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Purpose: To determine the expected out-of-pocket costs of IVF with preimplantation genetic testing for aneuploidy (PGT-A) to attain a 50%, 75%, or 90% likelihood of a euploid blastocyst based on individual age and AMH, and develop a personalized counseling tool., Methods: A cost analysis was performed and a counseling tool was developed using retrospective data from IVF cycles intended for PGT or blastocyst freeze-all between January 1, 2014 and August 31, 2017 (n = 330) and aggregate statistics on euploidy rates of > 149,000 embryos from CooperGenomics. Poisson regression was used to determine the number of biopsiable blastocysts obtained per cycle, based on age and AMH. The expected costs of attaining a 50%, 75%, and 90% likelihood of a euploid blastocyst were determined via 10,000 Monte Carlo simulations for each age and AMH combination, incorporating age-based euploidy rates and IVF/PGT-A cost assumptions., Results: The cost to attain a 50% likelihood of a euploid blastocyst ranges from approximately $15,000 U.S. dollars (USD) for younger women with higher AMH values (≥ 2 ng/mL) to > $150,000 for the oldest women (44 years) with the lowest AMH values (< 0.1 ng/mL) in this cohort. The cost to attain a 75% versus 90% likelihood of a euploid blastocyst is similar (~ $16,000) for younger women with higher AMH values, but varies for the oldest women with low AMH values (~ $280,000 and > $450,000, respectively). A typical patient (36-37 years, AMH 2.5 ng/mL) should expect to spend ~ $30,000 for a 90% likelihood of attaining a euploid embryo., Conclusions: This tool can serve as a counseling adjunct by providing individualized cost information for patients regarding PGT-A.

Purpose: Adding preimplantation genetic screening to in vitro fertilization has been shown to increase live birth rate in women older than 37. However, preimplantation genetic screening is an expensive procedure. Information on the cost-effectiveness of preimplantation genetic screening can help inform clinical decision making., Methods: We constructed a decision analytic model for a hypothetical fresh, autologous in vitro fertilization cycle (with versus without preimplantation genetic screening) for women older than age 37 who had a successful oocyte retrieval and development of at least one blastocyst. The model incorporated probability and cost estimates of relevant clinical events based on data from published literature. Sensitivity analyses were performed to examine the impact of changes in model input parameters., Results: In base-case analysis, IVF-PGS offered a 4.2 percentage point increase in live birth rate for an additional cost of $4509, yielding an incremental cost-effectiveness ratio (ICER) of $105,489 per additional live birth. This ICER was below the expected cost of $145,063 for achieving one live birth with IVF (assuming an average LBR of 13.4% and $19,415 per cycle for this patient population). Sensitivity analysis suggested that ICER improved substantially with decreases in PGS cost and increases in PGS effectiveness. Monte Carlo simulation showed PGS to be cost-effective in 93.9% of iterations at an acceptability cutoff of $145,063., Conclusions: Considering the expected cost of achieving one live birth with IVF, PGS is a cost-effective strategy for women older than 37 undergoing IVF. Additional research on patients' willingness-to-pay per live birth would further inform our understanding regarding the cost-effectiveness of PGS.

The objective of this study was to determine if the technique of embryo transfer in cattle can be commercially feasible in a region situated in the humid tropics of Mexico. Twenty-six Bos taurus and twenty-six Bos indicus cows were estrous synchronized and superovulated to obtain a total of 80 embryos of both sub-species. Embryos were classified using stereoscopic microscopy based on established criteria. Nine dual-purpose farms situated in the tropics of Mexico were chosen to provide ten recipient cows each to transfer one embryo per cow. The females were transferred using a fixed-time protocol after verifying the presence of a corpus luteum on the seventh day after the end of hormonal treatment. Pregnancy diagnosis was carried out 28 days after embryo transfer by ultrasonography. Estimation of the cost was determined by calculating the expenses for preparation of the donor and embryo recovery, which were US $633 and US $589 for B. taurus and B. indicus, respectively. The cost of each embryo was determined considering the number of transferable embryos recovered, which was 3.8 on mean. The cost of each conception was calculated taking into account the percentage of pregnant animals (27% on mean), and the cost for preparing donor and recipient cows, for transferring embryo. The overall cost per gestation was US $1,447. Considering a 50:50 ratio of male to female born, the cost for a replacement heifer calf was US $2,894, which surpassed by far the commercial cost of a crossbred ready-to-bred heifer normally used as replacement (approximately US $900).