Affiliations: Genk Institute for Fertility Technology, ZOL,
Department of Obstetrics and Gynaecology, Schiepse Bos 6, 3600 Genk, Belgium.
E-mail: willem.ombelet@pandora.be | Chairman of the Scientific Committee of the Flemish
Society of Obstetrics and Gynaecology
Abstract: The major complication of assisted reproductive technologies is the
increased incidence of multiple pregnancies. Multiple pregnancies are
associated with higher morbidity and mortality rates related to a higher
incidence of prematurity and (very) low-birth-weight babies. The epidemic of
iatrogenic multiple births has increased the incidence of maternal, perinatal
and childhood morbidity and mortality. Healthcare cost of infertility treatment
did increase significantly and this may lead to social and political concern.
For in vitro fertilization, reducing the number of embryos transferred and the
use of natural cycle IVF will decrease the number of multiple gestations. For
non-IVF ovarian stimulation, a strict ovarian stimulation protocol aiming at
mono-ovulation should be followed. The Belgian project to prevent multiple
pregnancies was started in July 2003. A reimbursement of ART-related laboratory
activities was linked to a transfer policy aiming at substantial multiple
pregnancy reduction. It's a nice example of efficient forward looking health
economics through responsabilisation. The first results indicate an increase of
the number of IVF cycles by more than 30% and a more than 50% reduction
of twin pregnancies. The next step will be the prevention of multiple
pregnancies associated with non-IVF ovarian stimulation.
Keywords: Access to treatment, infertility treatment, IVF, multiple pregnancies, policy