. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Abstract citation ID: dead093.803 P-455 Transnational Gestational Surrogacy During Covid-19 pandemics and War in Ukraine. A qualitative, interdisciplinary study of Danish infertile couples’ experiences in a world of change M. Tanderup 1,2 , A. Pande 3 , L. Schmidt 4 , B.B. Nielsen 5 , P. Humaidan 1,2 , C. Kroløkke 6 1 Skive Regional Hospital, The Fertility Clinic, Skive, Denmark 2 Aarhus University, Department of Clinical Medicine, Aarhus, Denmark 3 University of Cape Town, Department of Sociology, Cape Town, South Africa 4 University of Copenhagen, Department of Public Health, Copenhagen, Denmark 5 Rigshospitalet, Department of Obstetrics, Copenhagen, Denmark 6 University of Southern Denmark, Department of Language- Culture- History and Communication, Odense, Denmark Study question: How do permanently infertile couples experience surrogacy in cross border reproductive care (CBRC) and which considerations do they have in relation to this? Summary answer: The couples find surrogacy treatment in CBRC satisfying but feel forced to use CBRC, and estranged from own country, missing re- productive body, and home What is known already: Permanently infertile couples in Denmark must go abroad if they want a genetically related child, as health care professionals are not allowed to assist in a surrogacy process. Divergent legislation on surro- gacy worldwide often creates a demography of permanently infertile couples, moving around depending on which country permits gestational surrogacy. Only few academic studies have described how external circumstances as Covid-19 pandemics and the current war in Ukraine affect the world of surro- gacy and even fewer studies have focused on the infertile couples’ situation. Study design, size, duration: Semi-structured qualitative interviews, includ- ing a total of fourteen couples, were conducted with permanently infertile couples across Denmark from May 2022 to September 2022. The couples chose place, time and if they preferred to be interviewed individually or to- gether. Eleven couples chose their own home, two preferred online inter- views and one interview was held in another place. Each interview lasted for an average of 93 minutes. Participants/materials, setting, methods: Fourteen infertile couples (N ¼ 23 participants), majority heterosexual, in different stages from planning to use a gestational carrier to having two children through surrogacy were interviewed. Interview themes included “history of infertility”, “experiences with surrogacy”, “openness about one’s own situation”, and “considerations about surrogacy”. The majority used/had used Ukraine as destination of sur- rogacy. The interviews were recorded, anonymized, and transcribed. Data were analysed using Malterud’s method of systematic text condensation. Main results and the role of chance: Most couples had a relative in Denmark who offered to be a gestational carrier, but all except one couple declined this offer as they felt very unsecure about the legal situation not only for them, but also for the carrier, and a potential child. Instead, they decided to go abroad, mainly to Ukraine, to have an enforceable transparent contract, professionals to advise and the possibility of using the intended mother’s eggs. They didn’t feel it as a “choice” but more as the only option to have the longed-for child. Many felt that Danish authorities on purpose tried to ob- struct their way home with the new born which contributed to this sentiment of estrangement. According to Danish legislation if the gestational carrier was reimbursed, the intended mother cannot be granted legal motherhood at any time. This lack of acknowledgement of motherhood was not only a practical issue for the couple, but deeply affected the intended mothers of not being “worthy mothers”. The empirical realities of these couples within the context of a pandemic, a war, and borders that open and close are a confrontation and clear illustra- tion of the different legislations on surrogacy in Denmark and worldwide. Limitations, reasons for caution: The study participants had all chosen to be part of this study after advertisement in targeted internet forums. Hence, the results may not be directly transferred to all permanently infertile couples regarding attitudes towards being infertile and using surrogacy. Wider implications of the findings: This study contributes to the under- standing of being permanently infertile and the implications of the Danish and international legislation on surrogacy. Findings from our study will be useful to form the academic basis of a near-future revision of the existing surrogacy legislation. Trial registration number: Institutional Review Board at Aarhus University, Denmark (HE 2022-001) Abstract citation ID: dead093.804 P-456 Economic evaluations of assisted reproductive technology in high income countries - a systematic review E. Olive 1 , C. Bull 2 , A. Gordon 3 , M. Davies-Tuck 4 , R. Wang 1 , E. Callander 2 1 Monash University, Department of Obstetrics and Gynecology, Melbourne, Australia 2 Monash University, School of Public Health and Preventative Medicine, Melbourne, Australia 3 University of Sydney, Faculty of Medicine and Health, Sydney, Australia 4 Hudson Institute of Medical Research, Melbourne, Australia Study question: In high-income country settings, what is the evidence sup- porting economic evaluations of in vitro fertilisation (IVF) interventions? Summary answer: Most interventions associated with IVF are high cost for minimal improvement in effectiveness, leading to excessively high acceptability thresholds. What is known already: The economic burden of infertility, and approaches to reduce costs and increase access have been identified in the top 10 research priorities for future infertility research. Meanwhile, there has been exponential growth in use of ART for infertility, especially in high-income countries. Therefore, it is important to map the landscape of economic evalu- ations in IVF research to inform health policy and future research. Study design, size, duration: A systematic review of studies of an IVF in- tervention together with an economic evaluation conducted in high income countries between 2011 and 2022 was completed. Seven electronic databases were searched for eligible studies (MEDLINE, PUBMED, EMBASE, COCHRANE, ECONLIT, SCOPUS or CINAHL). Participants/materials, setting, methods: Studies assessing a component of IVF with a cost effectiveness, cost benefit, cost utility or cost minimization assessment were included. Studies were examined to assess their chosen outcome measure, perspective, completeness of reporting and cost effectiveness of the intervention studied. Cost data were converted to USD, taking inflation into consideration. Main results and the role of chance: Of the 40 included studies, 62% evaluated an unselected population and 68% used livebirth as the effective- ness outcome measure. Modelling studies predominated (65%) over those alongside trials. Most (80%) spoke from a health funder perspective. There were 11 IVF interventions assessed together with an economic eval- uation. The incremental cost effectiveness ratio was greatest for those inter- ventions where the intervention did not improve efficacy significantly. The in- tervention of PGT-A was assessed as either less effective and more expensive, or more effective, but costing up to $600,000 USD for each addi- tional livebirth. Likewise, intracytoplasmic sperm injection for non-male factor infertility, conferred minimal benefit but cost up to $72000 USD per addi- tional livebirth. Choice of agents for ovarian hyperstimulation were assessed in 15 included papers. Recombinant FSH is more effective and slightly more expensive than biosimilars. The direction of effect of the cost effectiveness findings was the same for the groups of studies assessing IVF, ICSI, PGT-A and embryo transfer num- ber, increasing confidence in the findings across different settings and funding models. Limitations, reasons for caution: Systematic reviews of economic evi- dence rely on assumptions of evidence in included studies. The data on health outcomes (e.g. pregnancy rates) were sometimes optimistic compared with findings in evidence from large trials or systematic reviews. There is variable i408 39 th Hybrid Annual Meeting of the ESHRE, Copenhagen – Denmark, 25-28 June 2023 Downloaded from https://academic.oup.com/humrep/article/38/Supplement_1/dead093.803/7202729 by guest on 06 July 2023