Legal framework and IVF outcomes: a comparative analysis of fresh and frozen embryo transfers in Switzerland.

IF 3.7 2区医学 Q1 OBSTETRICS & GYNECOLOGY Reproductive biomedicine online Pub Date : 2024-10-18 DOI:10.1016/j.rbmo.2024.104483

Janna Pape, Jérémy Levy, Sofia Makieva, Michael von Wolff

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Abstract

Research question: To what extent do legislative measures impact standard reproductive outcome parameters?

Design: Retrospective cohort study using data from the Swiss national IVF registry analysing the outcomes of 13,908 women undergoing embryo transfers resulting from their first lifetime oocyte retrieval before (2014-2016) or after (2020-2022) revision of the legislation, allowing extended culture for 12 zygotes. Live birth rates (LBR) and cumulative LBR (cLBR) were compared in fresh and frozen embryo transfer strategies in both periods. Adjusted multivariable mixed model analyses were performed to determine OR and incidence rate ratios (IRR).

Results: Before revision of the legislation, LBR was higher for fresh embryo transfers compared with frozen embryo transfers (27.2% versus 22.7%; P = 0.006). After revision of the legislation, LBR was lower for fresh embryo transfers (29.3% versus 36.3%; P < 0.001), and cLBR was higher for the freeze-all embryo transfer strategy (59.0% versus 39.8%; P < 0.001). However, in a multivariable analysis, no difference in the odds of live birth was found between fresh and frozen embryo transfers (OR = 1.08, 95% CI 0.95-1.22), and the freeze-all embryo transfer strategy was not found to be more effective than the fresh embryo transfer strategy (IRR = 1.12, 95% CI 0.98-1.27). In a subgroup analysis, fresh blastocyst embryo transfers showed higher LBR than cleavage stage embryo transfers (OR = 2.01, 95% CI 1.62-2.49).

Conclusion: The change in national legislation provided the unique opportunity to evaluate the legal impact on reproductive outcomes. Besides a reduction in the number of multiple births, LBR in frozen embryo transfers improved, resulting in comparable success of fresh and frozen embryo transfer strategies. In addition to technological improvement, the legal framework influences the evolution of clinical practice, thereby contributing to enhanced reproductive outcomes.

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法律框架和体外受精结果：瑞士新鲜和冷冻胚胎移植的比较分析。

研究问题：立法措施在多大程度上影响标准生殖结果参数？设计：回顾性队列研究，使用瑞士国家试管婴儿登记处的数据，分析13908名接受胚胎移植的女性在（2014-2016）或（2020-2022）立法修订之前（2014-2016）或之后（2020-2022）进行第一次卵母细胞提取的结果，允许延长12个受精卵的培养时间。比较两期新鲜和冷冻胚胎移植策略的活产率（LBR）和累积LBR （cLBR）。采用调整后的多变量混合模型分析确定OR和发病率比（IRR）。结果：立法修订前，新鲜胚胎移植的LBR高于冷冻胚胎移植(27.2% vs 22.7%； = 0.006页)。立法修订后，新鲜胚胎移植的LBR较低(29.3%对36.3%；P < 0.001)，全冷冻胚胎移植策略的cLBR更高(59.0% vs 39.8%；P < 0.001)。然而，在多变量分析中，发现新鲜胚胎移植和冷冻胚胎移植的活产几率没有差异（OR = 1.08,95% CI 0.95-1.22），并且发现冷冻胚胎移植策略并不比新鲜胚胎移植策略更有效（IRR = 1.12,95% CI 0.98-1.27）。在亚组分析中，新鲜囊胚移植的LBR高于卵裂期胚胎移植（OR = 2.01,95% CI 1.62-2.49）。结论：国家立法的变化为评估法律对生殖结果的影响提供了独特的机会。除了减少多胎数量外，冷冻胚胎移植中的LBR得到改善，导致新鲜和冷冻胚胎移植策略的成功相当。除了技术改进之外，法律框架还影响着临床实践的演变，从而有助于提高生殖结果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Reproductive biomedicine online 医学-妇产科学

CiteScore

7.20

自引率

7.50%

发文量

391

审稿时长

50 days

期刊介绍： Reproductive BioMedicine Online covers the formation, growth and differentiation of the human embryo. It is intended to bring to public attention new research on biological and clinical research on human reproduction and the human embryo including relevant studies on animals. It is published by a group of scientists and clinicians working in these fields of study. Its audience comprises researchers, clinicians, practitioners, academics and patients. Context: The period of human embryonic growth covered is between the formation of the primordial germ cells in the fetus until mid-pregnancy. High quality research on lower animals is included if it helps to clarify the human situation. Studies progressing to birth and later are published if they have a direct bearing on events in the earlier stages of pregnancy.