Soheyla D. Gharib

The Cost of a Successful Delivery with in Vitro Fertilization

BACKGROUND The use of in vitro fertilization has engendered considerable debate about who should have the procedure, whether health insurance should cover the cost, and if so, to what extent. We investigated the cost of a successful delivery with in vitro fertilization. METHODS We calculated the cost per successful delivery with in vitro fertilization (defined as at least one live birth) for a general population of couples undergoing in vitro fertilization and for two subgroups: couples with a diagnosis of tubal disease (who have a better chance of success), and couples in which the woman is over the age of 40 years and the man has a low sperm count (who have a lower chance of success). Information on charges per cycle of in vitro fertilization was obtained from six facilities across the country; delivery rates with this procedure were estimated from the literature. RESULTS On average, the cost incurred per successful delivery with in vitro fertilization increases from

Sex steroid hormone regulation of follicle-stimulating hormone subunit messenger ribonucleic acid (mRNA) levels in the rat.

66,667 for the first cycle of in vitro fertilization to

Regulation of rat luteinizing hormone subunit messenger ribonucleic acids by gonadal steroid hormones.

114,286 by the sixth cycle. The cost increases because with each cycle in which fertilization fails, the probability that a subsequent effort will be successful declines. Sensitivity analyses indicated that the cost per delivery ranges from

Productivity, Quality, and Patient Satisfaction: Comparison of Part-time and Full-time Primary Care Physicians

44,000 to

Organization and Expression of Gonadotropin Genes

211,940. For couples with a better chance of successful in vitro fertilization (i.e., those with a diagnosis of tubal disease), it costs

CASE RECORDS of the MASSACHUSETTS GENERAL HOSPITAL. Case 21-2015. A 37-Year-Old American Man Living in Vietnam, with Fever and Bacteremia.

50,000 per delivery for the first cycle and

Case 21-2015

72,727 for the sixth. For couples in which the woman is older and there is a diagnosis of male-factor infertility, the cost rises from

Co-circulating mumps lineages at multiple geographic scales

160,000 for the first cycle to

Hormonal Regulation of Pituitary Gonadotropin Gene Expression

800,000 for the sixth. CONCLUSIONS The debate about insurance coverage for in vitro fertilization must take into account ethical judgments and social values. But analyses of costs and cost effectiveness help elucidate the economic implications of using in vitro fertilization and thus inform the policy discussion.

Cloning and Expression of Lutropin Genes

Follicle-stimulating hormone (FSH) beta, luteinizing hormone (LH) beta, and alpha subunit messenger RNA (mRNA) levels were examined in rats after castration and sex-steroid replacement. Subunit mRNAs were determined by blot hybridization using rat FSH beta genomic DNA, and alpha and LH beta complementary DNA (cDNA). Rat FSH beta mRNA is 1.7 kilobase in size. After ovariectomy, female FSH beta mRNA levels increased fourfold, whereas those of LH beta and alpha increased twenty- and eightfold, respectively. With estradiol, all subunits returned toward normal levels. Male LH beta and alpha mRNA levels rose eight- and fourfold, respectively, 40 d postcastration, but FSH beta mRNA levels increased minimally. After 7 d of testosterone propionate, LH beta and alpha mRNAs declined to normal levels, whereas FSH beta mRNA increased slightly. We conclude that in female rats FSH beta is negatively regulated by gonadal steroids, but to a lesser extent than LH beta or alpha mRNAs, and there is a differential regulation of FSH beta mRNA levels in males as compared with females at the time points examined.