UTJECAJ EMBRIO TRANSFERA NA ISHOD MPO – ANALIZA 6000 POSTUPAKA

Borut Kovačič

Dept. of Reproductive Medicine & Gynecologic Endocrinology

University Clinical Centre Maribor

Introduction

Factors with possible impact on embryotransfer outcome:

• Catheter type,• Catheter loading,• Transfer technique,• Team experience,• Use of ultrasound,• Location of embryo replacement in the uterus,• Uterus and cervix anatomy• Endometrium thickness and contractility• Luteal supplementation,• Natural or stimulated cycles• Fresh or frozen/thawed embryos• Embryo stage,• Embryo selection,• Embryo quality,• No of embryos transferred,• Single Embryo Transfer (SET) policies

MATERIAL

TECHNIQUE

ANATOMY

HORMONS

EMBRYOS

REGULATIONS

BLASTOCYST MORPHOLOGY Optimal:

BLASTOCYST MORPHOLOGY Suboptimal:

Blastocyst transfer outcome in young patient group (2779 cycles in period from 2001 - 2010)

Single blastocyst transfer Double blastocyst transfer

Blastocyst quality

Optimal Nonoptimal OptimalOptimal

Optimal Nonoptimal

NonoptimalNonoptimal

No. of transfers

869 362 555 377 616

Clinical pregnancies

546 (62.8) 124 (34.3) 373 (67.2) 227 (60.2) 248 (40.3)

Deliveries 475 (54.7) 118 (32.6) 335 (60.4) 200 (53.1) 214 (34.7)

Singletons 469 (98.7) 115 (97.5) 157 (46.9) 115 (57.5) 154 (72)

Twins 6 (1.3) 3 (2.5) 174 (51.9) 83 (41.5) 60 (28)

Triplets 0 0 4 (1.2) 2 (1) 0

Embryo transfer policies for favorizing single embryo transfer (SET):

• Professional non-regulatory consensus (Finland)

• Governmental regulation: • Legislation - SET must be a norm (Sweden)• Reimbursement policies, strongly favorizing SET (Belgium,

Slovenia from 2008) – semi obligatory

• Cross-boarder patients• Financial reasons influences their decision about SET.

Aim of the study:

To compare the embryo transfer outcome in young Slovenian and foreign patients (treated in Maribor IVF centre) in the period before and after the regulation of SET by reimbursement policy.

• Slovenian patients (N = 1833)IVF Reimbursement policy stimulates SET

• Cross-boarder patients (N = 573)

• IVF treatment according to ESHRE’s good practice guide for CBRC for centers and

practitioners (Hum Rep, 2011)

• Consultancy: SET advised by gynecologyst before ET:• Implantation rate per available embryo • Pregnancy and multiple pregnancy rate per same patient group• Medical complications related to multiple pregnancy

• Patient decision about SET / DET / TET

• High risk patients for multiple pregnancy after IVF (N = 2406) <36 years old, <3 previous IVF attempts, optimal embryos (blastocysts)

Material & methods:

Characteristics of study groupsSlovenian patients

Cross-boarderpatients

Cycles 1833 573

Female age 30.8 ± 3.3 31.9 ± 3

Gonadotrophins (ampules) 25.3 ± 7.6 25.4 ± 7.8

Oocytes 12.1 ± 5.7 12.1 ± 6

Embryos 7.6 ± 3.9 7.8 ± 4

Blastocysts rate 57.3 56.9

Optimal blastocyst per embryo 25.2 24.9

Single blastocyst transfers (SBT) 1011 (55.2) 125 (21.8) *

SBT optimal blastocyst 73.1 66.4 *

Double blastocyst transfers (DBT) 822 (44.8) 448 (78.2) *

DBT at least 1 optimal blastocyst 46.8 64.1 *

* P<0.005

Double blastocyst transfer rate

2003 2004 2005 2006 2007 2008 2009 20100

10

20

30

40

50

60

70

80

90

SLOVENIAN CROSS-BOARDER

Clinical pregnancy rate after blastocyst transfer

2003 2004 2005 2006 2007 2008 2009 20100

10

20

30

40

50

60

70

80

SLOVENIAN CROSS-BOARDER

Implantation rate after blastocyst transfer

2003 2004 2005 2006 2007 2008 2009 20100

10

20

30

40

50

60

70

SLOVENIAN CROSS-BOARDER

Delivery rate after blastocyst transfer

2003 2004 2005 2006 2007 2008 2009 20100

10

20

30

40

50

60

70

SLOVENIAN CROSS-BOARDER

Twins / delivery after blastocyst transfer

2003 2004 2005 2006 2007 2008 2009 20100

5

10

15

20

25

30

35

40

45

50

SLOVENIAN CROSS-BOARDER

Conclusions

• Double blastocyst transfer does not increase IVF success rate in comparison with single blastocyst transfer.

• Reimbursement policies for favorization SET are efficient in decreasing the multiple pregnancies in Slovenian patients.

• Financial reasons lead the cross-boarder patients more frequently to decision on multiple embryo transfers.

• Only obligatory SET policies could decrease the multiple pregnancy rate in young cross-boarder IVF patients.