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UTJECAJ EMBRIO TRANSFERA NA ISHOD MPO – ANALIZA 6000 POSTUPAKA

UTJECAJ EMBRIO TRANSFERA NA ISHOD MPO – ANALIZA 6000 POSTUPAKA. Borut Kovačič. Dept. of Reproductive Medicine & Gynecologic Endocrinology University Clinical Centre Maribor. Introduction. Factors with possible impact on embryotransfer outcome : Catheter type , Catheter loading ,

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UTJECAJ EMBRIO TRANSFERA NA ISHOD MPO – ANALIZA 6000 POSTUPAKA

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  1. UTJECAJ EMBRIO TRANSFERA NA ISHOD MPO – ANALIZA 6000 POSTUPAKA Borut Kovačič Dept. of Reproductive Medicine & Gynecologic Endocrinology University Clinical Centre Maribor

  2. Introduction Factorswithpossibleimpact on embryotransferoutcome: • Cathetertype, • Catheterloading, • Transfer technique, • Team experience, • Use ofultrasound, • Locationofembryoreplacement in the uterus, • Uterus andcervixanatomy • Endometriumthicknessandcontractility • Lutealsupplementation, • Natural or stimulatedcycles • Fresh or frozen/thawedembryos • Embryostage, • Embryoselection, • Embryoquality, • No ofembryostransferred, • SingleEmbryo Transfer (SET) policies MATERIAL TECHNIQUE ANATOMY HORMONS EMBRYOS REGULATIONS

  3. BLASTOCYST MORPHOLOGY Optimal:

  4. BLASTOCYST MORPHOLOGY Suboptimal:

  5. Blastocyst transfer outcome in youngpatientgroup(2779 cycles in period from 2001 - 2010)

  6. Embryo transfer policiesforfavorizingsingleembryo transfer (SET): • Professional non-regulatoryconsensus(Finland) • Governmentalregulation: • Legislation - SET mustbe a norm (Sweden) • Reimbursementpolicies, stronglyfavorizing SET (Belgium, Sloveniafrom 2008) – semiobligatory • Cross-boarderpatients • Financialreasonsinfluencestheirdecisionabout SET.

  7. Aimofthestudy: To comparetheembryo transfer outcome in youngSlovenianandforeignpatients (treated in Maribor IVF centre) in the period beforeandaftertheregulationof SET byreimbursementpolicy.

  8. Material & methods: • Highriskpatientsfor multiple pregnancyafter IVF (N = 2406) • <36 yearsold, <3 previous IVF attempts, optimalembryos (blastocysts) • Slovenianpatients (N = 1833) • IVF Reimbursementpolicystimulates SET • Cross-boarderpatients (N = 573) • IVF treatment • according to ESHRE’s goodpracticeguidefor CBRC forcentersandpractitioners(Hum Rep, 2011) • Consultancy: SET advisedbygynecologystbefore ET: • Implantationrateperavailableembryo • Pregnancyand multiple pregnancyrateper same patientgroup • Medicalcomplicationsrelated to multiple pregnancy • Patientdecisionabout SET / DET / TET

  9. Characteristicsofstudygroups

  10. Doubleblastocyst transfer rate

  11. Clinicalpregnancyrateafterblastocyst transfer

  12. Implantationrateafterblastocyst transfer

  13. Deliveryrateafterblastocyst transfer

  14. Twins / deliveryafterblastocyst transfer

  15. Conclusions • Doubleblastocyst transfer does not increase IVF successrate in comparisonwithsingleblastocyst transfer. • Reimbursementpoliciesforfavorization SET are efficient in decreasingthe multiple pregnancies in Slovenianpatients. • Financialreasonsleadthecross-boarderpatients more frequently to decision on multiple embryotransfers. • Onlyobligatory SET policiescoulddecreasethe multiple pregnancyrate in youngcross-boarder IVF patients.

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