26 February 2014

#hfeaconference2014

26 February 2014

Andrew RiddleMedical Director Person Responsible, Nuffield Health Woking Hospital

Key factors of a successful strategy

ACE 2014 Oral Presentation

Successful establishment of eSET criteria with multiple pregnancy

rate reduced to below 5%

Original Criteria(prior to 2011)

Developing Criteria(2011-2012)

Current Criteria(2013 onwards)

<37 All patients ≤40 2 or more TQE on day 2 or 3

9 TQE 5 TQE 1 TQE and multiple average quality embryos

Previous unsuccessful attempt when TQE transferred

4 TQE or Consider patient history

Long discussion with patient 3 TQE If >40 consider blastocyst based on previous history

3

How have our blastocyst criteria developed?

Increase in blastocyst transfers from6.4% in 2011 to 72.1% in 2013

How have our eSET criteria developed?

4

Original Criteria

Consider for any patient <37

TQE to replace

1st cycle

Any previous pregnancies

If spare embryos suitable for freezing

Current Criteria

Consider for any patient <41

If the morula or blastocyst is good

quality

1st or 2nd cycle

Any previous pregnancies

Pregnancy rates eSET vs. DET: Year 4Patient age eSET preg.

rate eSET multiple preg. rate

DET preg. rate

DET multiple preg. rate

Under 35 41.4 1.5 37.9 33.4

35-37 34.8 2.8 33.9 24.9

38-39 31.8 1.3 29.5 23.2

Other 35.1 1.9 28.3 27.0

All ages 38.8 1.6 32.9 29.2

Preg. rates blastocyst eSET vs. DET: Year 4Patient age eSET

blastocyst preg. rate

eSET multiple preg. rate

DET blastocyst preg. rate

DET multiple preg. rate

Under 35 44.6 1.6 44.0 40.3

35-37 38.7 2.0 42.0 29.4

38-39 35.7 1.5 38.8 28.7

Other 39.5 2.0 36.3 32.8

All ages 42.3 1.7 40.5 35.2

Overview of National trendsPre-policy Year 1 Year 2 Extended

Year 3 Year 4

Proportion of transfers that are eSET(%)

4.9 11.3 15.9 19.7 26.1

Proportion of transfers that are blastocyst transfers (%)

13.0 20.6 30.3 38.8 48.2

Multiple pregnancy rate (%)

26.6 24.1 21.3 19.5 16.5

Multiple live birth rate (%)

23.6 21.4 19.2 17.4 15.6?

Overall pregnancy rate (%)

30.3 32.1 31.6 32.6 32.9

Clinic data: % eSET fresh cycles

y1 y2 y3 y40.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

14.5 13.9

29.4

69

11.315.9

19.7

26.1

Woking Nuffield National trend

Y1: Jan 2009 to end March 2010

Y2: April 2010 to end March 2011

Y3: April 2011 to end September 2012

Y4: October 2012 to end September 2013

Clinic data: % blastocyst transfers fresh cycles

Y1 Y2 Y3 Y40.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

4.20499342969777 3.4

24.5

73

20.6

30.3

38.8

48.2

Woking Nuffield National trend





Clinic data: % CPR, MPR, MBR

Y1 Y2 Y3 Y40.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

45.0

25.4580520732883 26.2

33.1

38.2

20.4545454545455 21.7

18.4

5.1

16.2878787878788 15.4 15.8

4.1

Clin Preg Rate MPR MBR





Clinic data: CUSUM plot multiple birthsMultiple pregnancy rate by pregnancy, for all IVF, ICSI and FET cycles

For period: Oct 2012 – Jan 2014 (as of 02/02/14)

Number of births

Year 4 centre performance: funnel plotMultiple live birth rate by live birth, for all IVF, ICSI and FET cycles For period: Oct 2012 – Sep 2013 (as of 09/01/14) at 10%

Number of births

With Thanks to:

Aimee Hetherington

Rebecca Fabian

Caroline Franklin

All the team at Nuffield Health Woking Hospital

Acknowledgements

Any questions?

#hfeaconference2014

Andrew has replicated the practice in Sweden and achieved almost identical results in terms of MBR, but with a higher pregnancy rate using a blastocyst based programme.

Table discussionsWhat are the key factors of this successful strategy?

What did you need to put in place to ensure that the majority of patients would be able to take part in a blastocyst transfer programme?

What proportion of your patients have blastocysts for transferWhat are the trigger points for review/audit?

Feedback…

Discussion

Thank you.

#hfeaconference2014

Documents

26 February 2014