Assisted reproductive technologies in public and private clinics

JBRA Assisted Reproduction

Objective: The aim of this study was to analyze the application of assisted reproductive technologies (ART) in Brazil from the active clinics and the population served considering the changes in the last resolutions of the Federal Council of Medicine (CFM), which enabled the use of the techniques for anyone, regardless of their health insurance system, gender or marital status. Methods: This paper was based on the analysis from the "Reproductive Technologies and (in) fertility study: regulation, market and rights". We used quantitative and qualitative methodologies. In this paper, we used the empirical data produced in the quantitative study. The quantitative online survey was carried out in 2016-2018, answered by 81 fertility clinics in Brazil about their performance in 2015-2016. We opted to use the REDCap Program, a web-based application for the construction and management of online surveys and databases. The questionnaire addressed the characteristics of services, practices performed, population served and existing forms of funding. Results: The questionnaires returned corresponded to 63.1% of the clinics in the southeast region. ART is mainly offered by 90.1% private clinics. We report that 63.8% of establishments have up to 20 employees; 44.5% have been in operation between 11 and 20 years. 85.1% of the clinics reported having treated non-Brazilian residents. Conclusions: There has been a significant increase in the provision of ART in Brazil. Access remains thoroughly dependent on its own financial resources. The new CFM resolutions have shifted from the prevailing concept of "health care" to "assisting with new family configurations".

JBRA Assisted Reproduction, 2020

Objective: To analyze the epidemiological profile of patients treated at the Fertility Outpatient Clinic of a tertiary public hospital in Juiz de Fora. Methods: This cross-sectional study analyzed the medical records of 448 patients who sought fertility treatment at a tertiary public hospital. The data collected from the medical records were used to assess the main causes of infertility, find the most frequently performed procedures, and the cases eligible to therapeutic or prophylactic intervention. Results: Of the 448 patients included in the study, 385 (86%) sought fertility consultation, 49 (10%) came in for repeated miscarriages, and 14 (3%) for other reasons. Of the 438 infertile patients, 280 (63.9%) had primary and 158 (36.1%) had secondary infertility. The top-three conditions of the 295 patients with established diagnoses were chronic anovulation (n=98; 33%); tubal factor infertility (n=86; 29%); and male factor infertility (n=59; 20%). Conclusions: Improving care in reproductive health requires a more profound comprehension of the epidemiological profile of patients seeking treatment. There are alternative cost-effective means to contain the development of infertility. Additional expenditure in public healthcare is needed to accommodate the growing number of individuals seeking fertility treatment in Brazil.

2016

BACKGROUND: European results of assisted reproductive techniques from treatments initiated during 2004 are presented in this eighth report. METHODS: Data were mainly collected from existing national registers. From 29 countries, 785 clinics reported 367 066 treatment cycles including: IVF (114 672), ICSI (167 192), frozen embryo replacement (FER, 71 997), egg donation (ED, 10 334), preimplantation genetic diagnosis/screening (PGD/PGS, 2701) and in vitro maturation (IVM, 170). Overall, this represents only a marginal increase since 2003, due to a huge reduction in treatments in Germany. European data on intrauterine insemination using husband/partner's semen (IUI-H) and donor semen (IUI-D) were reported from 20 countries. A total of 115 980 cycles (IUI-H, 98 388; IUI-D, 17 592) were included. RESULTS: In 14 countries where all clinics reported to the IVF register, a total of 248 937 ART cycles were performed in a population of 261.6 million, corresponding to 1095 cycles per million inhabitants. For IVF, the clinical pregnancy rates per aspiration and per transfer were 26.6% and 30.1%, respectively. For ICSI, the corresponding rates were 27.1% and 29.8%. After IUI-H, the clinical pregnancy rate was 12.6% in women below 40. After IVF and ICSI, the distribution of transfer of 1, 2, 3 and 4 or more embryos was 19.2%, 55.3%, 22.1% and 3.3%, respectively. Compared with 2003, fewer embryos were transferred, but huge differences still existed between countries. The distribution of singleton, twin and triplet deliveries after IVF and ICSI combined was 77.2%, 21.7% and 1.0%, respectively. This gives a total multiple delivery rate of 22.7% compared with 23.1% in 2003 and 24.5% in 2002. After IUI-H in women below 40 years of age, 11.9% were twin and 1.3% triplet gestations. CONCLUSIONS: Compared with earlier years, the reported number of ART cycles in Europe increased and the pregnancy rates increased marginally, even though fewer embryos were transferred and the multiple delivery rates were reduced.

Reproductive Biomedicine Online, 2010

The multiple pregnancy rate in assisted reproduction treatment cycles depends, fundamentally, on the number of embryos transferred. It is essential that patients and professionals should have good practical guidelines on the best number of embryos to be transferred in each cycle in order to obtain high pregnancy rates with minimal risk of multiple pregnancies. This study analysed the impact made by the Spanish Fertility Society (SEF) guidelines on the number of embryos to be transferred, as regards the policies adopted at clinics in Spain and the resulting financial repercussions. Data were collected from the assisted reproduction treatment register of the SEF and compared over three periods of time: 2002-2003, with no legal regulation and no SEF guidelines; 2004, with only legal regulation; and 2005-2006, with legal regulation and SEF guidelines. The acceptance of SEF guidelines varies according to the IVF technique. The guidelines have led to a reduction in multiple pregnancy rates, especially concerning triplets, in patients' own-egg and with donor-egg cycles. Even without full implantation, these results validate the clinical utility of the SEF guidelines. They constitute a useful tool to reduce the incidence of the principal adverse effect of treatment cycles: multiple pregnancies. RBMOnline Reproductive BioMedicine Online (2010) 21, 667-675 w w w . s c i e n c e d i r e c t . c o m w w w . r b m o n l i n e . c o m

Revista de Saúde Pública, 2012

To analyze users' reasons for choosing in vitro fertilization treatment in public or private services and to identify their suggestions for improving fertility treatment.

Human Reproduction, 2013

BACKGROUND: European results of assisted reproductive techniques (ARTs) from treatments initiated during 2003 are presented in this seventh report. METHODS: Data were mainly collected from already existing national registers. From 28 countries, 725 clinics reported 365 103 treatment cycles with: IVF 132 932, ICSI 162 149, frozen embryo replacement (FER) 60 412, oocyte donation (OD) 7548, PGD/PGS 1956 and IVM 109. Overall, this represents a 13% increase since 2002. For the third time, results on European data on intrauterine inseminations (IUIs) were reported from 19 countries. A total of 99 577 cycles (IUI-H, 82 834; IUI-D, 16 743) were included. RESULTS: In those 15 countries

Cambridge quarterly of healthcare ethics : CQ : the international journal of healthcare ethics committees, 2009

It might come as a surprise to many that Spain, a country with a strong Catholic tradition that officially banned contraceptive technologies until 1978, has some of the most liberal regulations in assisted reproduction in the world. Law No. 35/1988 was one of the first and most detailed acts of legislation undertaken on the subject of assisted-conception procedures. Indeed, not only did the law permit research on nonviable embryos, it made assisted reproductive technologies available to any woman, whether married or not, through the national healthcare system.

JBRA assisted reproduction, 2011

Introduction: Since 1990, the Latin American Registry of Assisted Reproduction (RLA) has registered ART procedures performed in Latin America. The RLA has increased its regional coverage including to date more than 80% of ART cycles performed. 140 centers enter their data directly on line, and an administrative office collects and analyses the data. Material and methods: This paper analyses trends over the last twenty years, as well as biomedical data corresponding to ART procedures initiated between 1990 and 2009, and babies born up to 2010. Overall, the data include 275,883 embryo transfer-cycles, 71,875 deliveries and the birth of 95,436 babies. results: Some of the major changes include: an increase in the age of female partners undergoing fresh, autologous embryo transfers; and a marked shift towards the use of ICSI over IVF. As expected, there has been a steady increase over the last ten years in the delivery rates with at least one live born per embryo transfer, reaching 25.3% in IVF/ ICSI cycles, and 31.6% in OD cycles. Over the years, there has been a progressive but slight decrease in the mean number of ET, but still, almost one third of all births are either twins or triplets. In the last 15 years, the proportion of transfers of one or two embryos has increased from 11 and 17% in 1995, to 14%• and 43% respectively in 2009, conclusions: Access to ART has experienced a meager increase during the period covered in this report. Our region faces two main challenges: to facilitate access to ART and to decrease the rate of multiple births.

Human Reproduction, 2009

background: Results of assisted reproductive techniques from treatments initiated in Europe during 2005 are presented in this ninth report. Data were mainly collected from existing national registers. methods: From 30 countries, 923 clinics reported 418 111 treatment cycles including: IVF (118 074), ICSI (203 329), frozen embryo replacement (79 140), oocyte donation (ED, 11 475), preimplantation genetic diagnosis/screening (5846) and in vitro maturation (247). Overall, this represents a 13.6% increase since 2004, partly due to inclusion of 28 417 cycles from Turkey. European data on intrauterine insemination using husband/partner's semen (IUI-H) and donor semen (IUI-D) were reported from 21 countries and included 128 908 IUI-H and 20 568 IUI-D cycles. results: In 16 countries where all clinics reported to the IVF register, 1115 cycles were performed per million inhabitants. For IVF, the clinical pregnancy rates per aspiration and per transfer were 26.9% and 30.3%, respectively. For ICSI, the corresponding rates were 28.5% and 30.9%. After IUI-H, the clinical pregnancy rate was 12.6% per insemination in women ,40. After IVF and ICSI, the distribution of transfer of one, two, three and four or more embryos was 20.0%, 56.1%, 21.5% and 2.3%, respectively. Huge differences exist between countries. The distribution of singleton, twin and triplet deliveries after IVF and ICSI was 78.2%, 21.0% and 0.8%, respectively. This gives a total multiple delivery rate of 21.8% compared with 22.7% in 2004 and 23.1% in 2003. In women ,40 years of age, IUI-H was associated with a twin and triplet pregnancy rate of 11.0% and 1.1%, respectively. conclusions: Compared with earlier years, there was an increase in the reported number of ART cycles in Europe. Although fewer embryos were transferred per treatment, there was a marginal increase in pregnancy rates and a reduction in multiple deliveries.

Fertility and Sterility, 2014

Objective: To analyze information on assisted reproductive technology (ART) performed worldwide and trends in outcomes over successive years. Design: Cross-sectional survey on access, effectiveness, and safety of ART procedures performed in 53 countries during 2005. Setting: A total of 2,973 clinics from national and regional ART registries. Patient(s): Infertile women and men undergoing ART globally. Intervention(s): Collection and analysis of international ART data. Main Outcome Measure(s): Number of cycles performed by country and region, including pregnancies, single and multiple birth rates, and perinatal mortality. Result(s): Overall, 1,052,363 ART procedures resulted in an estimated 237,315 babies born. The availability of ART varied by country from 15 to 3,982 cycles per million of population. Of all initiated fresh cycles, 62.9% were intracytoplasmic sperm injection. The overall delivery rate per fresh aspiration was 19.6% and for frozen embryo transfer 17.4%, with a cumulative delivery rate of 23.9%. With wide regional variations, single embryo transfer represented 17.5% of cycles, and the proportion of deliveries with twins and triplets from fresh transfers was 23.6% and 1.5%, respectively. Conclusion(s): Systematic collection and dissemination of international ART data allows patients, health professionals, and policy makers to examine and compare the impact of reproductive strategies or lack of them as markers of reproductive health. (Fertil Steril Ò 2014;101:366-78.