with multiple births. Those findings were reflected in substantially higher inpatient hospital costs during infancy as well as the first year of life. Later in life, inpatient hospital costs seemed to equalize between multiples and singletons, the authors reported.

Of the births studied, 1% of the singletons, 15.4% of twins, and 34.7% of higher-order multiples were conceived using assisted reproductive technology. Stillbirths, preterm birth, and being born small for gestational age, were all more likely among multiples than among singletons.

And hospital costs reflected those odds when researchers calculated the total costs for a child to the age of 5. The average hospital cost for singletons was $2,730; in comparison, the average hospital cost for twins was $8,993 and for higher-order multiples was $24,411.