What if...

• What if IVF was available and accessible and cheap for all of those who needed it?
  
• What if we could reduce the rates of stillbirth and premature birth in IVF patients?
  
• What if we could achieve both of these goals and decrease the burden on the healthcare system?

What if IVF didn't cost US$12,000 per attempt? What if it was available to all patients in need, without needing to sacrifice a chunk of their wealth to gamble on a few blastocysts?

In many countries, double embryo transfer is routinely performed to increase the success rate and to decrease the financial impact on patients. Around one third of double embryo transfers result in twins and higher order multiples.

However, the burden of multiples is great - on the babies, the mother's body, their parents, and the health care system. It seems unfair that a woman who spends so much emotional and material wealth on achieving a pregnancy should have to face higher rates of misfortune compared to a fertile woman.

In Belgium, the cost to the healthcare system for each singleton up to three months old is 3,400 euro. The cost to the healthcare system for each twin child up to the age of three months is 13,000 euro.

The cost to the Belgian healthcare system for a single IVF/ICSI cycle is 2,426 euro.

In European countries such as Finland, Sweden, Norway, and Belgium, IVF is available to all patients under the universal health care scheme. However, in women under 36 in their first or second IVF attempt, only a single embryo may be transferred. The mean pregnancy rate after single embryo transfer is now around 34% with 1% twins, compared to 35% with double embryo transfer with 33% multiple pregnancies.

This permits the Belgian healthcare system to offer six IVF cycles (technically six oocyte retrievals) to every woman who needs it, reduce the rates of pregnancy complications, and reduce the overall healthcare budget.

It is not only compassionate to offer IVF to all patients in need, it is also financially prudent. What if all countries could recognise this?

Gerris J, De Sutter P, De Neubourg D, Van Royen E, Vander Elst J, Mangelschots K, Vercruyssen M, Kok P, Elseviers M, Annemans L, Pauwels P, Dhont M. A real-life prospective health economic study of elective single embryo transfer versus two-embryo transfer in first IVF/ICSI cycles. Hum Reprod. 2004 Apr;19(4):917-23.

Gerris JM. Hum Reprod Update. 2005 Mar-Apr;11(2):105-21. Epub 2004 Oct 28.
Single embryo transfer and IVF/ICSI outcome: a balanced appraisal.
Hum Reprod Update. 2005 Mar-Apr;11(2):105-21.

This post is part of Mel's Project IF, supported by RESOLVE for National Infertility Awareness Week.