Management of the First in Vitro Fertilization Cycle for Unexplained Infertility: A Cost-Effectiveness Analysis of Split in Vitro Fertilization-Intracytoplasmic Sperm Injection

Fertil Steril. 2013 Nov;100(5):1381-8. doi: 10.1016/j.fertnstert.2013.06.035. Epub 2013 Jul 19.


Objective: To determine the cost-effectiveness of split IVF-intracytoplasmic sperm injection (ICSI) for the treatment of couples with unexplained infertility.

Design: Adaptive decision model.

Setting: Academic infertility clinic.

Patient(s): A total of 154 couples undergoing a split IVF-ICSI cycle and a computer-simulated cohort of women <35 years old with unexplained infertility undergoing IVF.

Intervention(s): Modeling insemination method in the first IVF cycle as all IVF, split IVF-ICSI, or all ICSI, and adapting treatment based on fertilization outcomes.

Main outcome measure(s): Live birth rate, incremental cost-effectiveness ratio (ICER).

Result(s): In a single cycle, all IVF is preferred as the ICER of split IVF-ICSI or all ICSI ($58,766) does not justify the increased live birth rate (3%). If two cycles are needed, split IVF/ICSI is preferred as the increased cumulative live birth rate (3.3%) is gained at an ICER of $29,666.

Conclusion(s): In a single cycle, all IVF was preferred as the increased live birth rate with split IVF-ICSI and all ICSI was not justified by the increased cost per live birth. If two IVF cycles are needed, however, split IVF/ICSI becomes the preferred approach, as a result of the higher cumulative live birth rate compared with all IVF and the lesser cost per live birth compared with all ICSI.

Keywords: Cost-effectiveness; split IVF-ICSI; unexplained infertility.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Cost-Benefit Analysis
  • Decision Support Techniques
  • Decision Trees
  • Female
  • Fertility*
  • Fertilization in Vitro / economics*
  • Health Care Costs*
  • Humans
  • Infertility / economics*
  • Infertility / etiology
  • Infertility / physiopathology
  • Infertility / therapy*
  • Live Birth / economics
  • Male
  • Models, Economic
  • Patient Selection
  • Pregnancy
  • Pregnancy Rate
  • Sperm Injections, Intracytoplasmic / economics*
  • Treatment Outcome