LOGIN TO YOUR ACCOUNT

Username
Password
Remember Me
Or use your Academic/Social account:

CREATE AN ACCOUNT

Or use your Academic/Social account:

Congratulations!

You have just completed your registration at OpenAire.

Before you can login to the site, you will need to activate your account. An e-mail will be sent to you with the proper instructions.

Important!

Please note that this site is currently undergoing Beta testing.
Any new content you create is not guaranteed to be present to the final version of the site upon release.

Thank you for your patience,
OpenAire Dev Team.

Close This Message

CREATE AN ACCOUNT

Name:
Username:
Password:
Verify Password:
E-mail:
Verify E-mail:
*All Fields Are Required.
Please Verify You Are Human:
fbtwitterlinkedinvimeoflicker grey 14rssslideshare1
Sills, E. Scott
Languages: English
Types: Doctoral thesis
Subjects: UOW2
Common to other practice settings, standard in vitro fertilisation (IVF) in California\ud strongly skews the multiple gestation/preterm birth rate upward to approximately 50% of\ud all deliveries, while unassisted conceptions yield this outcome in only 3% of births.\ud Preterm/multiple gestation babies from IVF are “super-utilisers” and consume a\ud disproportionate share of healthcare resources, particularly during the first year of life.\ud However, early experience with molecular cytogenetic techniques has shown that single\ud embryo transfer (SET) with IVF can now lift pregnancy rates to an acceptable level\ud while not altering the normal multiple gestation rate. This approach would effectively\ud solve the preterm and multiple gestation problem historically associated with IVF.\ud Building on the author’s previous research in medically assisted reproduction, the\ud current proposal describes a new public health policy to incentivise SET by modifying\ud the California Insurance Code (benchmark health plan), when it may next be revised in\ud 2015. The proposal would partially cover IVF costs for qualified California residents\ud with the proviso that only one embryo is transferred per procedure after comprehensive\ud chromosomal screening of embryos with array comparative genomic hybridisation\ud (aCGH). This investigation considers the interconnected problems of preterm birth and\ud multiple gestation in a demographic context, showing that although the contribution\ud made by conventional IVF to these adverse outcomes in California is numerically minor,\ud substantial costs can still be recovered by redirecting expenditures away from high-risk\ud IVF deliveries when the increased multiple gestation/preterm birth rate from standard\ud IVF is corrected.\ud This analysis is the first to examine costs calculated for all delivery types in California as\ud a function of antecedent IVF treatment vs. unassisted conception, based on 2009 birth\ud records, and apply this to a new model of comprehensive embryo testing and mandatory\ud SET. These data reveal that even if partially subsidised IVF with aCGH and SET were\ud provided for every California IVF cycle initiated in 2009 (n=18,405), the state would\ud still realise a net surplus of at least $20M per year by stabilising the IVF multiple birth\ud rate at ~3.2%. Thus, California can avoid up to 4,810 iatrogenic preterm/multiple\ud gestation births by shifting the prevailing approach to IVF away from multiple embryo\ud transfers. The proposal is net revenue positive for California because although IVF with\ud aCGH and SET is expensive, the price to obtain this technology is always lower than the\ud cost for one high-risk preterm/multiple birth. While a compelling primary interest exists\ud to lower the multiple birth rate with IVF, this proposal also yields a socially valuable\ud secondary public health benefit by improving general access to this advanced\ud reproductive treatment for all Californians.
  • The results below are discovered through our pilot algorithms. Let us know how we are doing!

    • 16. Sills ES, Collins GS, Brady AC, Walsh DJ, Marron KD, Peck AC, Walsh AP, Salem RD. Bivariate analysis of basal serum anti-Müllerian hormone measurements and human blastocyst development after IVF. Reprod Biol Endocrinol 2011 Dec 2;9:153. PMID: 22136508
    • 17. Sills ES, Collins GS, Salem SA, Jones CA, Peck AC, Salem RD. Balancing selected medication costs with total number of daily injections: a preference analysis of GnRH-agonist and antagonist protocols by IVF patients. Reprod Biol Endocrinol 2012 Aug 30;10:67. PMID: 22935199
    • 18. Sills ES, Yang Z, Walsh DJ, Salem SA. Comprehensive genetic assessment of the human embryo: can empiric application of microarray comparative genomic hybridization reduce multiple gestation rate by single fresh blastocyst transfer? Arch Gynecol Obstet 2012 Sep;286(3):755-61. PMID: 22678560
  • No related research data.
  • No similar publications.

Share - Bookmark

Download from

Cite this article