Regional Variation in Rates of IVF Treatment across Australia: A Population-based Study.

Louise Rawlings,Pauline Ding,Stephen J Robson

doi:10.36469/9795

Abstract

Background: There is variation in uptake of in vitro fertilisation (IVF) between countries, and Australia has high incidence rates of IVF due to universal public funding. However, it remains unclear whether there is regional variation and, if present, what might cause this.Objectives: We sought to determine whether regional variations in treatment rates existed and what might influence these.Methods: The number of cycles of fresh IVF and intrauterine insemination (IUI) for women were obtained for the period 2011 until 2014 in two age groups (25 to 34 years and 35 to 44 years) to calculate incidence rates. Proxy indicators that might influence treatment affordability were: unemployment rates; average weekly total earnings; coverage of private health insurance; and, percentage of women in the highest socioeconomic quintile. Measures of accessibility considered were percentage of the population remote from urban areas and average state population density. Linear regressions were performed using log-transformed ratio of IVF and IUI incidence rates.Results: Variations were found in IVF uptake between states with greater differences in older women. There was no significant association between IVF procedures and population density or geographic isolation. Economic factors were not associated with IVF uptake.Conclusion: These findings suggest that factors such as physician preference, clinical practice guidelines, and cryopreservation protocols of ART units might explain the national variation in uptake of IVF.

Highlights

There is variation in uptake of in vitro fertilisation (IVF) between countries, and Australia has high incidence rates of IVF due to universal public funding
We examined the effects of the socio-economic factors measuring affordability and remoteness/population density as measures of accessibility
Taking into account the possibility of a substitution of intrauterine insemination (IUI) for IVF in some women, Figure 5 demonstrates the trend of IVF over IUI at state level and the national level in both age groups: as expected the incidence rate of IVF was higher in the older age group in all five states

Summary

Introduction

There is variation in uptake of in vitro fertilisation (IVF) between countries, and Australia has high incidence rates of IVF due to universal public funding. In 2013 in Australia 4.4% of all births were the result of ART, the majority in women having their first child[1]: that rate is similar to other developed countries.[2] Despite the acceptance and uptake of ART there remains variation in its use internationally and it is recognised that many factors influence the rate of ART usage in different parts of the world.[3] While some influences such as public funding of in vitro fertilisation (IVF) treatment are relatively easy to study quantitatively other factors, in particular socio-religious and cultural influences, have not been extensively investigated. In view of the potential differences in indications, clinical practices, and outcomes for IVF we set out to determine whether there were associated differences in IVF uptake a regional level in Australia

Objectives

Methods

Results

Conclusion