JBRA Assist. Reprod. 2008;12(3):10-10
EDITORIAL
doi: 10.5935/1518-0557.2008.12.3.01
Fertility Clinic, Department of Obstetrics-Gynaecology-Fertility, Middelheim Hospital.Belgium
In Europe we have witnessed in recent years the introduction of quality related measures in society in general and in ART more specifically. In countries with a highly developed social security system such as the Scandinavian countries the authorities are concerned about the costs created by early births as a consequence of multiple pregnancy after ART. A therapy that leads to such high extra cost is considered by health economists as lacking in quality.
In our country, Belgium, several laws have been passed to optimise spending of public funds by the authorities. In women below the age of 36 only single embryo transfer is allowed in the first cycle. In the second cycle double embryo transfer is only allowed “if no good quality embryo is available”. In further cycles 2 embryos is the maximum below the age of 36. In women between 36 and 40 years of age double embryo transfer is allowed in the first and second and maximum 3ET in the following cycles. For women over 40 years of age there is no limit. In cryo transfers a maximum of DET is imposed for all ages. This law dating from July 2003 in return provided reimbursement of all lab related costs for 6 cycles during a woman’s life time.
More recently a new law specifies that all cryo preserved embryos should first be thawed and transferred before a fresh cycle can be started.
We also have seen limitations of the amount of FSH that can be used per fresh IVF/ICSI cycle and also of the application of FSH in IUI cycles.
Will this evolution lead to lower pregnancy results? Not necessarily if we can select the embryo with the highest implantation potential. In our centre we had a multiple pregnancy rate of 43% in 1996. In 1997 started the gradual introduction of SET. In 2007 69% of all transfers was SET and we had a life birth rate of 35% while twinning rate was 7%. In the last 3 years twinning was below 10% and during the last 5 years there was no triplet pregnancy. All of this was accomplished without high tech and with day 3 transfer.
In general we are moving from an unregulated to a more strictly regulated situation aiming at a higher level of quality. Quality meaning an improved overall result for a minimal overall cost. This seems to be an unavoidable evolution and we think it is wise to follow and contribute to it in order to be prepared for the future.
Endereço: Lindendreef 1, 2020 Antwerp, Belgium
Email: eric.van.royen@pandora.be