The combined effect of age and basal follicle-stimulating hormone on the cost of a live birth at assisted reproductive technology

Mansour

et al. 2010

Section: Discussionmentioning

confidence: 99%

Analysis of 2,386 consecutive cycles of in vitro fertilization or intracytoplasmic sperm injection using autologous oocytes in women aged 40 years and above

Mansour

et al. 2010

“…Some ART clinics have chosen to abandon any screening and proceed to stimulate all candidates using a 'proof-in-the-pudding' type of logic (16). Of course, this practice leads to high cancellation rates, or oocyte retrieval for patients for whom live birth rates are expected to less than 5%, at great cost to patients (31). Therefore, a more cost-effective approach is certainly warranted.…”

Section: A Solution To the Problem Of Ovarian Insufficiency Screeningmentioning

confidence: 99%

“…There are significant consequences associated with the diagnosis, such as reduction in pregnancy rate, increased miscarriage rate (6)(7)(8)(9)(10)(11)34), and increased cost per delivery (31,(35)(36)(37).…”

Section: Should Screening Tests For Ovarian Insufficiency Be Abandoned?mentioning

confidence: 99%

“…The increase in cost due to impaired ovarian reserve was illustrated in a study of 1238 first IVF cycles at Walter Reed Army Medical Center from January 1 st , 1999 to December 31 st , 2003 (31). In another study (37), calculations were based on cycle start to account for the actual cancellation rates in each age group and to give a more accurate estimate of the impact of ovarian insufficiency and spontaneous abortion rates on live birth.…”

Section: Should Screening Tests For Ovarian Insufficiency Be Abandoned?mentioning

confidence: 99%

See 1 more Smart Citation

A new approach to ovarian reserve testing

Sun

Stegmann

Henne

et al. 2008

Self Cite

Objective-To critically examine ovarian reserve testing prior to assisted reproduction. Design-A PUBMED computer search to identify relevant literature. Setting-Multiple sites Interventions-Testing for ovarian reserve Main Outcome Measures-IVF and pregnancy outcomesResult(s)-The prevalence of ovarian insufficiency varies significantly for women aged 30-45 years. Generalization or averaging of threshold values across different aged women leads to very poor sensitivity, specificity, and positive predictive value for all tests of ovarian reserve. Because of the changing prevalence of ovarian insufficiency, there is no single, suitable threshold value for any screening test of ovarian reserve. Our analysis supports dividing impaired ovarian reserve into two groups: age-dependent ovarian aging (physiologic) and premature (non-physiologic) reductions in the oocyte pool. Interpretation of any screening test used requires that age is considered as a variable. To guide clinical interpretation of test results, we suggest using a nomogram of FSH values versus expected delivery rate-per-cycle-start with ART for a given age. Conclusions(s)-Proper interpretation of screening tests for ovarian insufficiency in couplesconsidering ART is important since the presence of impaired ovarian reserve is associated with a low likelihood of pregnancy. The condition of premature (non-physiologic) ovarian insufficiency warrants additional research. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. More than 100 years ago, population studies clearly documented a decrease in fertility with increasing age (1). In today's culture of widely available birth control and workforce equality, women often delay child-bearing to pursue a career. As a result, the childbearing age for women has been delayed from the 20's to the 30's and even into the early 40s (2). This societal shift has resulted in an increase in the number of women who are interested in fertility and have regular cycles, but who are subfertile due to a reduction in their oocyte (egg) supply. Recognition of the profound adverse effect of a reduction in oocyte supply on fertility led to the concept of ovarian reserve and the moniker of 'Diminished Ovarian Reserve' (DOR (5,13,14). NIH Public AccessThe pathophysiology associated with the age-related reduction in fertility (1) is a reduction in the oocyte pool accompanied by an increase in FSH due to reduced feedback from estrogen and inhibins (15). There are also reduced levels of hormones such as anti-Mullerian hormone (AMH) (16). Theoretically, in some women the reduction in the oocyte po...

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“…Although studies have examined the cost of IVF in the United States (2–4), including the influence of state-mandated insurance coverage on utilization (5, 6) as well as the impact of age and/or basal FSH levels (7, 8), to the best of our knowledge the only qualitative research addressing IVF patients’ attitudes toward costs and insurance has been in the United Kingdom. Peddie et al (9) performed semistructured interviews with 25 women who had decided to end treatment after unsuccessful IVF treatment, and Redshaw et al (10) analyzed the open-ended written responses to a mailed questionnaire of 108 women who had conceived after IVF.…”

mentioning

confidence: 99%

Expensive but worth it: older parents’ attitudes and opinions about the costs and insurance coverage for in vitro fertilization

Nachtigall

MacDougall

Davis

et al. 2012