Assisted reproductive technologies (ARTs): Evaluation of evidence to support public policy development

Reproductive Health

Devidas Menon³  Kristin Klein¹  Tarek Motan²  Tania Stafinski³  Alexa A Nardelli³ 

[1] Faculty of Medicine and Dentistry, University of Alberta, Room 3021 Research Transition Facility, 8308 114 Street, Edmonton, Alberta T6G 2 V2, Canada;Division of Reproductive Endocrinology & Infertility, Department of Obstetrics & Gynaecology, Royal Alexandra Hospital, 10240 Kingsway Ave, Edmonton, AB T5H 3 V9, Canada;Health Technology and Policy Unit, School of Public Health, Department of Public Health Sciences, University of Alberta, Room 3021 Research Transition Facility, 8308 114 Street, Edmonton, Alberta T6G 2 V2, Canada

关键词: Systematic review;    Outcomes;    Assisted reproductive technology;    ICSI;    IVF;   

Others  :  1132100
DOI  :  10.1186/1742-4755-11-76

 received in 2014-01-15, accepted in 2014-10-25,  发布年份 2014

【 摘 要 】

Over the years, IVF/ICSI protocols have continued to evolve with efforts to improve outcomes. As a result, treatment success may be related to certain procedural factors, including number of embryos transferred and stage at which they are transferred. This review aims to assess the safety and effectiveness of IVF/ICSI in comparison to spontaneous conception and less invasive ARTs and the impact of procedure-related factors on the outcomes of IVF/ICSI in order to support the development of local clinical and policy guidance. Following Cochrane Collaboration guidelines and the PRISMA statement, a comprehensive systematic review of literature examining the impact of procedural characteristics on the safety or effectiveness of IVF/ICSI from 2007 to date was performed. 33 systematic reviews and 3 primary studies evaluating the impact of procedural differences, IVF/ICSI in comparison to less invasive ARTs, and ARTs in comparison to spontaneous conception were found. IVF was shown to offer significant benefits over no treatment and IUI in achieving pregnancy and live birth among couples with endometriosis or unexplained infertility. Frozen and blastocyst-stage embryo transfers were as effective as fresh and cleavage-stage embryo transfers, respectively. In comparison to single embryo transfer, double embryo transfer significantly increased pregnancy, live birth and multiple pregnancy/birth rates. IVF/ICSI was associated with more complications during pregnancy and delivery, and in infants compared to naturally conceived pregnancies, particularly when multiple embryo transfer was used. Frozen embryo transfer had fewer adverse events during pregnancy and delivery than fresh embryo transfer, and was at least as safe in terms of infant outcomes. The potential complications of IVF/ICSI may be minimized through procedural choices, but such choices often impact effectiveness. Thus, in developing clinical and policy guidance around IVF/ICSI, the risk-benefit trade-offs patients and providers are willing to accept must be carefully considered.

【 授权许可】

   
2014 Nardelli et al.; licensee BioMed Central Ltd.

【 图 表 】

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