Author/Editor		Knez, Jure; Kovačič, Borut; Vlaisavljević, Veljko
Title		Effectiveness of Slovenian health insurance reimbursement policy in twin's rate reduction in medically assisted reproduction
Type		članek
Source		4450111
Publication year		2012
Volume		str. 125-140
Language		eng
Abstract		Multiple pregnancies are the most frequent complication of medically assisted reproduction (MAR) and present a serious perinatal risk for mother and child. Half of all babies born after MAR are the result of multiple pregnancies. High multiple pregnancy rates were acceptable in the past since satisfactory success rates have been achieved only after transferring three or four early cleavage stage embryos. By improving the culture conditions, developing extended embryo cultivation media and introducing blastocyst culture, the reduction of the number of embryos for transfer was enabled. Moreover, it has been proved in many studies that the transfer of only one blastocyst in a group of patients with the highest probability for concteption can result in similar pregnancy rates as the transfer of two blastocysts, but the proportion of multiple pregnancies is significantly reduced. In the last decade, selected countries have implemented regulations that stimulate elective single embryo transfer (eSET). In Slovenia, eSET favorizing policy was accepted in 2008. It widened the rights of patients by reimbursing them for two additional MAR cycles. However, only one top quality embryo must be transferred in the first or second MAR attempt in women younger than 36 years. Single-centre analysis of 2,072 consecutive IVF/ICSI embryo transfer cycles undergoing extended, blastocyst stage embryo cultivation was performed. Only couples eligible for eSET were included in the study. Single (SBT) or double blastocyst transfer (DBT) was performed after the consultation with the patients. Clinical outcomes were compared between the groups of Slovenian patients that were under the influence of implemented eSET stimulating reimbursement policy and the self-funding group of cross-border patients. In spite of equal approach to patient consultation about the number of embryos for transfer, cross-border patients opted for DBT more frequently than domestic patients. The imposition of insurance policy contributed to additional plummeting of twin rate deliveries in domestic patients to 7-8 %, while the rate remained high in cross- border patients. In spite of this, clinical pregnancy and delivery rates were comparable in both groups of patients.
Descriptors		Pregnancy, Multiple Nosečnost, mnogoplodna Fertilization in Vitro Oploditev in vitro Embryo Transfer Zarodek, prenos Insurance, Health, Reimbursement Odškodninsko zdravstveno zavarovanje Adverse effects Stranski učinki