Skip to main content

Advertisement

SpringerLink
Log in

Public health implications of a North American publicly funded in vitro fertilization program; lessons to learn

  • Assisted Reproduction Technologies
  • Published:
Journal of Assisted Reproduction and Genetics Aims and scope Submit manuscript

Abstract

Purpose

A retrospective study was conducted to determine trends in practice and outcomes that occurred since the implementation of the publicly funded in vitro fertilization (IVF) and single embryo transfer (SET) program in Quebec, in August, 2010.

Methods

Data presented was extracted from an advisory report by the Health and Welfare Commissioner, and from a report by the Ministry of Health and Social Services published in June 2014 and October 2013, respectively. This data is publicly available, and was collected from all six private and three public-assisted reproduction centers in Quebec providing IVF services. Data pertains to all IVF cycles performed from the 2009–2010 to 2012–2013 fiscal years.

Results

SET was performed in 71 % of cycles in 2012. The number of children born from IVF was 1057 in 2009–2010 and 1723 in 2012–2013 (p < 0.0001). Multiple birth rates from IVF were 24 % in 2009–2010 (before the program began) and 9.45 % in 2012–2013 (p < 0.0001). The proportions of IVF babies that were premature, that were the result of multiple births, or that required neonatal intensive care unit admission (NICU) all decreased by 35.5 % (p < 0.0001), 55 % (p < 0.0001), and 37 % (p < 0.0001), respectively, from 2009–2010 to 2012–2013. The cost per NICU admission for an IVF baby increased from $19,990 to $28,418 from 2009–2010 to 2011–2012.

Conclusion

This first North American publicly funded IVF program with a SET policy shows that such a program contributes substantially to number of births. It has also succeeded in increasing access to treatment and decreasing perinatal morbidity by decreasing multiple birth rates from IVF. A substantial increase in global public health care costs occurred as well.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. De Sutter P, Van der Elst J, Coetsier T, Dhont M. Single embryo transfer and multiple pregnancy rate reduction in IVF/ICSI: a 5-year appraisal. Reprod Biomed Online. 2003;6:464–9.

    Article  PubMed  Google Scholar 

  2. Debrock S, Spiessens C, Meuleman C, Segal L, De Loecker P, Meeuwis L, et al. New Belgian legislation regarding the limitation of transferable embryos in in vitro fertilization cycles does not significantly influence the pregnancy rate but reduces the multiple pregnancy rate in a threefold way in the Leuven University Fertility Center. Fertil Steril. 2005;83:1572–4.

    Article  PubMed  Google Scholar 

  3. Khalaf Y, El-Toukhy T, Coomarasamy A, Kamal A, Bolton V, Braude P. Selective single blastocyst transfer reduces the multiple pregnancy rate and increases pregnancy rates: a pre- and post-intervention study. BJOG. 2008;115:385–90.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  4. Kutlu P, Atvar O, Vanlioglu OF, Kutlu U, Arici A, Yilmaz S, et al. Effect of the new legislation and single-embryo transfer policy in Turkey on assisted reproduction outcomes: preliminary results. Reprod Biomed Online. 2011;22:208–14.

    Article  CAS  PubMed  Google Scholar 

  5. Ryan GL, Sparks AE, Sipe CS, Syrop CH, Dokras A, Van Voorhis BJ. A mandatory single blastocyst transfer policy with educational campaign in a United States IVF program reduces multiple gestation rates without sacrificing pregnancy rates. Fertil Steril. 2007;88:354–60.

    Article  PubMed  Google Scholar 

  6. Van Landuyt L, Verheyen G, Tournaye H, Camus M, Devroey P, van Steirteghem A. New Belgian embryo transfer policy leads to sharp decrease in multiple pregnancy rate. Reprod Biomed Online. 2006;13:765–71.

    Article  PubMed  Google Scholar 

  7. Kresowik JD, Stegmann BJ, Sparks AE, Ryan GL, van Voorhis BJ. Five-years of a mandatory single-embryo (mSET) policy dramatically reduces twinning rate without lowering pregnancy rates. Fertil Steril. 2011;96:1367–9.

    Article  PubMed  Google Scholar 

  8. Francois K, Ortiz J, Harris C, Foley MR, Elliott JP. Is peripartum hysterectomy more common in multiple gestations? Obstet Gynecol. 2005;105:1369–72.

    Article  PubMed  Google Scholar 

  9. Giuffrè M, Piro E, Corsello G. Prematurity and twinning. J Matern Fetal Neonatal Med. 2012;25:6–10.

    Article  PubMed  Google Scholar 

  10. Walker MC, Murphy KE, Pan S, Yang Q, Wen SW. Adverse maternal outcomes in multifetal pregnancies. BJOG. 2004;111(11):1294–6.

    Article  PubMed  Google Scholar 

  11. Wen SW, Demissie K, Yang Q, Walker MC. Maternal morbidity and obstetric complications in triplet pregnancies and quadruplet and higher-order multiple pregnancies. Am J Obstet Gynecol. 2004;19(1):254–8.

    Article  Google Scholar 

  12. Pandian Z, Marjoribanks J, Ozturk O, Serour G, Bhattacharya S. Number of embryos for transfer following in-vitro fertilisation or intra-cytoplasmic sperm injection. Cochrane Database Syst Rev. 2013; (7): CD003416. doi: 10.1002/14651858.CD003416.pub4.

  13. Thurin A, Hausken J, Hillensjo T, Jablonowska B, Pinborg A, Strandell A, et al. Elective single-embryo transfer versus double-embryo transfer in in vitro fertilization. N Engl J Med. 2004;351:2392–402.

    Article  CAS  PubMed  Google Scholar 

  14. Canadian Agency for Drugs and Technologies in Health. Status of public funding for in vitro fertilization in Canada and internationally. 2010; (14). http://www.cadth.ca/products/environmental-scanning/environmental-scans/issue-14 Accessed 1 Nov 2014.

  15. Baker VL, Jones CE, Cometti B, Hoehler F, Salle B, Urbancsek J, et al. Factors affecting success rates in two concurrent clinical IVF trials: an examination of potential explanations for the difference in pregnancy rates between the United States and Europe. Fertil Steril. 2010;94:1287–91.

    Article  PubMed  Google Scholar 

  16. Vélez MP, Connolly MP, Kadoch IJ, Phillips S, Bissonnette F. Universal coverage of IVF pays off. Hum Reprod. 2014;29(6):1313–9.

    Article  PubMed  Google Scholar 

  17. Commissaire à la santé et au bien-être; Government of Quebec. Avis détaillé sur les activités de procréation assistée au Québec. 2014. http://www.csbe.gouv.qc.ca/publication.html?tx_csbepublicationsapplication_liste[publication]=100&tx_csbepublicationsapplication_liste[action]=fiche&cHash=37c82fc7107031f885c10591921c2d9e. Accessed 10 Oct 2014.

  18. Ministère de la Santé et des Services Sociaux. Rapport sur la mise en oeuvre de la loi sur les activités cliniques et de recherché en matière de procréation assistée. 2013. http://www.assnat.qc.ca/Media/Process.aspx?MediaId=ANQ.Vigie.Bll.DocumentGenerique_75851&process=Default&token=ZyMoxNwUn8ikQ+TRKYwPCjWrKwg+vIv9rjij7p3 Accessed 10 Oct 2014.

  19. Gouvernement du Québec. Québec assisted reproduction program. http://sante.gouv.qc.ca/en/programmes-et-mesures-daide/programme-quebecois-de-procreation-assistee/. Accessed 12 Oct 2014.

  20. Beauchamp S, Lance JM. Fécondation in vitro: portrait comparatif de pays d'Europe et d’Océanie. Fiches informatives de l’Agence d’évaluation des technologies et des modes d’intervention en santé du Québec. 2009.

  21. Aparicio B, Cruz M, Meseguer M. Is morphokinetics analysis the answer? Reprod Biomed Online. 2013;27:654–63.

    Article  CAS  PubMed  Google Scholar 

  22. Kirkegaard K, Agerholm IE, Ingerslev HJ. Time-lapse monitoring as a tool for clinical embryo assessment. Hum Reprod. 2012;27(5):1277–85.

    Article  PubMed  Google Scholar 

  23. Commission de l’éthique en science et en technologie. Position statement—ethics and assisted procreation: guidelines for the donation of gametes and embryos, surrogacy and preimplantation genetic diagnosis. 2009. http://www.ethique.gouv.qc.ca/en/. Accessed 1 Nov 2014.

  24. Kupka MS, Ferraretti AP, de Mouzon J, Erb K, D’Hooghe T, Castilla JA, et al. and The European IVF-monitoring (EIM) Consortium, for the European Society of Human Reproduction (ESHRE). Assisted reproductive technology In Europe, 2010: results generated from European registers by EHSRE. Hum Reprod. 2014;29(10):2099–113.

    Article  CAS  PubMed  Google Scholar 

  25. Macaldowie A, Wang YA, Chambers GM, Sullivan E. Assisted reproductive technology in Australia and New Zealand 2010. Assisted reproduction series no. 16. 2012. http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=10737423255. Accessed 15 Oct 2014.

  26. Institut de la statistique du Québec. Le bilan démographique du Québec. 2014. http://www.stat.gouv.qc.ca/statistiques/population-demographie/bilan-demographique_an.html. Accessed 11 Dec 2014.

  27. Draper ES, Kurinczuk JJ, Abrams KR, Clarke M. Assessment of separate contributions to perinatal mortality of infertility history and treatment: a case–control analysis. Lancet. 1999;353(9166):1746–9.

    Article  CAS  PubMed  Google Scholar 

  28. Kondapalli LA, Perales-Puchalt A. Low birth weight: is it related to assisted reproductive technology or underlying infertility? Fertil Steril. 2013;99(2):303–10.

    Article  PubMed Central  PubMed  Google Scholar 

  29. McElrath TF, Wise PH. Fertility therapy and the risk of very low birth weight. Obstet Gynecol. 1997;90(4):600–5.

    Article  CAS  PubMed  Google Scholar 

  30. Pinborg A, Wennerholm UB, Romundstad LB, Aittomaki K, Soderstrom-Anttila V, Ngyren KG, et al. Why do singletons conceived after assisted reproduction technology have adverse perinatal outcome? Systematic review and meta-analysis. Hum Reprod Update. 2013;19(2):87–104.

    Article  CAS  PubMed  Google Scholar 

  31. Romundstad LB, Romundstad PR, Sunde A, von During V, Skjaerven R, Gunnell D, et al. Effects of technology or maternal factors on perinatal outcome after assisted fertilization: a population-based cohort study. Lancet. 2008;372(9640):737–43.

    Article  PubMed  Google Scholar 

  32. Santos MA, Kuijk EW, Macklon NS. The impact of ovarian stimulation for IVF on the developing embryo. Reproduction. 2010;139(1):23–34.

    Article  CAS  PubMed  Google Scholar 

  33. Zhu JL, Basso O, Obel C, Bille C, Olsen J. Infertility, infertility treatment, and congenital malformations: a Danish national birth cohort. BMJ. 2006. doi:10.1136/bmj.38919.495718.AE.

    PubMed Central  PubMed  Google Scholar 

  34. Hayashi M, Nakai A, Satoh S, Matsuda Y. Adverse obstetric and perinatal outcomes of singleton pregnancies may be related to maternal factors associated with infertility rather than the type of assisted reproductive technology procedure used. Fertil Steril. 2012;98(4):922–8.

    Article  PubMed  Google Scholar 

  35. Cleary-Goldman J, Malone FD, Vidaver J, Ball RH, Nyberg DA, Comstock CH, et al. Impact of maternal age on obstetric outcome. Obstet Gynecol. 2005;105:983–90.

    Article  PubMed  Google Scholar 

  36. Cnattingius S, Forman MR, Berendes HW, Isotalo L. Delayed childbearing and risk of adverse perinatal outcome. JAMA. 1992;268:886–90.

    Article  CAS  PubMed  Google Scholar 

  37. Jacobson B, Ladfors L, Milsom I. Advanced maternal age and adverse parinatal outcome. Obstet Gynecol. 2004;104:727–33.

    Article  Google Scholar 

  38. Jolly M, Sebire N, Harris J, Robinson S, Regan L. The risks associated with pregnancy in women aged 35 years or older. Hum Reprod. 2000;15:2433–7.

    Article  CAS  PubMed  Google Scholar 

  39. Joseph KS, Allen AC, Dodds L, Turner LA, Scott H, Liston R. The perinatal effects of delayed childbearing. Obstet Gynecol. 2005;105:1410–8.

    Article  CAS  PubMed  Google Scholar 

  40. Luke B, Brown MB. Elevated risks of pregnancy complications and adverse outcomes with increasing maternal age. Hum Reprod. 2007;22:1264–72.

    Article  PubMed  Google Scholar 

  41. Tough SC, Newburn-Cook C, Johnston DW, Svenson LW, Rose S, Belik J. Delayed childbearing and its impact on population rate changes in lower birth weight, multiple birth, and preterm delivery. Pediatrics. 2002;109:399–403.

    Article  PubMed  Google Scholar 

  42. Helmerhorst FM, Perquin DAM, Donker D, Keirse MJN. Perinatal outcome of singletons and twins after assisted conception: a systematic review of controlled studies. BMJ. 2004. doi:10.1136/bmj.37957.560278.EE.

    Google Scholar 

  43. Jackson RA, Gibson KA, Wu YW, Croughan MS. Perinatal outcomes in singletons following in vitro fertilization: a meta-analysis. Obstet Gynecol. 2004;103(3):551–63.

    Article  PubMed  Google Scholar 

  44. Pandey S, Shetty A, Hamilton M, Bhattacharya S, Maheshwari A. Obstetric and perinatal outcomes in singleton pregnancies resulting from IVF/ICSI: a systematic review and meta-analysis. Hum Reprod Update. 2012;18(5):485–503.

    Article  PubMed  Google Scholar 

  45. Schieve LA, Meikle SF, Ferre C, Peterson HB, Jeng G, Wilcox LS. Low and very low birth weight in infants conceived with use of assisted reproductive technology. N Engl J Med. 2002;346(10):731–7.

    Article  PubMed  Google Scholar 

  46. Zegers-Hochschild F, Adamson GD, de Mouzon J, Ishihara O, Mansour R, Nygren K, et al. International committee for monitoring assisted reproductive technology (IMCIVF) and the world heath organization (WHO) revised glossary of IVF terminology, 2009. Fertil Steril. 2009;92(5):1520–4.

    Article  CAS  PubMed  Google Scholar 

Download references

Compliance with ethical standards

Conflicts of interests

None to declare, on behalf of all authors.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. As the sources of data used in study are available online on government sites (listed in the reference section), this study did not require Ethic Committee approval. For this type of study format, consent is not required.

Author information

Authors and Affiliations

  1. Reproductive Centre, McGill University Health Centre, 687 Pine Avenue West, Montreal, QC, H3A 2B4, Canada

    Talya Shaulov & Michael H. Dahan

  2. Department of Obstetrics and Gynecology, University of Montreal Hospital Centre, 1058 rue Saint-Denis, Montreal, QC, H2X 3J4, Canada

    Serge Belisle

Authors
  1. Talya Shaulov
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Serge Belisle
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michael H. Dahan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Talya Shaulov.

Additional information

Capsule This first North American publicly funded IVF program with a SET policy has contributed substantially to number of births, has increased access to treatment, and has decreased multiple birth rates from IVF.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shaulov, T., Belisle, S. & Dahan, M.H. Public health implications of a North American publicly funded in vitro fertilization program; lessons to learn. J Assist Reprod Genet 32, 1385–1393 (2015). https://doi.org/10.1007/s10815-015-0530-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10815-015-0530-2

Keywords

Search

Navigation