P-743 Is the use of IVF in Australia appropriate?

Abstract

Abstract Study question How often is ART treatment necessary and what is the true demand of ART treatment in Australia, as opposed to the published ART use? Summary answer The use of ART in Australia, as reported by ANZARD, exceeds the estimated demand of couples requiring ART treatment by 59%. What is known already ART has gained increasing attention over the years in high resourced settings allowing easier access to this technology. The use of IVF and ICSI has become a standard treatment for infertility, with Australia having a high utilisation rate of ART. During the last decade, infertility treatments have been applied to all types of infertility, including unexplained subfertility. This trend has resulted in the possible over-treatment of couples that have a reasonable chance of natural conception. We used modelling to determine whether over- or under-servicing of ART is occurring. Study design, size, duration A model-based approach in which we estimated the annual demand for ART based on a calculated population suffering from infertility. This estimate number of couples requiring ART was then compared to Australia’s reported ART usage, to determine if over- or under-servicing is present in the country. The demand for ART was estimated using demographic data from the Australian New Zealand Assisted Reproduction Database (ANZARD), Australian government databases and literature. Participants/materials, setting, methods The initial assumptions included an estimate of the total infertile population in Australia based on demographic data, with an infertility rate of 10% or 16% (sensitivity) and the prevalence of infertility types obtained from literature. A treatment model was based on three categories (couples with “absolute indications requiring ART”, anovulatory and unexplained infertility).The sum of couples that conceived without ART and those unable to requiring ART was estimated and compared to the ANZARD report. Main results and the role of chance Following the model calculations and based on 305,800 live births and 15,150 ART deliveries, and assuming an infertility rate of 10%, the total infertile population was approximately 40,700 couples. It was estimated that an average of 27,300 couples was calculated to need ART treatment in Australia in 2019. Out of these couples, 58% indicated absolute indications for ART (including uni- and bilateral tubal obstruction and severe male infertility), 14% were couples with anovulatory infertility (couples diagnosed with ovulation disorders) and 28% were couples with ovulatory infertility (including couples suffering from endometriosis and unexplained infertility). The reported number from the ANZARD 2019 report stated that 46,000 couples underwent ART treatment in Australia (59% overuse), with approximately 81,000 completed ART cycles. When comparing the reported number with the estimated number of cycles from the model, we found a 68% overutilisation of ART in Australia. When in the sensitivity analysis, the infertility rate for was adjusted to 16%, and it was estimated that 43,200 couples required ART treatment in Australia in 2019 which seems comparable to 46,000 people that actually received ART treatment in 2019 (6% overuse). Limitations, reasons for caution This model was developed using variables obtained from literature and the calculations were based on a hypothetical population. The model did not include possible combination of infertility causes that ART reports do, and if included, the estimated number of couples would be lower Wider implications of the findings Assuming infertility rates of 10% to 16%, Australia shows clear to limited overuse of IVF. Global ART schemes and funding policies need to be revisited to avoid ART overtreatment and to improve clinical pathways that direct the use of ART. Trial registration number Not applicable