Clinical and cost effectiveness of elective single embryo versus double embryo transfer policy in assisted reproduction

IVF involving replacement of two embryos (DET) results in a twin rate of 25%. This is in contrast to a natural incidence of 1.25% for twin births in the general population. Twin pregnancies result in significant morbidity and mortality for both mother and child, as well as increased costs. The Human Embryology and Fertilisation Authority are encouraging more liberal use of elective single embryo transfer (eSET) in women at risk of twins. However, a blanket policy of eSET in all women is likely to reduce success rates and hence the cost effectiveness of IVF. The solution was to develop a selective eSET policy based on characteristics of women and embryos which are clinically and cost effective. This project made use of anonymised data from 3 major Scottish IVF Units to model the costs and consequences and cost-utility of a selective eSET policy versus a DET policy in women of different ages over a 20 year time horizon. A novel approach was developed and used to estimate maternal QALYs associated with the alternative policies. Given the high twin pregnancy rate associated with DET, coupled with uncertainty surrounding quality adjusted life year (QALY) gains associated with live births, the study concluded that eSET is likely to be the preferred option for most women aged 36 years and under. The cost-effectiveness of DET was found to improve with age, and may be considered cost-effective in some groups of older women.

Outcome and Translation

The NICE guideline development group reviewed this study and adopted a similar approach to the valuation of live births when carrying out new modelling to inform the updating of the fertility guideline (

HERU researchers involved in this research project: Graham Scotland (HERU/HSRU)

External Collaborators: S Bhattacharaya, K Harrild (Applied Clinical Sciences, University of Aberdeen); J Kurinczuk (University of Oxford); H Lyall (Glasgow Royal Infirmary); A Harold and M Rajkhowa (Ninewells Hospital)


Bhattacharya, S., Scotland, G., Harrild, K., Kurinczuk, J.K., Lyall, H., Rajkhowa, M. and Harrold, A. (2010) Clinical and cost-effectiveness of elective single embryo versus double embryo transfer policy in assisted reproduction. Final Report submitted to the Chief Scientist Office (CZG/2/361), Scottish Government Chief Scientist Office.

Scotland, G., McLernon, D., Kurinczuk, J.J., McNamee, P., Harrild, K., Lyall, H., Rajkhowa, M., Hamilton, M. and Bhattacharya, S. (2011) 'Minimising twins in in vitro fertilisation: a modelling study assessing the costs, consequences and cost–utility of elective single versus double embryo transfer over a 20-year time horizon', BJOG: An International Journal of Obstetrics & Gynaecology, 118(9), 1073--1083.


Scotland, G., McLernon, D., Kurinczuk, JJ., Jamieson, M., Lyall, H., Rajkhowa, M., Harrold, A. and Bhattacharya, S. (2010) 'Avoiding twins in IVF: the cost-effectiveness and cost-utility of elective single and double embryo transfer over a 20 year time horizon', Annual Meeting of the European Society for Human Reproduction and Embryology, Rome, June 2010.