Cost effectiveness of routine utilization of atypically-pronucleated zygotes in in vitro fertilization cycles with preimplantation genetic testing

Fecha de publicación: 01/09/2026 Fecha Ahead of Print: 01/08/2026

Autores de IIS La Fe

María José De Los Santos Molina

Autor

Participantes ajenos a IIS La Fe

Capalbo, A
Mulas, F
Cavagnola, R
Paraboschi, EM
Caroselli, S
Spath, K
Rienzi, L
Vaiarelli, A
Ubaldi, FM
Guido, M
Morelli, M
Coticchio, G
Cozzolino, M
Bravo, VV
Maggiulli, R
Cimadomo, D
Ottolini, CS

Grupos

Biomarcadores, Medicina Genómica, Estadística y Análisis masivo de datos en Reproducción humana asistida

Abstract

Objective: To evaluate the cost effectiveness of including embryos derived from atypically-pronucleated zygotes (APZs) in in vitro fertilization (IVF) cycles with preimplantation genetic testing for aneuploidy (PGT-A), compared with standard use of only typically fertilized (2PN) embryos. Design: Model-based cost-effectiveness analysis using retrospective clinical data. Subjects: Data were derived from two clinical embryology datasets from a private IVF center in Italy, comprising 8,334 intracytoplasmic sperm injection cycles with PGT-A (2015-2022) and 826 intracytoplasmic sperm injection cycles with time-lapse monitoring (2013-2020). Exposure: A decision-tree model compared two IVF strategies over up to two treatment cycles: standard selection of euploid blastocysts derived exclusively from 2PN zygotes and inclusion of PGT-A-confirmed euploid blastocysts derived from APZs (1PN or >= 3PN) in addition to 2PN embryos. Main Outcome Measures: The primary effectiveness outcome was the probability of achieving at least one live birth per treatment pathway, and costs reflected patient out-of-pocket expenses. Incremental cost-effectiveness ratios were calculated against a patient-derived willingness-to-pay threshold of & euro;422.25 per 1% absolute increase in live-birth probability. Deterministic (+/- 20% parameter variation) and probabilistic (10,000 Monte Carlo simulations) sensitivity analyses evaluated parameter uncertainty and the robustness and transferability of results across clinical and economic settings, with subgroup analyses by maternal age and embryo availability. Results: Inclusion of APZ-derived euploid blastocysts increased cumulative live-birth probability (absolute increase 1.42%), although marginally reducing mean treatment cost (& euro;12,737.92 vs. & euro;12,749.49), resulting in a cost saving of & euro;11.57 per couple. Across all sensitivity analyses and subgroups, the APZ-inclusive strategy consistently demonstrated higher effectiveness with lower costs or favorable incremental cost-effectiveness ratios, remaining economically dominant or cost effective within the predefined willingness-to-pay threshold. Notably, higher treatment costs further enhanced the relative cost effectiveness of APZ utilization by increasing the economic value of incremental gains in live-birth probability. Conclusion: Inclusion of PGT-A-confirmed euploid APZ-derived blastocysts improves IVF live-birth outcomes at lower or comparable cost and remains cost effective across diverse clinical and economic scenarios. This is particularly relevant in healthcare systems with higher IVF and PGT-A costs, supporting routine integration of APZ-derived embryos as a generalizable and economically efficient approach. (Fertil Steril (R) 2026;126:509-17. (c) 2026 by American Society for Reproductive Medicine.)

Datos de la publicación

ISSN/ISSNe:: 0015-0282, 1556-5653
Tipo:: Article
Páginas:: 509-517
DOI:: 10.1016/j.fertnstert.2026.06.012
PubMed:: 42252050
Factor de Impacto:: 1,895 SCImago ℠
Cuartil:: Q1 SCImago ℠

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Métricas

Filiaciones

Capalbo, A:: Juno Genet, Reprod Genet, Rome, Italy

G dAnnunzio Univ Chieti Pescara, Ctr Adv Studies & Technol, Dept Med Genet, Chieti, Italy

G dAnnunzio Univ Chieti Pescara, Dept Neurosci Imaging & Clin Sci, Chieti, Italy
Mulas, F:: Juno Genet, Reprod Genet, Rome, Italy
Cavagnola, R:: Juno Genet, Reprod Genet, Rome, Italy
Paraboschi, EM:: Juno Genet, Reprod Genet, Rome, Italy
Caroselli, S:: Juno Genet, Reprod Genet, Rome, Italy
Spath, K:: Juno Genet, Reprod Genet, Rome, Italy
Rienzi, L:: IVIRMA Italia, IVIRMA Global Res Alliance, Rome, Italy

Univ Urbino Carlo Bo, Dept Biomol Sci, Urbino, Italy
Vaiarelli, A:: Genera Clin Valle Giulia, IVIRMA Global Res Alliance, Rome, Italy
Ubaldi, FM:: Genera Clin Valle Giulia, IVIRMA Global Res Alliance, Rome, Italy

Univ Calabria, Dept Pharm & Hlth Sci & Nutr DFSSN, Arcavacata Di Rende, Cosenza, Italy
Guido, M:: Univ Calabria, Dept Pharm & Hlth Sci & Nutr DFSSN, Arcavacata Di Rende, Cosenza, Italy
Morelli, M:: Univ Calabria, Dept Pharm & Hlth Sci & Nutr DFSSN, Arcavacata Di Rende, Cosenza, Italy
Coticchio, G:: IVIRMA Italia, IVIRMA Global Res Alliance, Rome, Italy
Cozzolino, M:: IVIRMA Italia, IVIRMA Global Res Alliance, Rome, Italy
Molina, MJD:: IVI Valencia, IVIRMA Global Res Alliance, Valencia, Spain

IVI Fdn Fdn IIS Hosp La Fe, IVIRMA Global Res Alliance, Valencia, Spain
Bravo, VV:: IVIRMA Global, IVIRMA Global Res Alliance, Madrid, Spain
Maggiulli, R:: IVIRMA Italia, IVIRMA Global Res Alliance, Rome, Italy
Cimadomo, D:: IVIRMA Italia, IVIRMA Global Res Alliance, Rome, Italy

Univ Pavia, Dept Biol & Biotechnol Lazzaro Spallanzani, Lab Biol & Biotechnol Reprod, Pavia, Italy
Ottolini, CS:: Juno Genet, Reprod Genet, Rome, Italy

UCL, Inst Womens Hlth, Dept Maternal & Fetal Med, London, England

Keywords

Atypically-pronucleated zygotes; preimplantation genetic testing for aneuploidy; cost-effectiveness analysis; in vitro fertilization; live birth rate

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