To compare the economic consequences of proceeding directly to IVF to those of proceeding with gonadotropins followed by IVF in patients 80% chance of birth. The gonadotropin arm was over four times more likely to result in a high-order multiple pregnancy (HOMP). Despite this, when the base case estimates were utilized, immediate IVF emerged as more costly per live birth. In sensitivity analysis, immediate IVF became less costly per live birth when IVF was more likely to achieve birth (55.1% ) or cheaper (＄ 11,432) than our base case assumptions. Conclusion(s): After considering the risk and cost of HOMP, immediate IVF is more costly per live birth than a trial of gonadotropins prior to IVF.
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