Objective: To determine whether in vitro fertilization with preimplantation genetic screening (IVF/PGS) is cost effective compared with expectant management in achieving live birth for patients with unexplained recurrent pregnancy loss (RPL).
Design: Decision analytic model comparing costs and clinical outcomes.
Setting: Academic recurrent pregnancy loss programs.
Patient(s): Women with unexplained RPL.
Intervention(s): IVF/PGS with 24-chromosome screening and expectant management.
Main Outcomes Measure(s): Cost per live birth.
Result(s): The IVF/PGS strategy had a live-birth rate of 53% and a clinical miscarriage rate of 7%. Expectant management had a live-birth rate of 67% and clinical miscarriage rate of 24%. The IVF/PGS strategy was 100-fold more expensive, costing $45,300 per live birth compared with $418 per live birth with expectant management.
Conclusion(s): In this model, IVF/PGS was not a cost-effective strategy for increasing live birth. Furthermore, the live-birth rate with IVF/PGS needs to be 91% to be cost effective compared with expectant management.
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