[Ten years of results of in-vitro fertilisation in the Netherlands 1996-2005].
ABSTRACT To present the numbers and results of Dutch IVF treatment from 1996-2005 and to describe trends and differences between centres.
Retrospective data-collection, description and analysis.
The annual statistics from all Dutch IVF centres covering the years 1996-2005 were collected, described and analysed.
During this period 138,217 IVF or intracytoplasmic sperm injection (ICSI) cycles were started and 14,881 transfers of frozen-thawed embryos (cryo transfers) were performed. The number of ICSI treatments, in particular, increased to more than 6000 cycles during this period. These treatments resulted in 30,488 ongoing pregnancies (22.1% per cycle started; 19.1% for IVF and 23.4% for ICSI). The ongoing pregnancy rate per cycle increased from 17.6% in 1996 to 24.4% in 2005. The increase after cryo transfers was remarkable (from 9.4% to 17.6%). It is estimated that during this period, about 1 in 52 newborns in the Netherlands was an IVF or ICSI child (1996: 1 in 77, 2005: 1 in 43). There were differences between the individual centres regarding the ongoing pregnancy rate per cycle (range: 15.0-26.4%), the percentage of ICSI (range 20-58%), the percentage of cryo transfers per cycle (range: 4-22%) and the multiple pregnancy rate (range 5-27% in 2005).
In the Netherlands the pregnancy rate has increased over the last 10 years as has the number of IVF treatments. Cryo transfers have become increasingly important and the multiple pregnancy rate has decreased. Although thanks to the collaboration of all centres, the current registry produces important data and works well, there are a number of limitations e.g. the retrospective nature with no validation, which must be tackled over the coming years.
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ABSTRACT: To compare perinatal singleton and multiple outcomes in a large Dutch in-vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) population and within risk subgroups. Newborns were assigned to a risk category based on gestational age, birthweight, Apgar score and congenital malformation. Register-based retrospective cohort study. Netherlands Perinatal Registry data. 3041 singletons and 1788 multiple children born from IVF/ICSI in 2003-2005. Student's t-test or Mann-Whitney U-test was used to analyze continuous data, χ²-analyses were used for categorical data. Multivariate logistic and linear regression analysis was performed to analyze whether the risk stratification criteria were associated with neonatal hospital admission and length of stay. Start of labor, mode of delivery, gestational age, birthweight, Apgar score, congenital malformation, neonatal hospital admission, neonatal intensive care unit admission and mortality. IVF/ICSI conceived multiples had considerably poorer outcomes than singletons in terms of cesarean section rate, preterm birth, birthweight, being small-for-gestational age, Apgar score, neonatal hospital admission, neonatal intensive care unit admission and neonatal mortality. As opposed to the results found in the total study population and the low- and moderate-risk population, high-risk multiples showed better outcomes than high-risk singletons regarding cesarean section rate, birthweight and Apgar score. All risk stratification variables were associated with being hospitalized after birth. Length of stay was associated with all risk stratification criteria except Apgar score. Perinatal outcomes in IVF/ICSI conceived multiples are considerably poorer than in singletons. This finding mainly pertains to low-risk children. High-risk multiples had significantly better perinatal outcomes than high-risk singletons. This article is protected by copyright. All rights reserved.Acta Obstetricia Et Gynecologica Scandinavica 01/2014; · 1.85 Impact Factor
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ABSTRACT: OBJECTIVE: To determine the effect of audits and feedback on the level of patient-centeredness in fertility care, and to obtain a more in-depth understanding of professionals' views on patient-centered care and achieving improvements. DESIGN: Mixed-method design, using semistructured in-depth interviews and patient questionnaires. SETTING: Fifteen Dutch fertility clinics. PATIENT(S): Women in infertility treatment (quantitative section) and fertility care professionals (qualitative section). INTERVENTION(S): Audit of the level of patient-centeredness of care, and feedback provided to clinics by a personalized paper-based feedback report. MAIN OUTCOME MEASURE(S): Quantitative section: the patient-reported differences in the level of patient-centered fertility care between 2009 and 2011 measured by the Patient-Centeredness Questionnaire-Infertility. Qualitative section: professionals views on improving patient-centered fertility care arranged into a Hibbard framework for behavioral change. RESULT(S): Multilevel regression analysis showed no statistically significant differences between the overall levels of patient-centeredness in 2009 and 2011. Qualitative research showed that professionals' urge to change and their ability to translate feedback were suboptimal to achieve behavioral change. CONCLUSION(S): Audits and feedback alone are not enough to improve the level of patient-centeredness in fertility care. Increasing professionals' desire to change and their ability to translate feedback about their performance into an optimal quality improvement strategy appear to be the key issues.Fertility and sterility 01/2013; · 3.97 Impact Factor
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ABSTRACT: Prognostic models for natural conception help to identify subfertile couples with high chances of natural conception, who do not need fertility treatment yet. The use of such models and subsequent tailored expectant management (TEM) is not always practiced. Previous qualitative research has identified barriers and facilitators of TEM among patients and professionals. The aim of this study was to assess the prevalence of those barriers and facilitators and to evaluate which factors predict patients' appreciation of TEM and professionals' adherence to TEM. We performed a nationwide survey. Based on the previously identified barriers and facilitators two questionnaires were developed and sent to 195 couples and 167 professionals. Multivariate analysis was performed to evaluate which factors predicted patients' appreciation of TEM and professional adherence to TEM. In total, 118 (61%) couples and 117 (70%) professionals responded and 96 couples and 117 professionals were included in the analysis. Patients' mean appreciation of TEM was 5.7, on a 10-point Likert scale. Patients with a lower appreciation of TEM had a higher need for patient information (P = 0.047). The professionals reported a mean adherence to TEM of 63%. Adherence to TEM was higher when professionals were fertility doctors (P = 0.041). Facilitators in the clinical domain were associated with a higher adherence to TEM (P = 0.091). Barriers in the professional domain had a negative impact on adherence to TEM (P = 0.008). The limited implementation of TEM is caused by both patient and professional-related factors. This study provides practical tools to improve the implementation of TEM.Human Reproduction 02/2012; 27(4):1050-7. · 4.67 Impact Factor