Rapid policy change to single-embryo transfer while maintaining pregnancy rates per initiated cycle

Abstract

Public financing of IVF aims at increasing access to treatment while decreasing the expenses associated with multiple pregnancies. Critics argue that it is associated with lower pregnancy rates. This study compared cycles performed during 2009 (before implementation of Quebec’s public IVF programme; period I) to those performed in the year following implementation (period II) in a single IVF centre. First fresh cycles in period I (499 women) and first fresh cycles (815 women) along with their corresponding first vitrified–warmed transfer (271 women) in period II were evaluated. From period I to period II, single-embryo transfer increased from 17.3% to 85.0% (P<0.001), multiple ongoing pregnancy rate decreased from 25.8% to 1.6% (P<0.001) and ongoing pregnancy rate decreased from 31.9% to 23.3% (P=0.001). During period II, the ongoing pregnancy rate per vitrified–warmed embryo transfer was 19.2%, leading to a cumulative ongoing pregnancy rate per initiated cycle of 29.7%, which was not different to the pregnancy rate per fresh cycle during period I (31.9%). To conclude, Quebec’s public IVF programme decreased multiple pregnancy rates while maintaining an acceptable cumulative ongoing pregnancy rate, a more precise outcome to evaluate the impact of public IVF programmes.Public funding of IVF intends to increase access to IVF treatment and reduce the health and economic consequences of multiple pregnancies. However, the success of treatment, as measured by the pregnancy rates, may seem lower as expressed by critics of these public programmes. In order to evaluate the impact of the new public IVF programme in the province of Quebec, we compared the IVF cycles performed during 2009 (period I), the year previous to implementation of the programme, to the cycles performed 1year following the programme (period II) in a single IVF centre. The first fresh cycles performed in period I were compared with the first fresh cycles in addition to the fresh cryopreserved cycle during period II (a surrogate of cumulative pregnancy rate). The transfer of a single embryo increased (17.3% in period I versus 85.0% in period II), and as a consequence, the multiple pregnancy rate sharply decreased (25.8% in period I versus 1.6% in period II). Although the ongoing pregnancy rate decreased after the transfer of the first fresh embryo (31.9% in period I versus 23.3% in period II), the transfer of one cryopreserved embryo to those women who did not get pregnant during period II resulted in a cumulative pregnancy rate of 29.7% during period II (almost the same as the pregnancy rate of 31.9% during period I). Thus, in this centre, the Quebec public IVF programme attained the objective of decreasing multiple pregnancy rates while maintaining acceptable cumulative pregnancy rate, a more precise outcome to evaluate the impact of public IVF programmes.