M Gissler1, A Tiitinen. 1. STAKES National Research and Development Centre for Welfare and Health, Helsinki University Central Hospital, Helsinki, Finland. mika.gissler@stakes.fi
Abstract
BACKGROUND: In vitro fertilization and its variants have become routine infertility treatments in industrialized countries. Our purpose is to summarize the procedures and treatment outcomes in Finland in the 1990s and to compare the results between public and private clinics. METHODS: The data came from the Finnish IVF statistics for 1992 to 1999. Most analyses were done for the years 1994 to 1998 for which identical data-collection sheets were used. RESULTS: In 1999, 12 of the 19 clinics offering assisted reproductive treatments were private. The number of treatments increased from 2,331 in 1992 to 7,213 in 1999. In total 58% were performed in the private sector. Most treatments were given for women aged 30 to 39 years, but in the private sector women were up to on average two years older. Most often care was given due to tubal factor or unexplained infertility (IVF) and due to male factor or multiple causes (ICSI). The number of transferred embryos decreased during the study period, but the transfer of two embryos was still most frequent. Three out of four IVF and ICSI pregnancies, and two out of three FET pregnancies ended in a live birth. The success rates improved for IVF and for ICSI after adjustment for the number of transferred embryos, but not for FET. Small but inconsistent differences were observed in the success rates between the private and public sectors. There was noticeable variation between clinics. CONCLUSION: The number of treatment cycles stabilized in the late 1990s. The success rates improved only slightly and the differences in outcome measures between private and public clinics were small. However, neither this nor the large clinical variation could be investigated more thoroughly without collecting individual register data.
BACKGROUND: In vitro fertilization and its variants have become routine infertility treatments in industrialized countries. Our purpose is to summarize the procedures and treatment outcomes in Finland in the 1990s and to compare the results between public and private clinics. METHODS: The data came from the Finnish IVF statistics for 1992 to 1999. Most analyses were done for the years 1994 to 1998 for which identical data-collection sheets were used. RESULTS: In 1999, 12 of the 19 clinics offering assisted reproductive treatments were private. The number of treatments increased from 2,331 in 1992 to 7,213 in 1999. In total 58% were performed in the private sector. Most treatments were given for women aged 30 to 39 years, but in the private sector women were up to on average two years older. Most often care was given due to tubal factor or unexplained infertility (IVF) and due to male factor or multiple causes (ICSI). The number of transferred embryos decreased during the study period, but the transfer of two embryos was still most frequent. Three out of four IVF and ICSI pregnancies, and two out of three FET pregnancies ended in a live birth. The success rates improved for IVF and for ICSI after adjustment for the number of transferred embryos, but not for FET. Small but inconsistent differences were observed in the success rates between the private and public sectors. There was noticeable variation between clinics. CONCLUSION: The number of treatment cycles stabilized in the late 1990s. The success rates improved only slightly and the differences in outcome measures between private and public clinics were small. However, neither this nor the large clinical variation could be investigated more thoroughly without collecting individual register data.