OBJECTIVE: Our objective was to compare patient and cycle characteristics, clinical pregnancy rates, and multiple gestation rates at a hospital based fertility clinic before and after the institution of government funded IVF/ICSI and mandated elective single embryo.
DESIGN: This is a retrospective database review of unlinked patient data.
MATERIALS AND METHODS: Clinic and embryology lab data for all patients undergoing IVF and ICSI cycles over a four year period was mined for patient and cycle characteristics, clinical pregnancy rates, and multiple gestation rates. Extracted data was not linked to patient identifiers, therefore ethics approval was not required. We compared IVF and ICSI cycles from two years before funding (January 1, 2014 to December 31, 2015) to two years after funding (January 1, 2016 to December 31, 2017).
RESULTS: The number of cycles performed over a two year period increased from 554 before funding to 853 after funding; 76.2% were funded cycles. Patient age, BMI, and parity were similar before and after funding. The majority of patients undergoing IVF or ICSI after funding had not had a previous cycle. Cycle cancellation rates were similar before and after funding, however there were fewer embryo transfers per cycle start after funding (80.3% vs. 72.2%, P=0.001). The clinical pregnancy rate was similar before and after funding (37.8% vs. 32.5%, P=0.09), while the multiple gestation rate was significantly lower (13.1% vs. 3.5%, P=0.001).
CONCLUSIONS: Since the government of Ontario began funding IVF and ICSI cycles more patients are accessing treatment, many for the first time. At our clinic, the clinical pregnancy rate was maintained while multiple gestations were significantly reduced to well below the national average of 10.7%.1 These findings support the benefit of eSET in the context of funded IVF/ICSI.