+44-1518-081136Is the cumulative live birth rate following in vitro fertilization (IVF) lower with provincial government coverage than prior to coverage?
World Congress on Embryology and In vitro Fertilization
November 02-03, 2017 | Chicago, USA
Khudhari A, Hemmings R, Sampalis J, Phillips S and Sylvestre C
OVO Clinic, Canada Universite de Montreal, Canada
Scientific Tracks Abstracts : Res Rep Gynaecol Obstet
Abstract:
Introduction: To determine if there is a difference between the cumulative live birth rate per IVF cycle in good prognosis patients before and after IVF provincial coverage. Background: Most studies conclude that the cumulative pregnancy rate depends on embryo quality and quantity, which is directly related to patient’s age. In the best-case scenario, the cumulative pregnancy rate reaches 79% when the number of embryos reaches 15. Other studies reported 75% probability of live birth after six cycles of controlled ovarian stimulation and IVF. Design of Study: Retrospective cohort study comparing IVF cycles between January 2008 to December 2009 (before coverage), and between January 2012 to December 2013 (during coverage). Methodology: The study was carried out at a Universityaffiliated private IVF clinic. 298 good prognosis IVF patients from 2008-2009 and 610 patients from 2012-2013 were included. The cumulative LBR per IVF cycle was the main outcome measure; the secondary outcome measures were the type of protocol used, percentage of ICSI cycles, fertilization rate, proportion of day 3 versus (vs.) day 5 embryo transfers, average number of embryos transferred, average number of frozen embryos, the clinical pregnancy rate and the multiple pregnancies. Results: No statistically significant difference in the cumulative LBR was seen; it was 44.8% in 2008-2009 but 40.3% in 20122013 with p=0.134. The long agonist protocol was used the most during 2008-2009 (75.5% of the cycles) compared to antagonist protocol in 2012-2013 (77.2%) p<0.01. There was no difference in the use of ICSI, but the fertilization rate in 2012-2013 (60.9% vs. 65.9%, p=0.001). The proportion of day 3 embryos transferred in 2008-2009 (82.2%) and 20122013 (43.9%), p=0.005, and the proportion of day 5 embryos transferred is 3.7% in 2008-2009 but 54.9% in 2012-2013, p<0.001. The average number of embryos transferred in 20082009 was 1.96 vs. 1.08 in 2012-2013. The average number of frozen embryos per cycle was not significantly different. The clinical pregnancy rate was not significantly different (56.8% vs. 54.3%). The multiple pregnancy rates were 19.4% in 20082009 and 0.5% in 2012-2013. In good prognosis IVF patients, the cumulative LBR per cycle started was not significantly different after IVF provincial coverage and the move towards eSET on day 3 or day 5. No advantage of transferring multiple embryos in this group of patients, and that transferring one at a time reduces significantly the multiple pregnancy rate and its complications. Limitation & Conclusion: Not all of the patients have had all of their embryos transferred. The design of the provincial coverage influenced the management of the patients to a certain degree. Patients undergoing an IVF cycle will be able to know their CLBR from that cycle.
Biography:
Dr Adwaa Khudhari is a Consultant in Obstetrics & Gynecology at Reproductive endocrinology & Infertility which is located at Jeddah, K.S.A
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