OBJECTIVES: The objective of this study was to evaluate the cost and clinical outcomes of single versus double embryo transfer using cleavage-stage or blastocyst-stage embryo in assisted reproduction. METHODS: Markov model was designed to simulate outcomes of: 1) single-(cleavage-stage) embryo transfer (SET); 2) double-embryo transfer (DET); 3) single-blastocyst transfer (SBT); and 4) double-blastocyst transfer (DBT). Model inputs were estimated from literature and cost analysis was conducted from healthcare provider’s perspective. RESULTS: The base-case analysis showed that DBT was the most costly (US$5173) and effective strategy (birth rate=0.311) in fresh cycle. The cumulative cost and birth rate of SET were the highest in all cycles. Monte Carlo 10,000 simulations showed that the probability of DBT to be cost-effective in fresh cycle was the highest when willingness-to-pay (WTP) per live birth was ≥US$85,000. In all cycles, the probability of SET to be cost-effective was the highest when WTP was ≥US$50,000. CONCLUSIONS: CONCLUSIONS  DBT appears to be the most costly and most effective strategy in fresh cycle whereas SET seems to have the highest cumulative cost and live birth rate.