Preimplantation genetic screening in married couples with pathozoospermia in men: Cost-effectiveness analysis


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Abstract

Background. Different disorders of spermatogenesis in men are associated with elevated levels of sperm chromosome aneuploidy and, as a consequence, with increased risk of embryonic aneuploidy. Objective. To compare the clinical and economic efficiency of in vitro fertilization (IVF) followed by prenatal genetic diagnosis and that of IVF with preimplantation genetic screening (IVF/PGS) by the fluorescence in situ hybridization (FISH) method to avoid the birth of babies with aneuploidies in the couples with different types of pathozoospermia in men. Design. Comparison of IVF and IVF/PGS by the FISH method to search for the least cost-based and maximally effective (birth of a healthy = euploid child) procedure was done by a decision-making analysis. Subject. Childless couples with pathozoospermia: teratozoospermia, asthenozoospermia, and/or oligozoospermia in men. Methods. IVF or IVF/PGS by the FISH method. Primary endpoint: the cost of the birth of a healthy (euploid) neonatal infant. Results. The use of a model for rating costs and probabilities in the childless couples with pathozoospermia in men showed that the likelihood of the birth of a euploid baby was 28.5 and 31.4% when infertility was treated with IVF and IVF/PGS (FISH), respectively. The average treatment costs were 129,742.86 and 186,990.26 rbl, respectively. The incremental cost-effectiveness ratio of IVF and IVF/PGS was 20,123.62 rbl. Unlike the general population of the childless couples, in whom the cost of treatment with IVF and IVF/PGS, as calculated with reference to the birth of a healthy child, differed by 63%, that in the couples with pathozoospermia in men was only 23%. Conclusion. IVF is a more clinically and economically reasonable treatment for infertility in the general population of childless couples than IVF/PGS. In the couples with pathozoospermia in men, the latter using the FISH method may be clinically and economically reasonable if the cost of PGS is lowered.

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About the authors

Nataliya Vitalievna Dolgushina

Academician V.I. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia

Email: n_dolgushina@oparina4.ru
MD, PhD, MPH, Head of R&D Department

Svetlana Alexandrovna Sokur

Academician V.I. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia

Email: sokursv@yandex.ru
MD, Postgraduate of the Laboratory of Reproductive Genetics

Anastasia Grigorievna Gorshkova

Academician V.I. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia

Email: a_gorshkova@oparina4.ru
MD, Postgraduate of the Department of assistive reproductive technology in the treatment of infertility

Lubov Nickolaevna Sporysheva

Academician V.I. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia

Email: l_sporisheva@oparina4.ru
Head of Manager Service Department

Elena Anatolievna Kalinina

Academician V.I. Kulakov Research Center of Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: e_kalinina@oparina4.ru
Doctor of Science,Head of the Department of Assisted Technologies in the Infertility Treatment

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