Comparison of embryo transfer strategies and assisted reproduction outcome in Slovenian and cross-border patients

Abstract

A reduction in the number of embryos transferred is the most important step in decreasing multiple gestation rates after medically assisted reproduction. Slovenia has implemented insurance company regulations that regulate single-embryo transfer in selected good-prognosis couples. The aim of the present study was to evaluate its effects on the Slovenian population compared with cross-border patients, who are not affected by the insurance company policy. Ultimately, 2403 couples undergoing IVF or intracytoplasmic sperm injection were included in the retrospective analysis. Patients were classified according to their origin. The decision about the number of embryos transferred and the treatment success were evaluated. The implementation of the policy favouring single-embryo transfer resulted in a significant decrease in the twin birth rate in Slovenian patients (24.4% before policy versus 6.7% after policy implementation, P<0.001). Although in cross-border patients twin birth rates have declined through the study period, they remained significantly higher compared with Slovenian patients (23.1% versus 6.7%, P<0.001). The data demonstrate that insurance company policies favouring single-embryo transfer are an effective tool in decreasing multiple gestation rates. Similar mechanisms should be implemented in the cross-border patient population.

Cross-border reproductive care in North America: a pilot study testing a prospective data collection program for in vitro fertilization clinics in Canada and the United States

“…CBRC is generally less efficient and associated with less informed consent, less medical information, and poorer follow-up, all of which can result in a higher psychologic cost to the patient and even to health care providers (31). Lower-quality care can also result if national regulations and guidelines are not applied to international patients (32). The potential combination of lower quality, more risky health care with complications, and poorer follow-up can result in increased costs to the home country after the patient returns home with, for example, complications from a multiple pregnancy or ovarian hyperstimulation (29).…”

Paternal factors contributing to embryo quality

“…Reports also associate sperm DNA damage to lower cleavage rates [97] and arrest of embryonic development after the second or third cleavage [99,98]. Faster dividing cleavage stage bovine embryos have been shown to be more likely to develop into blastocysts [100] and fast dividing embryos have been associated with higher pregnancy rates [101]. Thus, DNA fragmentation impacts both blastocyst formation rates and pregnancy rates.…”

Promoting the use of elective single embryo transfer in clinical practice

“…These programs have been associated with increases in the utilization of ART, live births following ART treatments, and the proportion of eSET or SET cycles, and a decrease in the rate of multiple births [34, 44–46]. These trends are observed regardless of whether SET is mandated or just encouraged.…”

“…Several other countries have regulations on the number of transferred embryos that are tied to insurance and public funding programs that provide comprehensive or partial coverage for ART. However, patients are not forced to adhere to these regulations if they prefer to pay for ART themselves [34, 44–46]. In Finland, there is no formal legislation or requirement for SET, but IVF clinics together elected to move towards an SET policy for most patients [62].…”