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26 February 2014

26 February 2014. Andrew Riddle. Medical Director Person Responsible, Nuffield Health Woking Hospital. Key factors of a successful strategy. ACE 2014 Oral Presentation. Successful establishment of eSET criteria with multiple pregnancy rate reduced to below 5 %.

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26 February 2014

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  1. 26 February 2014 • Andrew Riddle • Medical Director Person Responsible, Nuffield Health Woking Hospital • Key factors of a successful strategy

  2. ACE 2014 Oral Presentation Successful establishment of eSET criteria with multiple pregnancy rate reduced to below 5%

  3. How have our blastocyst criteria developed? Increase in blastocyst transfers from 6.4% in 2011 to 72.1% in 2013

  4. How have our eSET criteria developed? • Original Criteria • Consider for any patient <37 • TQE to replace • 1st cycle • Any previous pregnancies • If spare embryos suitable for freezing • Current Criteria • Consider for any patient <41 • If the morula or blastocyst is good quality • 1st or 2nd cycle • Any previous pregnancies

  5. Pregnancy rates eSET vs. DET: Year 4

  6. Preg. rates blastocyst eSET vs. DET: Year 4

  7. Overview of National trends

  8. Clinic data: % eSET fresh cycles Y1: Jan 2009 to end March 2010 Y2: April 2010 to end March 2011 Y3: April 2011 to end September 2012 Y4: October 2012 to end September 2013

  9. Clinic data: % blastocyst transfers fresh cycles Y1: Jan 2009 to end March 2010 Y2: April 2010 to end March 2011 Y3: April 2011 to end September 2012 Y4: October 2012 to end September 2013

  10. Clinic data: % CPR, MPR, MBR Y1: Jan 2009 to end March 2010 Y2: April 2010 to end March 2011 Y3: April 2011 to end September 2012 Y4: October 2012 to end September 2013

  11. Clinic data: CUSUM plot multiple births • Multiple pregnancy rate by pregnancy, for all IVF, ICSI and FET cycles • For period: Oct 2012 – Jan 2014 (as of 02/02/14) • Number of births

  12. Year 4 centre performance: funnel plot • Multiple live birth rate by live birth, for all IVF, ICSI and FET cycles • For period: Oct 2012 – Sep 2013 (as of 09/01/14) at 10% • Number of births

  13. Acknowledgements With Thanks to: Aimee Hetherington Rebecca Fabian Caroline Franklin All the team at Nuffield Health Woking Hospital

  14. Discussion Andrew has replicated the practice in Sweden and achieved almost identical results in terms of MBR, but with a higher pregnancy rate using a blastocyst based programme. Table discussions What are the key factors of this successful strategy? • What did you need to put in place to ensure that the majority of patients would be able to take part in a blastocyst transfer programme? • What proportion of your patients have blastocysts for transfer What are the trigger points for review/audit? Feedback…

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