\uc9tude comparative des figures de corrosion des Amphiboles et des Pyrox\ue8nes

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A cost-effectiveness comparison of embryo donation with oocyte donation. Fertil Steril

Objective: To compare the cost-effectiveness of embryo donation (ED) to that of oocyte donation (OD). Design: Calculation of cost-effectiveness ratios (costs per outcome achieved) using data derived from clinical practices. Setting: In vitro fertilization centers and embryo donation programs. Embryo donation (ED), or embryo adoption, has become an increasingly attractive method to achieve pregnancy for infertile couples who have either failed to conceive or not chosen to pursue IVF using their own gametes (1-3). Because embryo donation does not require the recipient woman to undergo oocyte retrieval, the procedure is medically less complex and less expensive than either autologous IVF or oocyte donation (OD) (4). However, the pregnancy and live delivery rates from an infertility procedure need to be considered in light of their success rates. An effective measure for doing this is the cost-effectiveness ratio (CER)-the cost of the procedure divided by the live delivery rate (dollars per live delivery achieved) (5). Comparison of the CERs of oocyte and embryo donation can help determine whether the higher success rate of oocyte donation is enough to justify its higher cost. MATERIALS AND METHODS For the first phase of the study, the cost of a single cycle of OD in the United States was estimated by averaging the charges of 15 geographically representative IVF centers calculated from information furnished by their staff members or published on their Web sites (6-20). These costs included donor and recipient medications, fees paid to the egg donor, administrative costs, short-term donor medical insurance, and charges for clinical services. This cost figure was divided by the delivery rate for OD cycles without prior assisted reproductive technique (ART) derived from the National ART Surveillance System (NASS) administered by the Centers for Disease Control and Prevention (G. Jeng, personal communication, January 2009) to obtain a single-cycle CER for OD. Seven ED programs (four IVF centers and three programs that match embryo donors) supplied ED costs. These costs included clinical fees, counseling and family studies, medications, and shipping charges. In four of the seven programs, a clinical entity works with a social services entity to serve the patient; in these cases, costs from both entities were included. The other three programs offer all the services ''under one roof.'' An average of the costs, weighted by the number of embryo transfers done by each program, was divided by the previously published aggregate delivery rate for the programs (3) to obtain a single-cycle CER for ED. For the second phase, five IVF centers that perform both OD and ED supplied average costs for first (fresh) and second and third (cryopreserved) cycles for OD, and the numbers of patients participating in and delivering in each cycle. Centers reported numbers of patients seen during the last 12 years, for a total of 20 clinic-years for OD and 19 clinic-years for ED. A given patient remained in the model only up through her first live delivery. The IVF centers supplied the same informatio