Factors influencing Assisted Reproductive Technology [ART] Outcome: possible implications for a private and public sector fertility clinic

[摘要] ENGLISH ABSTRACT: Infertility treatment, more specifically Assisted Reproductive Technology [ART], is available worldwide, but in many countries and public clinics, this service is not being offered, mostly dueto limited resources and funds. Many factors can influence the outcome of ART and insufficientfunds can have an effect on ovarian stimulation protocols, assisted reproduction procedures,laboratory procedures and equipment (i.e. CO₂ incubator). Strategies making ART as affordableand accessible as possible is of importance.The objective of the study was to investigate which factors in ART treatment might have the mostsignificant effect on ART outcome in two ART laboratories – one in the public sector and one inthe private sector. Two studies, one retrospective and one prospective were conducted.The retrospective study (2013 - 2014) investigated the effect of two different CO₂ incubators(MINC® benchtop incubator and large conventional Forma® incubator) used at a private fertilityclinic, on ART outcome. Fertilization, embryo quality and development, and clinical pregnancyrate [CPR] outcomes were compared. A strict exclusion criteria was applied to eliminate otherfactors that could have an effect on the outcomes and patients were well paired for the study.Three hundred and eighty five (385) cycles were included. No statistical significant difference wasobserved between the two incubators for embryo quality on culture days 2 and 5. For day 3, theMINC® incubator showed a significant superiority over the Forma® incubator for the proportionof good quality embryos [GQE]/number of ova aspirated (44.58% vs. 39.31%; p < 0.05). Therewas no statistical significant difference in CPR between the incubators (45.43% vs 47.17%; p =0.81).The prospective study aimed at determining (by means of regression analyses) the possiblenegative or positive impact of female patient profile (specifically number of oocytes, age, bodymass index [BMI], Anti-Mullerian Hormone [AMH] and female diagnosis - tubal factor andendometriosis) in two different ART clinics (public and private fertility clinic) on ART outcome withregard to CPR. Eight hundred and twenty (820) cycles (572 in the private clinic; 248 in the publicclinic) were included. Patient profiles in the two clinics were very different. The most commonfemale diagnosis at the private clinic was Advanced Maternal Age compared to Tubal FactorInfertility [TFI] at the public clinic. Patients with a high BMI was also much more prevalent in thepublic clinic. No statistically significant association, in both clinics (with pooled and separate data),was observed between BMI, AMH, endometriosis or TFI and CPR. The only significantassociation with CPR in the final regression analysis (pooled data) was the Site (clinic) and thenumber of metaphase II oocytes available. Data analysis for the two clinics separately,considering all confounding factors investigated, indicated that the number of metaphase IIoocytes available was the only factor that showed a significant association with CPR - and only at the private clinic. For the public clinic, none of the factors had a significant association withCPR when all factors were included in the analysis.Various factors contribute to ART outcome, and these factors may differ in public and privateclinics as shown in this study. Although the results did not show marked differences in outcomebetween the incubator types, all outcomes were better in the MINC® and its use should beencouraged. The result of an independent, significant association between number of MII oocytesand CPR is linked to specific ovarian stimulation protocols and potential alternative strategiesshould be investigated to optimize outcome without increasing costs.

[发布机构] Stellenbosch University