Impact of the Spanish Fertility Society guidelines on the number of embryos to transfer

Infertile Women's Perception on the National Support Program for Infertile Couples

PURPOSE

The purpose of this study was to explore the perception of infertile women on the use of the national support program that provides medical expense aid to infertile couples.

METHODS

Thirty Korean infertile women participated in five focus groups. Data were collected from January to August 2014. After obtaining permission from the participants, each session of the focus group was audio-taped and transcribed. The responses were analyzed using qualitative content analysis.

RESULTS

The main themes identified from the sessions with the participants were "feeling thankful for the reliable support program," "feeling happy or unhappy," "enduring inconveniences," and "hoping for a more comprehensive support service." Although most of the participants perceived the benefits of the national support service positively, they stated that the service was not comprehensive because it did not cover all the medical expenses for tests and other medical treatments.

CONCLUSION

The benefits given to infertile couples by the program should be increased by covering all the medical expenses, expanding its criteria to include more eligible candidates, and by including special leave benefits for working women. Furthermore, it is essential to take measures for infertility prevention at the individual and national policy levels.

Debating Elective Single Embryo Transfer after in vitro Fertilization: A Plea for a Context-Sensitive Approach

The number of embryos transferred after in vitro fertilization (IVF) have been a topic of debate for over a decade now. Due to the risk associated with multiple pregnancy, there has been a global effort at reducing the multiple pregnancy rates to a minimum while maintaining an acceptable level of successful IVF pregnancy rate. Elective single embryo transfer (eSET) is advocated in most European countries. In Belgium and Sweden, eSET is mandatory for couples with a good prognosis. However, despite clinical recommendations and policy statements, patients in clinical practice frequently do request for the transfer of multiple embryos in order to have twins. Such requests conflict with policy guidelines and create an ethical dilemma for physicians: Should the physician do as the couple requests, and there with respect the autonomy of patients, or adhere to medical policy that takes the health of the mother and children at heart? This article provides an exploration of the arguments found in the literature that plays a role in the discussion on this topic and eventually argues that what a physician should do depends on the specificities of the context in which patients and physicians are implicated. These contextual issues can be taken into account in a shared decision-making procedure, which allows reflections and the responsibilities of both patients and physicians to be attended in decision about assisted reproduction.

An international survey of assisted reproductive technologies (ARTs) policies and the effects of these policies on costs, utilization, and health outcomes

OBJECTIVES

The purpose of this study was to compare existing policies regarding access to 7 assisted reproductive technologies (ARTs) and to examine the effects of these policies on costs, utilization, and health outcomes in 14 countries and 2 Canadian provinces based on publicly available information.

METHODS

A systematic review of publicly available information from peer-reviewed literature (using biomedical and social science databases) and grey literature (e.g., health ministry websites, health technology assessment agency websites, etc.) was performed.

RESULTS

ARTs services permitted or funded vary across jurisdictions. The goals and eligibility restrictions (e.g., on maternal age, number of embryos transferred, and number of cycles) defined in ARTs policies also vary across jurisdictions. Studies on the impact of such policies have primarily been retrospective and focused on short-term service utilization. Nevertheless, they suggest that the policies have achieved specific outcomes, such as reductions in multiple births and in costs to payers.

CONCLUSIONS

Based on the evidence reviewed, policies aimed at reducing public coverage of ARTs or restricting the number of embryos transferred have achieved these goals. However, their effects on maternal and infant health outcomes have not been well explored.

Elective single embryo transfer and cumulative pregnancy rate: five-year experience in a Southern European Country

To compare cumulative pregnancy and live birth rates of single embryo transfer (SET) vs. double embryo transfer (DET) in women <35 years old with good-quality embryos, we designed an observational prospective study carried out between October 2002 and December 2006. Patients who accepted SET were compared with those who decided DET. A total of 628 couples who underwent embryo transfers met the criteria for SET: 52% accepted it, while 47.8% asked for DET. Implantation rate was higher in SET, 46.6% (p < 0.05), whereas pregnancy rate (PR) per transfer was higher in DET, 38.3% (p < 0.05). Twin PR in DET was 26.4% compared with 0.7% in SET (p < 0.05). SET group performed 278 frozen embryo transfer and DET 128. The mean of embryos transferred was the same, resulting in similar pregnancy and twin PR (SET: 24.8% and 21.7% vs. DET: 25.0% and 28.1%). Cumulative PR was 66.2% in SET and 69.7% in DET, not showing significant differences (NS). Likewise, cumulative live birth rates did not show differences. Cumulative twin PR in SET was 7.2% and in DET 26.6%, (p < 0.05). Cumulative PR over time leveled at 15-18 months follow-up in both groups. In Conclusion, in order to reduce twins we support the promotion of SET.