The impact of legally restricted embryo transfer and reimbursement policy on cumulative delivery rate after treatment with assisted reproduction technology

Abstract

The authors have no conflict of interest to declare. No funding was obtained for this study.

Economic evaluation of elective single-embryo transfer with subsequent single frozen embryo transfer in an in vitro fertilization/intracytoplasmic sperm injection program

“…For example, in the Nordic countries SET is performed in 56% of fresh embryo treatment cycles compared with 13% in the USA (41). To date, the most representative experiences of SET promotion programs at the international level are those of Sweden (42) and Belgium (43)(44)(45), which have yielded very positive results.…”

“…In Belgium, current legislation combines the reimbursement of six ART cycles with a legally enforced reduction in the number of embryos transferred. This policy has enabled pregnancy rates to be maintained while limiting the number of ART cycles to six and the duration of ART treatment to 36 months, and at the same time it has produced a 50% reduction in the multiple pregnancy rate, from 24% to 12%, as well as a reduction in the associated costs (43)(44)(45). In Andalusia, Spain, the number of cycles is being increased from two to three, provided that an eSET has been performed during the first cycles (47).…”

Double trouble: Should double embryo transfer be banned?

“…One important reason behind the increased health risk from pregnancy with IVF is the increased likelihood of multiple births [4]. Approximately 25 % of successful cycles result in a multiple pregnancy compared with 1 % of spontaneously conceived pregnancies [5]. The increased risk of multiple births from IVF is, in turn, often related to decisions to transfer multiple embryos instead of one embryo at a time (elective single embryo transfer, SET).…”

“…4 We will focus in this article on single versus double embryo transfer (DET) since it is this question that has led to the most debate in recent years [12,13], and because there is more published empirical evidence about the risks of DET compared with SET than there is for transfer of larger numbers of embryos. 5 Later in the article, we will consider the implications of our arguments for multiple ([2) embryo transfer. 1 Other forms of ART (for example, controlled ovarian stimulation without IVF) are also associated with increased rates of multiple birth [6].…”

“…As we will argue, a central question is whether the harms (to woman, child or others) attributable to DET are sufficiently weighty that double embryo transfer should not be permitted. 5 If DET should be banned (at least for some women), a fortiori, transfer of larger number of embryos should also be prohibited. However, if the arguments in favour of limiting DET do not succeed, there is a further question about multiple ([2) embryo transfer.…”