Welcome to the IFFS-UIT resource centre hosted by Reproductive Biomedicine Online. Funded by the International Federation of Fertility Societies and Ferring, this resource centre provides access to the latest literature on infertility treatment. The site features peer-reviewed articles, video material from IFFS, UIT and other academic symposia, interviews with eminent researchers, Netter images and medical surveys. Please sign up to the E-Alert when you would like to keep up with the new content updates.Read more »
Article Commentary - Richard Kennedy, Chair Standards and Practice Committee and President Elect, IFFS
Safety and Quality are key priorities in delivering effective ART services. This series from leaders in the field of Quality Management in ART focusses on the IVF Laboratory and will take readers through paradigms essential for ensuring high quality laboratory outputs.Optimizing the culture environment in the IVF laboratory: impact of pH and buffer capacity on gamete and embryo quality By Jason E Swain RBMOnline 2010 Jul;21(1):6-16
Article Commentaries from Dr Joe Leigh Simpson, and Dr. Sheryl van der Poel
Comment:On the cost and prevention of iatrogenic multiple pregnancies By Brian D Allen, Eli Y Adashi and Howard W Jones Jr Reproductive BioMedicine Online
An increased rate of multiple and higher order multiple pregnancy is an avoidable complication of Assisted Reproductive Therapy (ART) that is associated with increased neonatal morbidity and mortality, and increased obstetric and neonatal costs. The authors examine regional data to identify savings from minimizing multiple birth rates, extrapolate their findings to potential national savings, and make a financial case for healthcare insurers providing ART utilizing protocols designed to avoid iatrogenic multiple birth. The authors report that the resultant reduction in obstetric and neonatal costs would fund the provision of ART services. These findings are not surprising, and are supported by a subsequent publication by Chamber et al in JAMA Pediatrics - http://archpedi.jamanetwork.com/article.aspx?articleid=1903018.
Multiple births cost more, (often a great deal more), in terms of obstetric and pediatric care. Children resulting from multiple births are frequently less healthy than those from a singleton birth. Given the substantial improvement in IVF pregnancy rates, the fertility community has been progressing towards routinely recommending elective single embryo transfer. However, people receiving treatment want to maximize their chance of having children, with the associated financial pressures, and so multiple-embryo transfer is frequently requested. It is the responsibility of medical care systems to consider long-term health and financial consequences of care that is provided. Providing funded IVF treatment (publicly or insurance-funded) where elective single embryo transfer is routine, combines the most cost effective care with the highest standard of evidence-based medical care.
Dr Joe Leigh Simpson, President IFFS
The evidence presented by Allen et al, on the cost-effectiveness of decreasing and preventing iatrogenic multiple pregnancies as compared to providing appropriate fertility treatment, is compelling and has critical global public health implications. Most newborn deaths are preventable and health complications associated with multiple pregnancies can be avoided. Addressing these will save costs in both private and public health systems. Multiple gestations more often than singleton pregnancies, result in early births and prematurity. Furthermore, the WHO has identified prematurity as the leading cause of neonatal mortality. Additionally, prematurity is the second leading cause of death after pneumonia in children under the age of 5. Thus, global progress in child survival and health cannot be achieved without addressing preterm birth, as stated within the new global “Every Newborn Action Plan to End Preventable Deaths” (endorsed by all Ministries of Health during the World Health Assembly in May, 2014.)
Interestingly, the “greater use of infertility treatments” had been identified as a possible cause for the global increase in prematurity. (“The Global Action Report on Preterm Birth” - the WHO, the March of Dimes, Save the Children and The Partnership for Maternal, Newborn and Child Health.) However, this comment refers to the unfortunate, unregulated and non-evidenced based practices often associated with infertility treatments. If public health (and insurance) systems supported evidence-based fertility interventions, provided appropriate assessment of couples with fertility problems, provided elective single embryo transfer to decrease multiple gestations, and also provided appropriate monitoring of ovarian stimulation during non-IVF cycles to decrease multiple gestations, then neonatal mortality and under 5 child morbidity rates would decrease. The research of Allen et al, as well as Chamber et al, (the latter which was recently published research in JAMA Pediatrics,) reveal the clear cost-effectiveness of providing fertility interventions. However, both articles expose a critical gap: Health systems that do not support evidence-based interventions for the health care issue of infertility/subfertility will result in inadvertently negatively effecting another – the health of the neonate and future child health. Can health systems afford to avoid the cost of fertility interventions? The evidence says, no.
Dr. Sheryl van der Poel,
World Health Organization, Department of Reproductive Health and Research including the UNDP, UNFPA, UNICEF, WHO, World Bank Human Reproduction Programme, Geneva, Switzerland.
This comment does not represent an official view of the World Health Organization.
Volume 29, Issue 3, September 2014, Pages 281–285
Long-term follow up of couples initially randomized between immobilization and immediate mobilization subsequent to IUI By I. Scholten, I.M. Custers, L.M. Moolenaar, P.A. Flierman, T. Cox, J. Gianotten, P.G.A. Hompes, F. van der Veen and B.W.J. Mol
About the Editor
4 October - 9 October
XXI FIGO World Congress of Gynecology and Obstetrics