Cost-effectiveness of preimplantation genetic testing for aneuploidy for women with subfertility in China: an economic evaluation using evidence from the CESE-PGS trial

In vitro fertilization as an option for couples with genetic disorders

Errors in human DNA may cause genetic disorders. Technological developments have raised hopes for reducing the risks of genetic inheritance among married couples who have a history of such disorders. Among the developments in reproductive health technology that reduce those risks is the in vitro fertilization (IVF) process. This review aimed to describe the current strategies using IVF and preimplantation genetic testing (PGT), which would be effective for couples with genetic disorders to have healthy offspring. The literature review included full-text, open-access research articles from ScienceDirect, PubMed, and Google Scholar that were published between 2013 and 2023, with 65 articles obtained from various journals. The keywords were 'in vitro fertilization,' 'reproductive genetic disorders,' 'PGT-A,' 'PGT-M,' 'PGT-SR,' and 'oocyte donor.' A total of 46 articles were selected as the most relevant to the review topic, and the results show that the IVF process can be an option for couples with a history of genetic disorders. Several additional procedures can be performed following IVF, such as oocyte donation and PGT, to help couples who want to have offspring without transmitting their genetic disorders. IVF can be an option for couples who have or carry genetic disorders. With IVF, couples can undertake several procedures such as oocyte donation and PGT for aneuploidy, monogenic disorders, or structural rearrangement.

Financial cost of assisted reproductive technology for patients in high-income countries: A systematic review protocol

BACKGROUND

Infertility affects one in six people globally, with similar prevalence rates across high-income and low- and middle-income countries. Technological advancements, particularly in Assisted Reproductive Technology (ART), have improved fertility treatment options. Although access to ART is presumed to be better in high-income countries (HICs), economic factors and eligibility restrictions could still impact effective utilization in these settings. Informed by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocols (PRISMA-P), this protocol outlines the methodological and analytical approaches to examine the ART costs paid by patients in HICs and the correlation with economic indicators and ART regulatory frameworks.

METHODS

Following the PRISMA approach, we will search for articles indexed in PubMed, EMBASE, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Web of Science, PsycINFO, and Latin American & Caribbean Health Sciences Literature (LILACS). Grey literature from relevant organizations' virtual databases will also be searched. The review will encompass studies published between 2001 and 2024, with the primary outcome being ART direct medical and direct non-medical costs, while secondary outcomes shall include ART financing arrangements. The review will synthesize ART costs, adjusting them to USD Purchasing Power Parity for cross-country comparison, and correlate findings with GNI per capita and ART financing policies. The Integrated Quality Criteria for Review of Multiple Study Designs (ICROMS) tool will be utilized to evaluate the quality of the included studies. We will conduct a meta-analysis if the studies provide sufficient cost-effect size estimates.

DISCUSSION

The review findings will contribute to our understanding of the potential financial burden faced by (disadvantaged) individuals in HICs due to ART costs. Additionally, the review shall highlight the implications that ART financing policies have in enhancing access and affordability, offering valuable insights for healthcare planning and policy formulation. The results will be disseminated through a peer-reviewed journal article and relevant international conferences.

TRIAL REGISTRATION

Systematic review registration: PROSPERO number: CRD42023487655.

Assessment of patient preferences for assisted reproductive technology in China: a discrete choice experiment

OBJECTIVES

Given China's low fertility rate, assisted reproductive technology (ART) can be used assist infertile patients in having children. This study aimed to analyse patients' preferences for ART and to determine the relative importance (RI) and willingness to pay (WTP) of key attributes.

DESIGN

We identified six attributes of ART and used a D-efficient design to generate choice sets for conducting a discrete choice experiment. Patients were asked to choose between two scenarios that differed in participation in treatment decision-making (TDM), clinical pregnancy rate, live birth rate, risk of maternal and neonatal complications, and out-of-pocket cost.

SETTING

Jiangsu province, China. The anonymous survey was carried out between December 2022 and February 2023.

PARTICIPANTS

Female patients aged 20-45 years, with low fertility or experience of ART treatment. We recruited 465 participants.

OUTCOMES MEASURES

Patient-reported preferences for each attribute were estimated using a mixed logit model. The latent class model was also used to investigate preference heterogeneity.

RESULTS

All attributes were associated with patient preferences. Patients considered the live birth rate as the most important attribute (RI=29.05%), followed by participation in TDM (RI=21.91%). The latent class model revealed two distinct classes named 'outcome driven' and 'cost driven'. Preferences varied according to their age, monthly household income and location.

CONCLUSIONS

This study investigated the preferences of infertile patients when seeking medical assistance for infertility. The study outcomes can contribute to evidence-based counselling and shared decision-making and provide an empirical basis for creating and implementing future policies.

Optimal embryo management strategies for patients undergoing antagonist protocols in IVF treatment

PURPOSE

Selection of optimal embryo transfer strategies for IVF patients treated with antagonist protocols.

METHODS

A retrospective study was conducted to assess whether whole embryo culture to the blastocyst stage could enhance the cumulative live birth rate (CLBR). The study included data from the first oocyte retrieval cycle of 4131 patients who underwent IVF treatment between January 2018 and June 2022. Patients were categorized into two strategies based on whether they underwent partial blastocyst culture (PBC) or whole embryo culture (WEC), and were further subdivided into three subgroups according to the number of high-quality embryos on Day 3: 0-2 embryos (subgroup 1), 3-7 embryos (subgroup 2), and 8 or more embryos (subgroup 3). Propensity score matching was used to perform a 1:1 match for patients across the three subgroups. The primary outcome measure was the CLBR per oocyte retrieval cycle.

RESULTS

After propensity score matching, there were no statistically significant differences in the baseline data among patients across the three corresponding subgroups for the PBC and WEC strategies. The analysis of CLBR in single oocyte retrieval cycles revealed that subgroup 1 had a significantly higher rate with the PBC strategy compared to the WEC strategy (33.0% vs. 25.7%, P = 0.018). In subgroups 2 and 3, there were no statistically significant differences in the CLBR between patients using the two embryo management strategies.

CONCLUSIONS

When patients have 0-2 high-quality embryos on Day 3, opting for Day 3 embryo transfer rather than blastocyst culture can increase the chances of embryo transfer and improve the CLBR.

Novel embryo selection strategies-finding the right balance

The use of novel technologies in the selection of embryos during in vitro fertilisation (IVF) has the potential to improve the chances of pregnancy and birth of a healthy child. However, it is important to be aware of the potential risks and unintended consequences that may arise from the premature implementation of these technologies. This article discusses the ethical considerations surrounding the use of novel embryo selection technologies in IVF, including the growing uptake of genetic testing and others, and argues that prioritising embryos for transfer using these technologies is acceptable, but discarding embryos based on unproven advances is not. Several historical examples are provided, which demonstrate possible harms, where the overall chance of pregnancy may have been reduced, and some patients may have missed out on biological parenthood altogether. We emphasise the need for caution and a balanced approach to ensure that the benefits of these technologies outweigh any potential harm. We also highlight the primacy of patients' autonomy in reproductive decision-making, especially when information gained by utilising novel technologies is imprecise.