Abstract：
OBJECTIVE:We sought to examine the costs of transferring one through five embryos per in vitro fertilization cycle from each of three perspectives: society, the infertile couple, and the insurer. METHODS:Data from the 2003 Assisted Reproductive Technology Report was used to create Markov decision analytic models stratified by maternal age subgroup. We modeled both total costs, cost-effectiveness (cost per live birth), and clinical outcomes: multiple births, preterm deliveries, and cerebral palsy. RESULTS:From a societal and insurer perspective, it was least expensive to transfer one embryo. For women aged younger than 35 years, it cost society 80% more to transfer five rather than one embryo at a time (total cost 39,212 dollars compared with 21,661 dollars). For women aged older than 42 years, it cost 13% more (29,102 dollars compared with 25,723 dollars). From a parental perspective, it was least expensive to transfer between two and five embryos, depending on maternal age. One-embryo transfers markedly improved clinical outcomes. For example, two compared with one-embryo transfers for women aged younger than 35 years reduced preterm birth and cerebral palsy rates by 55% and 41%, respectively. Univariable sensitivity analysis and Monte Carlo simulation showed our results to be robust. CONCLUSION:Transferring one embryo per cycle is the least expensive strategy from a societal perspective, especially for younger women, yet it is the most expensive option from a parental perspective. To reduce in vitro fertilization-associated multiple birth rates, public policy must address these disparate financial incentives.
journal_name
Obstet Gynecoljournal_title
Obstetrics and gynecologyauthors
Little SE,Ratcliffe J,Caughey ABdoi
10.1097/01.AOG.0000230534.54078.b3subject
Has Abstractpub_date
2006-09-01 00:00:00pages
593-601issue
3 Pt 1eissn
0029-7844issn
1873-233Xpii
108/3/593journal_volume
108pub_type
杂志文章abstract：:Removal of both ovaries in the premenopausal patient is performed infrequently, but when it is, attention must be paid to hormone replacement. The benefits of hormone replacement include protection from osteoporosis, elimination of vasomotor symptoms, improvement in general well-being, and some decrease in the risk of...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章,评审
doi：
更新日期：1990-04-01 00:00:00
abstract：OBJECTIVE:To compare the perinatal outcomes of normotensive women with those of women with a history of chronic hypertension with normal blood pressures before 20 weeks of gestation, stratifying the latter by whether they were receiving antihypertensive medication. METHODS:We conducted a retrospective cohort study of ...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：10.1097/AOG.0000000000002574
更新日期：2018-05-01 00:00:00
abstract：BACKGROUND:Symptomatic vulvovaginal candidiasis is rare in postmenopausal subjects because of the estrogen-dependence of this infection. Tamoxifen, a breast-cancer cell estrogen-antagonist, has not previously been reported to predispose to vulvovaginal candidiasis. CASES:Three postmenopausal women, age range 60-81 yea...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：10.1016/0029-7844(96)00123-8
更新日期：1996-10-01 00:00:00
abstract：OBJECTIVE:To explore the outcome and long-term follow-up of fertility sparing surgery for cervical adenocarcinoma in situ and early invasive adenocarcinoma. METHODS:Between 1985 and 1996, all women with adenocarcinoma in situ (AIS) and stage I adenocarcinoma were identified. Data were abstracted from clinical records ...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：10.1016/s0029-7844(01)01544-7
更新日期：2001-11-01 00:00:00
abstract：OBJECTIVE:To assess the predictability and accuracy of a simplified approach--the cough stress test and single-channel cystometry--in the diagnosis of genuine stress incontinence (GSI) by comparing these tests to the more complex multichannel cough urethral pressure profile and urethrocystometry. Conversely, we assesse...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：
更新日期：1993-03-01 00:00:00
abstract：:This month, we focus on current research about intrauterine devices. Dr. Hurd discusses four recent publications, and each is concluded with a "bottom line" that is the take-home message. The complete reference for each can be found in on this page, along with direct links to the abstracts. ...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：10.1097/AOG.0b013e3182a6ad9f
更新日期：2013-10-01 00:00:00
abstract：:The effects of a controlled sodium bicarbonate (SB) infusion on the acid-base balance of the primiparous mother and fetus at labor and delivery were evaluated. Two identical groups of primiparas with normal labor and delivery were studied. According to acid-base parameters observed in the mothers and fetuses of a cont...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：
更新日期：1979-11-01 00:00:00
abstract：OBJECTIVE:To investigate vascular reactivity in women's cerebral arteries from reproductive age to postmenopause. METHODS:The pulsatility index (PI) was measured cross-sectionally in the internal carotid and middle cerebral arteries of 120 women, using a Doppler ultrasound system. Fifteen women were enrolled in each o...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：10.1016/0029-7844(96)00119-6
更新日期：1996-07-01 00:00:00
abstract：:This month we focus on current research in recurrent pregnancy loss. Dr. Ros discusses four recent publications, which are concluded with a "bottom-line" that is the take-home message. A complete reference for each can be found on on this page along with direct links to abstracts. ...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：10.1097/AOG.0000000000003337
更新日期：2019-07-01 00:00:00
abstract：:The aortic diameters of 89 normotensive pregnant women were compared with those of nine rigorously defined preeclamptic women and 59 women who required antihypertensive therapy. Over the course of normal pregnancy, the diameter increased significantly; it was larger in preeclamptic than in normotensive women throughou...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：
更新日期：1991-12-01 00:00:00
abstract：:Management of the post-term pregnancy depends on the certainty of dating, likelihood of successful induction, and risks of expectant management. To estimate the risk of fetal death in an expectantly managed post-term population, we reviewed 8038 consecutive post-term gestations followed expectantly with a twice-weekly...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章,评审
doi：
更新日期：1992-06-01 00:00:00
abstract：:A woman in her 34th week of gestation required emergency appendectomy for perforation, with postoperative wound dehiscence secondary to fasciitis and tension on the suture line. Polypropylene mesh was used to repair the abdominal wall. Fetal distress necessitated a cesarean section. The mother and child both survived ...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：
更新日期：1985-07-01 00:00:00
abstract：OBJECTIVE:To ascertain whether the TDx-FLM assay is a better predictor of neonatal respiratory distress syndrome (RDS) than the lecithin-sphingomyelin ratio (L/S) and phosphatidylglycerol (PG). METHODS:Amniotic fluid samples of 140 women requiring assessment of fetal lung maturity and delivering within 72 hours of amn...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：
更新日期：1993-12-01 00:00:00
abstract：:One hundred thirty-one nulliparous patients between 28 to 34 weeks' gestation with no known history of renal disease or hypertension were placed in the left lateral recumbent position and their blood pressures were taken once and recorded. They then turned to the supine position where another blood pressure was taken ...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：
更新日期：1977-11-01 00:00:00
abstract：:Two U.S. Food and Drug Administration public health warnings regarding the use of mesh in stress incontinence and prolapse repairs have had far-reaching clinical and legal consequences. In this commentary, we explore the drastically distinct results from these mesh-based procedures, which revealed systemic flaws with ...
journal_title：Obstetrics and gynecology
pub_type： 社论
doi：10.1097/AOG.0000000000002776
更新日期：2018-09-01 00:00:00
abstract：:Several reports of pregnancy and sepsis associated with an intrauterine device have been reported. A case of a CU-7 in utero with sepsis due to Escherichia coli in a 10-12 week gestation is presented. ...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：
更新日期：1976-07-01 00:00:00
abstract：OBJECTIVE:Among all women with pelvic inflammatory disease (PID), prevention of adverse reproductive consequences appears to be similarly achieved by outpatient treatment and inpatient treatment. We assessed whether outpatient is as effective as inpatient treatment in relevant age, race, and clinical subgroups of women...
journal_title：Obstetrics and gynecology
pub_type： 临床试验,杂志文章,多中心研究,随机对照试验
doi：10.1097/01.AOG.0000175193.37531.6e
更新日期：2005-09-01 00:00:00
abstract：:Twenty-three patients undergoing second-trimester amniocentesis were ultrasonically monitored for 30 minutes before and 30 minutes after the amniocentesis. Fetal movements were recorded as movements of limbs, trunk, or combined limb-trunk movements. Fetal heart rates were determined at ten-minute intervals before and ...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：
更新日期：1986-03-01 00:00:00
abstract：BACKGROUND:Goodpasture syndrome, an immunologic disorder characterized by glomerulonephritis and pulmonary hemorrhage, rarely presents in pregnancy. CASE:We describe a patient who was diagnosed with Goodpasture syndrome in her second trimester. She required daily hemodialysis, intermittent plasmapheresis, and immunosu...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：10.1097/01.AOG.0000161061.35611.98
更新日期：2005-11-01 00:00:00
abstract：:Four cases of fetal puncture during midtrimester amniocentesis are reported; in one instance the baby apparently sustained temporary neurologic damage. None of the lesions was detected at the initial neonatal examination. From our data and a review of the literature, we estimate that fetal puncture occurs in 1-3% of m...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：
更新日期：1977-01-01 00:00:00
abstract：:The systolic/end-diastolic ratio (S/D) and pulsatility and resistance indices were calculated before and after diagnostic cordocentesis in 46 fetuses, after 19 intravascular transfusions in eight fetuses, and on two occasions 45 minutes apart in eight controls. The fetus was paralyzed with pancuronium (0.3 mg/kg sonog...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：
更新日期：1989-02-01 00:00:00
abstract：:Middle cerebral artery infarction explains some cases of congenital hemiparesis with or without neonatal stroke. The etiology of the stroke is often obscure. We describe two infants with imaging evidence of middle cerebral artery infarction whose mothers had elevated anticardiolipin antibody levels after delivery. We ...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：
更新日期：1992-09-01 00:00:00
abstract：BACKGROUND:Bernard-Soulier syndrome, a lack of glycoprotein IB/IX, is a rare autosomal recessive bleeding disorder characterized by platelet dysfunction. Women with Bernard-Soulier syndrome are at risk of being immunized against glycoprotein IB/IX, leading to severe isoimmune neonatal thrombocytopenia. CASE:A 26-year-...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：10.1016/s0029-7844(99)00253-7
更新日期：1999-11-01 00:00:00
abstract：:A 64-year-old woman with a 45,X karyotype and Turner's syndrome and recent onset of right lower quadrant pain was found to have a mucinous cystadenoma with focal areas of borderline malignancy and a typical Brenner tumor in the right adnexa. Ovarian tumors in patients with a 45,X karyotype and Turner's syndrome are ex...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：
更新日期：1979-11-01 00:00:00
abstract：OBJECTIVE:Emerging data suggest that oophorectomy at the time of hysterectomy for benign indications may increase long-term morbidity and mortality. We performed a population-based analysis to estimate the rates of oophorectomy in women undergoing hysterectomy for benign indications. METHODS:The Perspective database w...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：10.1097/AOG.0b013e3182887a47
更新日期：2013-04-01 00:00:00
abstract：:Approximately 0.5% of all births occur before the third trimester of pregnancy, and these very early deliveries result in the majority of neonatal deaths and more than 40% of infant deaths. A recent executive summary of proceedings from a joint workshop defined periviable birth as delivery occurring from 20 0/7 weeks ...
journal_title：Obstetrics and gynecology
pub_type： 共识发展会议,杂志文章
doi：10.1097/AOG.0000000000001483
更新日期：2016-06-01 00:00:00
abstract：:Single-incision laparoscopy is a minimally invasive technique that decreases the number of operative sites used in traditional laparoscopic surgery to one skin incision, with the potential advantages of improving cosmesis and decreasing postoperative pain. There are limited data to demonstrate the safety and feasibili...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：10.1097/01.AOG.0000433009.93971.23
更新日期：2013-08-01 00:00:00
abstract：OBJECTIVE:The objective of this study was to evaluate the value of neural network-directed review of smears determined to contain atypical squamous (glandular) cells of undetermined significance to identify those cases most likely to be associated with cervical intraepithelial neoplasia. METHODS:One hundred sixty smea...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：10.1016/s0029-7844(98)00017-9
更新日期：1998-04-01 00:00:00
abstract：OBJECTIVE:To compare station and cervical dilation at the time of epidural placement for predicting cesarean delivery risk. METHODS:This prospective cohort study included 275 women in labor with live, singleton fetuses at term in vertex presentations. We excluded women with preeclampsia or previous cesarean deliveries...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：10.1016/s0029-7844(98)00370-6
更新日期：1999-02-01 00:00:00
abstract：OBJECTIVE:To assess the diagnostic value of alternative (digital) colposcopy techniques for detection of cervical intraepithelial neoplasia (CIN) 2 or worse in a colposcopy population. DATA SOURCES:MEDLINE, EMBASE, ClinicalTrials.gov, and the Cochrane Library were searched from inception up to January 11, 2016, for st...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章,meta分析,评审
doi：10.1097/AOG.0000000000001613
更新日期：2016-10-01 00:00:00
