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The history of Belgian assisted reproduction technology cycle registration and control: a case study in reducing the incidence of multiple pregnancy

D De Neubourg, K Bogaerts, C Wyns, A Albert, M Camus, M Candeur, M Degueldre, A Delbaere, A Delvigne, Petra De Sutter UGent, et al. (2013) HUMAN REPRODUCTION. 28(10). p.2709-2719
abstract
Study question: What is the effect of a legal limitation of the number of embryos that can be transferred in an assisted reproductive technology (ART) cycle on the multiple delivery rate? Summary answer: The Belgian national register shows that the introduction of reimbursement of ART laboratory costs in July 2003, and the imposition of a legal limitation of the number of embryos transferred in the same year, were associated with a 50 reduction of the multiple pregnancy rate from 27 to 11 between 2003 and the last assessment in 2010, without any reduction of the pregnancy rate per cycle. What is known already: Individual Belgian IVF centres have published their results since the implementation of the law, and these show a decrease in the multiple pregnancy rate on a centre by centre basis. However, the overall national picture remains unpublished. Study design, size, duration: Cohort study from 1990 to 2010 of all ART cycles in Belgium (2685 cycles in 1990 evolving to 19 110 cycles in 2010), with a retrospective analysis from 1990 to 2000 and prospective online data collection since 2001. Participants/materials, setting, methods: Registration evolved from paper written reports per centre to a compulsory online registration of all ART cycles. From 2001 up to mid-2009, data were collected from Excel spread sheets or MS Access files into an MS Access database. Since mid-2009, data collection is done via a remote and secured web-based system () where centres can upload their data and get immediate feedback about missing data, errors and inconsistencies. Main results and the role of chance: National Belgian registration data show that reimbursement of IVF laboratory costs in July 2003, coupled to a legal limitation in the number of embryos transferred in utero, were associated with a 50 reduction of the multiple pregnancy rate from 27 to 11 without reduction of the pregnancy rate per cycle, and with an increase in the number of fresh and frozen ART cycles due to improved access to treatment. Limitations, reasons for caution: There is potential underreporting of complications of ART treatment, pregnancy outcome and neonatal health. Wider implications of the findings: Over the 20 years of registration, the pregnancy rate has remained constant, despite the reduction in the number of embryos transferred, optimization of laboratory procedures and stimulation protocols, introduction of quality systems and implementation of the EU Tissue Directive over the period 20042010. Study funding/competing interest(s): No external funding was sought for this study. None of the authors has any conflict of interest to declare.
Please use this url to cite or link to this publication:
author
organization
year
type
journalArticle (original)
publication status
published
subject
keyword
EMBRYO-TRANSFER, QUALITY, INFERTILITY CARE, IVF, registration, assisted reproductive technology, Belgium, multiple pregnancies, INTERNATIONAL COMMITTEE, EUROPEAN REGISTERS, INDICATORS, ICMART, ESHRE, LEGISLATION
journal title
HUMAN REPRODUCTION
Hum. Reprod.
volume
28
issue
10
pages
2709 - 2719
Web of Science type
Article
Web of Science id
000324836300013
JCR category
OBSTETRICS & GYNECOLOGY
JCR impact factor
4.585 (2013)
JCR rank
2/78 (2013)
JCR quartile
1 (2013)
ISSN
0268-1161
DOI
10.1093/humrep/det269
language
English
UGent publication?
yes
classification
A1
copyright statement
I have transferred the copyright for this publication to the publisher
id
4198598
handle
http://hdl.handle.net/1854/LU-4198598
date created
2013-12-09 15:27:34
date last changed
2016-12-19 15:45:36
@article{4198598,
  abstract     = {Study question: What is the effect of a legal limitation of the number of embryos that can be transferred in an assisted reproductive technology (ART) cycle on the multiple delivery rate? 
Summary answer: The Belgian national register shows that the introduction of reimbursement of ART laboratory costs in July 2003, and the imposition of a legal limitation of the number of embryos transferred in the same year, were associated with a 50 reduction of the multiple pregnancy rate from 27 to 11 between 2003 and the last assessment in 2010, without any reduction of the pregnancy rate per cycle. 
What is known already: Individual Belgian IVF centres have published their results since the implementation of the law, and these show a decrease in the multiple pregnancy rate on a centre by centre basis. However, the overall national picture remains unpublished. 
Study design, size, duration: Cohort study from 1990 to 2010 of all ART cycles in Belgium (2685 cycles in 1990 evolving to 19 110 cycles in 2010), with a retrospective analysis from 1990 to 2000 and prospective online data collection since 2001.
Participants/materials, setting, methods: Registration evolved from paper written reports per centre to a compulsory online registration of all ART cycles. From 2001 up to mid-2009, data were collected from Excel spread sheets or MS Access files into an MS Access database. Since mid-2009, data collection is done via a remote and secured web-based system () where centres can upload their data and get immediate feedback about missing data, errors and inconsistencies. 
Main results and the role of chance: National Belgian registration data show that reimbursement of IVF laboratory costs in July 2003, coupled to a legal limitation in the number of embryos transferred in utero, were associated with a 50 reduction of the multiple pregnancy rate from 27 to 11 without reduction of the pregnancy rate per cycle, and with an increase in the number of fresh and frozen ART cycles due to improved access to treatment. 
Limitations, reasons for caution: There is potential underreporting of complications of ART treatment, pregnancy outcome and neonatal health.
Wider implications of the findings: Over the 20 years of registration, the pregnancy rate has remained constant, despite the reduction in the number of embryos transferred, optimization of laboratory procedures and stimulation protocols, introduction of quality systems and implementation of the EU Tissue Directive over the period 20042010. 
Study funding/competing interest(s): No external funding was sought for this study. None of the authors has any conflict of interest to declare.},
  author       = {De Neubourg, D and Bogaerts, K and Wyns, C and Albert, A and Camus, M and Candeur, M and Degueldre, M and Delbaere, A and Delvigne, A and De Sutter, Petra and Dhont, Marc and Dubois, M and Englert, Y and Gillain, N and Gordts, S and Hautecoeur, W and Lesaffre, E and Lejeune, B and Leroy, F and Ombelet, W and D'Hauterive, SP and Vandekerckhove, Frank and Van der Elst, J and D'Hooghe, T},
  issn         = {0268-1161},
  journal      = {HUMAN REPRODUCTION},
  keyword      = {EMBRYO-TRANSFER,QUALITY,INFERTILITY CARE,IVF,registration,assisted reproductive technology,Belgium,multiple pregnancies,INTERNATIONAL COMMITTEE,EUROPEAN REGISTERS,INDICATORS,ICMART,ESHRE,LEGISLATION},
  language     = {eng},
  number       = {10},
  pages        = {2709--2719},
  title        = {The history of Belgian assisted reproduction technology cycle registration and control: a case study in reducing the incidence of multiple pregnancy},
  url          = {http://dx.doi.org/10.1093/humrep/det269},
  volume       = {28},
  year         = {2013},
}

Chicago
De Neubourg, D, K Bogaerts, C Wyns, A Albert, M Camus, M Candeur, M Degueldre, et al. 2013. “The History of Belgian Assisted Reproduction Technology Cycle Registration and Control: a Case Study in Reducing the Incidence of Multiple Pregnancy.” Human Reproduction 28 (10): 2709–2719.
APA
De Neubourg, D, Bogaerts, K., Wyns, C., Albert, A., Camus, M., Candeur, M., Degueldre, M., et al. (2013). The history of Belgian assisted reproduction technology cycle registration and control: a case study in reducing the incidence of multiple pregnancy. HUMAN REPRODUCTION, 28(10), 2709–2719.
Vancouver
1.
De Neubourg D, Bogaerts K, Wyns C, Albert A, Camus M, Candeur M, et al. The history of Belgian assisted reproduction technology cycle registration and control: a case study in reducing the incidence of multiple pregnancy. HUMAN REPRODUCTION. 2013;28(10):2709–19.
MLA
De Neubourg, D, K Bogaerts, C Wyns, et al. “The History of Belgian Assisted Reproduction Technology Cycle Registration and Control: a Case Study in Reducing the Incidence of Multiple Pregnancy.” HUMAN REPRODUCTION 28.10 (2013): 2709–2719. Print.