부산대학교 도서관

Introduction: It is widely accepted that the single most important negative side-effect of ART treatment is the high percentage of multiple pregnancies (MP) with their associated health issues, both short and long term. Despite attempts to educate both health practitioners and patients to these risks, the levels of multiple pregnancy associated with ART remain high, especially in North America. One of the reasons often stated for such high MP levels is the fact that when patients have to pay for treatment they demand higher success and are willing to risk MP to achieve their parental project in less treatment attempts.In 2002, the government of Québec, Canada introduced a tax credit for the costs associated with infertility; patients received 30% of their expenses. This was increased to 50% in 2008, however despite this credit the multiple pregnancy rate did not reduce and the use of elective single embryo transfer (eSET) was not increased. Furthermore this tax credit did not permit complete access to ART across all socio-economic groups.In August 2010, Quebec included ART in the provincial health system; thereby funding three fresh cycles. At the same time the government introduced legislation related to ART which proposed the transfer of a single embryo in all cases. The law allows for the transfer of two embryos in patients less than 38 years of age and three in patients 38 and over, if it can be justified.Materials and Methods: From August 5th 2010 data related to IVF cycles was collected by the five ART centres in Quebec for the first three months of the state covered program. These data were combined and compared with previous data for the province from the Canadian ART registry (CARTR) which is managed by the Canadian Fertility and Andrology Society. (CFAS)Results: From August 5, 2010 to November 5, 2010, a total of 1353 IVF cycles were started in Quebec centres, resulting in 1103 embryo transfers. For comparison, only 517 IVF cycles were started in the same time period in 2009.Overall, the clinical pregnancy rate was 32% and eSET was used in 50% of embryo transfers. In patients <35 years old, eSET was used in 79% of embryo transfers and resulted in a clinical pregnancy rate of 40%.The multiple pregnancy rate was 3.7% (13 twin pregnancies); all of which resulted from transfer of two embryos, either elective double embryo transfer (eDET) or non-elective DET.Conclusions: Based on data from CARTR, the multiple pregnancy rate in Quebec for 2009 was 25.6% and eSET was used in only 1.6% of cycles. This was data produced during the period in which a 50% tax credit was available.The introduction of coverage of IVF in the provincial health system resulted in the rapid reduction of multiple pregnancies from 25.6% to only 3.7% by using 50% eSET. The associated legislation permits for the flexibility of transferring multiple embryos in those patients who warrant it but the agreed aim between the government and ART practitioners to transfer a single embryo in the majority of cycles ensured that multiple pregnancy rates remained close to naturally occurring levels.Furthermore the clinical pregnancy rate was maintained at a very acceptable level of 32% overall; in younger patients the clinical pregnancy rate was 40%. In addition data indicated that 42% of patients had supplementary embryos cryopreserved and this level increased to 60% of patients under 35 years of age permitting additional conception opportunities which should result in an elevated cumulative pregnancy rate.